Anatomic Correction of Corrected Transposition of the Great Arteries with Ventricular Septal Defect and Obstruction of the Left Ventricular Outflow Tract

Abstract

The long-term outcome of patients with corrected transposition of the great arteries and associated lesions after physiologic repair is uncertain. Anatomic correction, utilizing the morphologic left ventricle as a systemic pumping chamber and the mitral valve as the systemic atrio-ventricular valve, is considered the preferred method, especially for patients with either tricuspid valve regurgitation, with Ebstein’s malformation of the tricuspid valve, or with right ventricle dysfunction. Anatomic correction of corrected transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction represents a group of procedures in which the atrio-ventricular discordance is ‘corrected’ by an atrial switch, and ventriculo-arterial discordance is ‘corrected’ by the Rastelli procedure, by translocation of the aortic root, or by an arterial switch operation, depending on the underlying morphology and mechanism of the left ventricular outflow tract obstruction and/or morphology and position of the ventricular septal defect. These operations can be performed with minimal mortality and acceptable morbidity. In the mid-term, an excellent functional outcome can be achieved, which leads to normal ventricular function, with low incidence of complete heart block. However, the long-term functioning of the conduction system, the aortic valve, the intraventricular tunnel, the conduit, and the ventricles is variable and requires close surveillance. Prophylactic anatomic correction in patients without symptoms and a well-functioning tricuspid valve and right ventricle is not recommended.