Congenitally corrected transposition of the great arteries: ventricle to pulmonary artery connection strategies.

Congenitally corrected transposition of the great arteries is an uncommon congenital heart defect that may result in symptoms by virtue of associated cardiac anomalies. Ventricular septal defect, obstruction to pulmonary blood flow, tricuspid valve regurgitation, and conduction abnormalities may be found alone or in combination. In the presence of significant obstruction to pulmonary blood flow, repair generally requires the use of an extracardiac conduit from the morphologic left (pulmonary) ventricle to the pulmonary arteries in order to avoid surgically induced complete heart block. A combined atrial inversion by the Mustard or Senning technique and Rastelli operation has been applied in order to use the morphologic left ventricle in the systemic circulation, particularly when important systemic atrioventricular valve regurgitation is present. In this repair, a conduit is then placed from the morphologic right ventricle to the pulmonary arteries. An arterial repair may be used in preference to the Rastelli technique in the absence of pulmonary stenosis, avoiding the use of a conduit. Selection and timing of the optimal surgical repair is dependent on the specific knowledge of the anatomy in each individual patient.