Arterial switch procedure
Arterial switch procedure, also known as the Jatene switch procedure is performed to treat transposition of the great arteries.
Some facts about Arterial switch procedure:
- The Senning procedure is named after its inventor, the Swedish cardiac surgeon Ake Senning (1915–2000).
- A two-way baffle in the top part of the heart will be created by the surgeon which baffle serves as a bridge between the two sides of the heart.
- The patient's own tissue will be used to create the baffle in a Senning procedure.
- The procedure is called 'atrial switch procedures' because there is a baffle through the heart's top part, or atria, which allows the blood to reach the ventricles.
- A baffle or conduit is created in the Senning surgical repair, within the atria that reroutes the deoxygenated blood coming from the inferior and superior venae cavae to the mitral valve and therefore to the pulmonary circulation
- A systemic venous conduit is created that channels deoxygenated blood from the superior and inferior vena cava towards the mitral valve to ahhieve this.
- Flaps are used from the right atrial tissue and the interatrial septum and lets the oxygenated pulmonary venous blood flow to the tricuspid valve and from there to the systemic circulation.
- The ventriculo-arterial mismatch is left unrepaired as the anatomic left ventricle continues to pump into the pulmonary circulation and the anatomic right ventricle will work as the systemic pump.
Procedure for Arterial switch procedure:
- The general steps included in the procedure are:
- Multiple cardiovascular cannulations are performed after the aorta and pulmonary arteries are exposed in order to initiate a cardiopulmonary bypass
- The pulmonary artery and aorta are transected, the latter proximal to the bifurcation
- Both left and right coronary arteries are then resected together with a small patch of aorta surrounding the origin.
- The coronary arteries are implanted to the neoaorta which was formerly the main pulmonary artery.
- Neoaorta and neopulmonary trunk are created by switching transected great vessels
- A neoaorta is formed by shifting proximal transected pulmonary trunk posterior to the branch pulmonary arteries which is the Lecompte maneuver' and anastomosed to the distal aorta.
- Poximal transected aorta is patched with pericardial patch at the site of coronary artery explantation and subsequently, this is anastomosed to branch pulmonary arteries, forming a neopulmonary trunk.
- A right atrial incision is used to repair the atrial septal defect or septostomy lesion
- Modifications of the basic arterial switch procedure are sometimes done to accommodate the correction of other abnormalities.
Complications of Arterial switch procedure:
Complications of arterial switch procedure are:
- Supravalvular pulmonary stenosis at the anastomotic site is the most common complication encountered in the arterial switch procedure.
- Coronary artery stenosis is another complication, which may result in sudden death or myocardial infarction.
