Physiologic versus anatomic repair of congenitally corrected transposition of the great arteries.

When biventricular repair of congenitally corrected transposition of the great arteries (ccTGA) is possible, complete anatomic (left ventricle to the aorta, right ventricle to the pulmonary artery, and associated atrial baffle operation) or physiologic (left ventricle to pulmonary artery, right ventricle to aorta) connections are complex and associated with significant long-term problems such as arrhythmias, subaortic obstruction, valvar dysfunction, ventricular-to-pulmonary artery conduit changes, and deteriorating ventricular function. Recent advances have supported physiologic, anatomic, and single-ventricle repairs. The purpose of this article is to review the natural history of ccTGA, compare and contrast the physiologic and anatomic repairs, and reintroduce a new concept of physiologic repair for patients with ccTGA, ventricular septal defect, and pulmonary stenosis using left ventricular unloading techniques via a bidirectional shunt.