Palliative switch: a surgical decision after hybrid procedure

• Published in: World journal for pediatric & congenital heart surgery Vol. 5; no. 1; p. 85
• Main Authors: Perez-Negueruela, Carolina, Mayol, Javier, Cesar, Sergi, Muchart, Jordi, Segura, Susana, Caffarena-Calvar, Jose Maria
• Format: Journal Article
• Language: English
• Published: United States 01.01.2014
• Subjects: Abnormalities, Multiple - surgery; Aorta, Thoracic - pathology; Aorta, Thoracic - surgery; Fontan Procedure - methods; Heart Defects, Congenital - surgery; Heart Ventricles - abnormalities; Heart Ventricles - surgery; Humans; Infant, Newborn; Norwood Procedures - methods; Palliative Care; Reoperation; Transposition of Great Vessels - diagnosis; Transposition of Great Vessels - surgery; Treatment Outcome; Ultrasonography, Prenatal; systemic outflow tract obstruction; single ventricle; palliative switch; hybrid procedure
• ISSN: 2150-136X
• DOI: 10.1177/2150135113512135

The first-stage palliation of newborns with single-ventricle anatomy and transposed great arteries can be very challenging when associated with systemic ventricular outflow obstruction and aortic arch obstruction. Often, the initial intervention is a stage I Norwood procedure. We present the case of a newborn with double inlet left ventricle, discordant ventriculoarterial connection with restrictive ventricular foramen, and severe aortic arch obstruction. A hybrid procedure was performed initially as a means of addressing hemodynamic instability. Three months later, a palliative arterial switch procedure was performed as an alternative to the combined Norwood-Glenn procedure. Palliative arterial switch combined with arch reconstruction can be an effective surgical option in these complex, challenging patients.