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Arterial Switch Procedure
Randy R. Richardson, MD; Prakash M. Masand, MD
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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)
            • D-TGA involves ventriculoarterial discordance & atrioventricular concordance
              • Pulmonary trunk arises from left ventricle (LV)
              • Aorta arises from right ventricle (RV)
              • Frequently associated with ventricular septal defect (VSD) & outflow tract obstruction
          • Arterial switch was 1st successfully used in 1975 by Dr. Adib Jatene
            • Coronary arteries are transposed to base of neoaorta
            • Aorta & pulmonary trunks are then sectioned, transposed, & anastomosed
              • Ascending aorta ends up being connected to LV outflow tract
              • Main pulmonary artery (PA) is relocated anterior to aorta & connected to RV outflow tract
                • This relocation of pulmonary trunk is referred to as Lecompte maneuver
                • Reduces risk of coronary artery kinking
          • VSD is corrected if present
            • If no VSD is present, patient typically undergoes PA banding prior to correction to prepare LV for systemic pressures
          • Arterial switch is performed in first 2 weeks of life
          • If not performed early in neonatal period, PA banding ± Blalock-Taussig shunt is used to acclimate LV to systemic pressures in preparation for connection to aorta
          • Arterial switch is 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 is often used instead in this situation
          • Benefits of arterial switch
            • LV is 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

                1. Fraser CD Jr: Commentary: coronary origins after the arterial switch operation: let's think of it like anomalous aortic origin of the coronaries. J Thorac Cardiovasc Surg. 161(4):1406-7, 2021
                2. Casanova J: The arterial switch operation. Rev Port Cir Cardiotorac Vasc. 27(3):157, 2020
                3. van Broekhoven I et al: Imaging large arteries after arterial switch operation. Heart. 106(12):891-950, 2020
                4. Breinholt JP et al: Management of the adult with arterial switch. Methodist Debakey Cardiovasc J. 15(2):133-7, 2019
                5. Broda CR et al: Post-operative assessment of the arterial switch operation: a comparison of magnetic resonance imaging and echocardiography. Pediatr Cardiol. 39(5):1036-41, 2018
                6. Kutty S et al: Contemporary management and outcomes in congenitally corrected transposition of the great arteries. Heart. 104(14):1148-55, 2018
                7. Dodge-Khatami A et al: Past, present, and future of the arterial switch operation: historical review. Cardiol Young. 22(6):724-31, 2012
                8. 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
                9. Gaca AM et al: Repair of congenital heart disease: a primer-part 1. Radiology. 247(3):617-31, 2008
                10. Martins P et al: Transposition of the great arteries. Orphanet J Rare Dis. 3:27, 2008
                11. 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
                12. Lecompte Y et al: Anatomic correction of transposition of the great arteries. J Thorac Cardiovasc Surg. 82(4):629-31, 1981
                13. Jatene AD et al: Anatomic correction of transposition of the great vessels. J Thorac Cardiovasc Surg. 72(3):364-70, 1976
                Related Anatomy
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                Related Differential Diagnoses
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                References
                Tables

                Tables

                KEY FACTS

                • Terminology

                  • Imaging

                    • Top Differential Diagnoses

                      TERMINOLOGY

                      • Synonyms

                        • Jatene arterial switch
                      • Definitions

                        • Surgical procedure to correct D-transposition of great arteries (D-TGA)
                          • D-TGA involves ventriculoarterial discordance & atrioventricular concordance
                            • Pulmonary trunk arises from left ventricle (LV)
                            • Aorta arises from right ventricle (RV)
                            • Frequently associated with ventricular septal defect (VSD) & outflow tract obstruction
                        • Arterial switch was 1st successfully used in 1975 by Dr. Adib Jatene
                          • Coronary arteries are transposed to base of neoaorta
                          • Aorta & pulmonary trunks are then sectioned, transposed, & anastomosed
                            • Ascending aorta ends up being connected to LV outflow tract
                            • Main pulmonary artery (PA) is relocated anterior to aorta & connected to RV outflow tract
                              • This relocation of pulmonary trunk is referred to as Lecompte maneuver
                              • Reduces risk of coronary artery kinking
                        • VSD is corrected if present
                          • If no VSD is present, patient typically undergoes PA banding prior to correction to prepare LV for systemic pressures
                        • Arterial switch is performed in first 2 weeks of life
                        • If not performed early in neonatal period, PA banding ± Blalock-Taussig shunt is used to acclimate LV to systemic pressures in preparation for connection to aorta
                        • Arterial switch is 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 is often used instead in this situation
                        • Benefits of arterial switch
                          • LV is 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

                              1. Fraser CD Jr: Commentary: coronary origins after the arterial switch operation: let's think of it like anomalous aortic origin of the coronaries. J Thorac Cardiovasc Surg. 161(4):1406-7, 2021
                              2. Casanova J: The arterial switch operation. Rev Port Cir Cardiotorac Vasc. 27(3):157, 2020
                              3. van Broekhoven I et al: Imaging large arteries after arterial switch operation. Heart. 106(12):891-950, 2020
                              4. Breinholt JP et al: Management of the adult with arterial switch. Methodist Debakey Cardiovasc J. 15(2):133-7, 2019
                              5. Broda CR et al: Post-operative assessment of the arterial switch operation: a comparison of magnetic resonance imaging and echocardiography. Pediatr Cardiol. 39(5):1036-41, 2018
                              6. Kutty S et al: Contemporary management and outcomes in congenitally corrected transposition of the great arteries. Heart. 104(14):1148-55, 2018
                              7. Dodge-Khatami A et al: Past, present, and future of the arterial switch operation: historical review. Cardiol Young. 22(6):724-31, 2012
                              8. 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
                              9. Gaca AM et al: Repair of congenital heart disease: a primer-part 1. Radiology. 247(3):617-31, 2008
                              10. Martins P et al: Transposition of the great arteries. Orphanet J Rare Dis. 3:27, 2008
                              11. 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
                              12. Lecompte Y et al: Anatomic correction of transposition of the great arteries. J Thorac Cardiovasc Surg. 82(4):629-31, 1981
                              13. Jatene AD et al: Anatomic correction of transposition of the great vessels. J Thorac Cardiovasc Surg. 72(3):364-70, 1976