d-Transposition of the Great Arteries
Arterial switch repair is the preferred operation for d-transposition of the great arteries without severe anatomic left ventricular outflow tract narrowing or when such narrowing can be treated with resection. Other surgical repairs are rearely performed. The traditional contraindication to its use is the presence of an abnormal pulmonary valve, which would become the aortic valve after repair, although today one would consider combining a form of the Ross procedure and arterial switch operations for management of such a patient. Unusual coronary artery anatomy or intramural course of a coronary are not contraindications. Arterial switch is usually performed in the first week of life because the preparation of the left ventricle may be unpredictable after 10 to 14 days of age. If the operation is delayed, staged repair may be performed with preparatory temporary pulmonary artery banding and Blalock shunt followed by arterial switch after adequate left ventricular hypertrophy has developed.
KeywordsPulmonary Artery Aortic Valve Ventricular Septal Defect Ventricular Septal Defect Great Vessel
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