SURGICAL TECHNIQUE ___________________________________________________________ Palliative Arterial Switch for Congenitally Corrected Transposition of the Great Arteries with Ventricular Septal Defect and Subaortic Hypoplasia Duccio Federici, M.D.,* Stefano Marianeschi, M.D.,y Simona Marcora, M.D.,z and Lorenzo Galletti, M.D.* *Cardiac Surgery Unit, ‘‘Papa Giovanni XXIII’’ Hospital, Bergamo, Italy; yCardiac Surgery Unit, ‘‘Niguarda Ca’ Granda’’ Hospital, Milan, Italy; and zCardiovascular Department, ‘‘Papa Giovanni XXIII’’ Hospital, Bergamo, Italy ABSTRACT We present a case of palliative arterial switch with aortic arch reconstruction performed as the first stage of anatomical correction in a patient with congenitally corrected transposition of great arteries (ccTGA), ventricular septal defect (VSD), duct-dependent aortic coartation, and hypoplasia of the ascending aorta and subaortic tract. doi: 10.1111/jocs.12659 (J Card Surg 2015;30:908–909) Congenitally corrected transposition of great arteries with ventricular septal defect (VSD) and hypoplasia of sub-aortic and aortic tract is challenging in the neonatal period, especially when a biventricular correction seems feasible. In these patients, we propose a ‘‘two-stage’’ surgical approach in which the first stage is represented by palliative arterial switch along with aortic arch recon- struction, and the second stage is the completion of anatomical correction by a modified Senning procedure. SURGICAL TECHNIQUE A 3kg newborn male was admitted with the diag- nosis of congenitally corrected transposition of great arteries (ccTGA; S,L,L), nonrestrictive sub-pulmonary VSD, Ebstein-like tricuspid valve without regurgitation, ductal-dependent aortic coartation and severe hypo- plasia of the aortic arch, ascending aorta and subaortic tract. The great vessels arrangement was side by side. The pulmonary trunk diameter was about three times that of the ascending aorta. The coronary arteries were type I according to the Marie-Lannelongue classification. 1 Considering the morphological and physiopathologi- cal features we decided to perform a ‘‘two-stage’’ anatomical correction.The approval of our ethics committee was obtained to report this case. The first neonatal stage consisted of palliative arterial switch with aortic arch reconstruction. The second stage, performed later in life, consisted of atrial switch, VSD closure, and right ventricular outflow tract reconstruction. At the time of the first stage, the surgical repair of the coartation was achieved under selective cerebral perfu- sion by resection and end-to-side anastomosis with patch enlargement of the ascending aorta. The arterial switch procedure was performed on total cardiopulmo- nary bypass under moderate hypothermia. Considering the side-by-side arrangement of the great vessels we decided not to perform the Lecompte maneuver in order to avoid any compression on the coronary buttons. The neopulmonary trunk was reconstructed with autologous pericardial patch in the usual manner. In this setting, the hypoplastic neopulmonary trunk works as a natural form of pulmonary flow modulation (Fig. 1). The patient was weaned easily from cardiopulmonary bypass with 80% arterial O 2 saturation. The postoperative Abbreviations: ccTGA, congenitally corrected transposition of the great arteries; VSD, ventricular septal defect Conflict of interest: The authors acknowledge no conflict of interest in the submission. Funding: None. Address for correspondence: Duccio Federici, M.D., Cardiac Surgery Unit, ‘‘Papa Giovanni XXIII’’ Hospital, Piazzale OMS n.1, 24122 Bergamo, Italy. Fax: 0039-0352674894; e-mail: dfederici@hpg23.it CONGENITAL HEART DISEASE 908 © 2015 Wiley Periodicals, Inc.