Arterial switch first successfully used in 1975 by Dr. Adib Jatene
Coronary arteries transposed to base of neoaorta
Aorta & pulmonary trunks then sectioned, transposed, & anastomosed
Ascending aorta ends up being connected to left ventricular outflow tract
Main pulmonary artery (PA) relocated anterior to aorta & connected to right ventricular outflow tract
This relocation of pulmonary trunk referred to as Lecompte maneuver
Reduces risk of coronary artery kinking
VSD corrected if present
If no VSD present, typically undergo PA banding prior to correction to prepare LV for systemic pressures
Arterial switch performed in first 2 weeks of life
If not performed early in neonatal period, PA banding ± Blalock-Taussig shunt used to acclimate LV to systemic pressures in preparation for connection to aorta
Arterial switch contraindicated in presence of coronary anomalies such as intramural course
Arterial switch may not be feasible in presence of significant LV outflow obstruction
Rastelli procedure often used instead in this situation
Benefits of arterial switch
LV used as systemic pump & mitral valve as systemic atrioventricular valve
Lower incidence of arrhythmias compared to atrial switch (Senning/Mustard)
No baffle obstructions/leaks as with atrial switch (Senning/Mustard)
Can be performed earlier in neonatal period than atrial switch (Senning/Mustard)
Survival rate & freedom of reoperation at 5 years of 90% & 97%, respectively
IMAGING
General Features
CT Findings
MR Findings
DIFFERENTIAL DIAGNOSIS
Selected References
Dodge-Khatami A et al: Past, present, and future of the arterial switch operation: historical review. Cardiol Young. 22(6):724-31, 2012
Chung T et al: Transposition of the great vessels - the arterial switch operation, the atrial switch operation, the coronaries. Prog Pediatr Cardiol 28:35-43, 2010
Gaca AM et al: Repair of congenital heart disease: a primer-part 1. Radiology. 247(3):617-31, 2008
Martins P et al: Transposition of the great arteries. Orphanet J Rare Dis. 3:27, 2008
Sano S et al: [Surgical treatment of transposition of the great arteries: the arterial switch operation.] Nihon Geka Gakkai Zasshi. 102(8):584-9, 2001
Lecompte Y et al: Anatomic correction of transposition of the great arteries. J Thorac Cardiovasc Surg. 82(4):629-31, 1981
Jatene AD et al: Anatomic correction of transposition of the great vessels. J Thorac Cardiovasc Surg. 72(3):364-70, 1976
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References
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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
TERMINOLOGY
Synonyms
Jatene arterial switch
Definitions
Surgical procedure to correct D-transposition of great arteries (D-TGA)
Arterial switch first successfully used in 1975 by Dr. Adib Jatene
Coronary arteries transposed to base of neoaorta
Aorta & pulmonary trunks then sectioned, transposed, & anastomosed
Ascending aorta ends up being connected to left ventricular outflow tract
Main pulmonary artery (PA) relocated anterior to aorta & connected to right ventricular outflow tract
This relocation of pulmonary trunk referred to as Lecompte maneuver
Reduces risk of coronary artery kinking
VSD corrected if present
If no VSD present, typically undergo PA banding prior to correction to prepare LV for systemic pressures
Arterial switch performed in first 2 weeks of life
If not performed early in neonatal period, PA banding ± Blalock-Taussig shunt used to acclimate LV to systemic pressures in preparation for connection to aorta
Arterial switch contraindicated in presence of coronary anomalies such as intramural course
Arterial switch may not be feasible in presence of significant LV outflow obstruction
Rastelli procedure often used instead in this situation
Benefits of arterial switch
LV used as systemic pump & mitral valve as systemic atrioventricular valve
Lower incidence of arrhythmias compared to atrial switch (Senning/Mustard)
No baffle obstructions/leaks as with atrial switch (Senning/Mustard)
Can be performed earlier in neonatal period than atrial switch (Senning/Mustard)
Survival rate & freedom of reoperation at 5 years of 90% & 97%, respectively
IMAGING
General Features
CT Findings
MR Findings
DIFFERENTIAL DIAGNOSIS
Selected References
Dodge-Khatami A et al: Past, present, and future of the arterial switch operation: historical review. Cardiol Young. 22(6):724-31, 2012
Chung T et al: Transposition of the great vessels - the arterial switch operation, the atrial switch operation, the coronaries. Prog Pediatr Cardiol 28:35-43, 2010
Gaca AM et al: Repair of congenital heart disease: a primer-part 1. Radiology. 247(3):617-31, 2008
Martins P et al: Transposition of the great arteries. Orphanet J Rare Dis. 3:27, 2008
Sano S et al: [Surgical treatment of transposition of the great arteries: the arterial switch operation.] Nihon Geka Gakkai Zasshi. 102(8):584-9, 2001
Lecompte Y et al: Anatomic correction of transposition of the great arteries. J Thorac Cardiovasc Surg. 82(4):629-31, 1981
Jatene AD et al: Anatomic correction of transposition of the great vessels. J Thorac Cardiovasc Surg. 72(3):364-70, 1976
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