Technical aspects of the Rastelli and atrial switch procedure for congenitally corrected transposition of the great arteries with ventricular septal defect and pulmonary stenosis or atresia: results of therapy.

In conventional surgery for the associated lesions of congenitally corrected transposition of the great arteries, the right ventricle remains in the systemic circulation. In this situation, the right ventricle and tricuspid valve fail in an unpredictable manner. The double switch procedure was introduced to restore the morphologic left ventricle to the systemic circulation and considerable success has been seen over the last 10 years with this approach. The Rastelli and atrial switch procedure can be applied to patients with congenitally corrected transposition of the great arteries and pulmonary stenosis or atresia and a suitably placed ventricular septal defect in the outlet septum of the ventricle beneath the aortic valve. Thus, the left ventricle can be restored to the systemic circulation. The Rastelli-atrial switch is a complex operative procedure, but the operative risk and long-term results are good without evidence in the mid-term of ventricular failure as has been associated with the conventional repair. A disadvantage is that these patients require valved conduit changes over the years.