Arterial switch procedure

The arterial switch procedure (or Jatene switch) is an intervention designed to correct D-transposition of the great arteries at the level of the aorta and main pulmonary artery.

First, the left and right coronary arteries are transferred to the posterior artery (the main pulmonary artery, now the "neo-aorta") and then the gaps in the aorta are patched.

The supravalvular ascending aorta and supravalvular main pulmonary are then transected and switched. This redirects blood flow in the normal way.

The neo-aorta is positioned posteriorly to the main pulmonary artery bifurcation with the "Lecompte maneuver."

The manifestations of congenital heart disease often lie along a spectrum, and modifications of the basic arterial switch procedure are possible to accommodate correction of other abnormalities. Once such example is the Rastelli procedure, which helps simultaneously correct VSD and LVOT obstruction.

The "arterial switch" is in distinction to older corrections using an "atrial switch," such as the Senning repair or Mustard repair. The arterial switch results in less postprocedural arrhythmia.

The arterial and atrial switches have been combined to correct L-transposition in a double switch procedure.

Complications

The most common complication encountered in the arterial switch procedure is supravalvular pulmonary stenosis at the anastomotic site. Dilatation of the neo-aortic root has been encountered, but abnormal valve function is uncommon, and its significance is uncertain.

Related articles

• congenital heart disease
  • types of repair
    • tetralogy of Fallot​
      • total repair of TOF
      • Blalock-Taussig shunt
      • total repair of TOFWaterston shunt
    • transposition of the great arteries
      • Mustard repair
      • Senning repair
      • arterial switch procedure
      • Rastelli procedure
      • double switch procedure