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Neonatal Double Switch For Corrected Transposition, Attenuated Right Ventricle And Tricuspid Insufficiency
Glen Van Arsdell, Shyamasundar Balasubramanya, MD, Osman Al-Radi.
University of California Los Angeles, Los Angeles, CA, USA.
DROPBOX VIDEO
A 38 week, 4.6 Kg newborn presented with corrected transposition, mild to moderate tricuspid regurgitation, an attenuated right ventricle, and a large PDA. An MRI demonstrated an RVEDVI and LVEDVI of 29 and 58 mls indexed respectively. Options of pda closure alone, pda closure and later PA band, a hybrid approach for a morphologic RV growth, and a neonatal double switch with an ASD popoff were considered. The latter was chosen for the following reasons: 1) In simple transposition and a mild to moderately hypoplastic RV, we would perform an arterial switch with an ASD popoff - accepting some desaturation. 2) There not only was a borderline RV but there was associated systemic TR that would possibly necessitate a double switch later. 3) We would not have to retrain (and potentially damage) the LV, and 4) A neonatal double switch would be less surgery than a typical Taussig Bing arch/VSD/arterial switch.
An arterial Switch/Senning along with an adjustable asd popoff was performed. Crossclamp and cardiopulmonary bypass times were 119 and 141 minutes. There was moderate and some regional LV dysfunction immediately postoperative. An open chest and moderate inotropic support was employed. Chest closure occured on day 4 with child being extubate on day 6. ICU discharge occurred day 8. Discharge to home occurred at about 6 weeks - delayed related to feeding challenges. There was normal biventricular function, no venous pathway obstruction, and mild to moderate MR at that time.
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