Dextro-transposition of the great arteries arterial switch or jatene operation


 * Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [mailto:psingh@perfuse.org]; ; Keri Shafer, M.D. [mailto:kshafer@bidmc.harvard.edu]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [mailto:kfeeney@perfuse.org]

Overview
Arterial switch or Jatene Operation
 * The successful anatomical correction of TGA was first described in 1975 by Jatene et al.
 * It has become the preferred procedure for most of the D-TGA (see above for the conditions)
 * An arterial switch operation involves the following steps-
 * The baby will be placed under general anesthesia.
 * The heart and vessels are accessed via median sternotomy.
 * The heart/lung machine (cardiopulmonary bypass machine) is connected.
 * Since, the heart/lung machine needs its "circulation" to be filled with blood, a child will require a blood transfusion for this surgery.
 * The patient is cooled for 20 minutes to 20 Celsius degree rectal temperature.
 * Once the heart is stopped and emptied, the aorta and the pulmonary artery are divided.
 * The site of the aortic transection is marked before the cross clamp is applied.
 * The aorta and pulmonary artery are transected at a level above the valve sinuses.
 * The ostium of the coronary arteries are excised along with a large segment of surrounding aortic wall and sutured into place in the neo-aorta (basal part of the pulmonary artery).
 * The pulmonary trunk is moved forward into its new position anterior to the aorta.
 * Finally, the switched great arteries are sutured into place.
 * The heart is then allowed to fill and take over its normal function. Temporary pacemaker wires and drainage tubes are then placed and the chest is closed.
 * Some arterial switch recipients may present with post-operative pulmonary stenosis, which would then be repaired with angioplasty, pulmonary stenting via heart cath or median sternotomy, and/or xenograft.
 * Lecompte maneuver - During this surgery the bifurcation of the pulmonary arteries are placed anterior to the aorta. This helps in straddling the ascending aorta to the left and right pulmonary arteries. This reduces the tension that could be there due to anterio translocation of the pulmonary arterial root. This has helped to decrease the pulmonary artery stenosis that may occur as an complication of ASO.

==(ACC/AHA) recommendations for Imaging for Dextro-Transposition of the Great Arteries after Arterial Switch Operation (DONOT EDIT)==

Class I

1. Comprehensive echocardiographic imaging to evaluate the anatomy and hemodynamics in patients with d-TGA and prior arterial switch operation (ASO) repair should be performed at least every 2 years at a center with expertise in ACHD. (Level of Evidence: C)

2. After prior ASO repair for d-TGA, all adults should have at least 1 evaluation of coronary artery patency. Coronary angiography should be performed if this cannot be established noninvasively. (Level of Evidence: C)

Class IIa

1. Periodic MRI or CT can be considered appropriate to evaluate the anatomy and hemodynamics in more detail. (Level of Evidence: C)

Recommendation for Cardiac Catheterization after Arterial Switch Operation

Class IIa

1. Coronary angiography is reasonable in all adults with d-TGA after ASO to rule out significant coronary artery obstruction. (Level of Evidence: C)

Acknowledgements and Initial Contributors to Page
Leida Perez, M.D.