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J Card Surg. 2020 Feb;35(2):444-446. doi: 10.1111/jocs.14342. Epub 2019 Dec 3.

A unique indication for the senning procedure: Atrioventricular discordance with ventriculoarterial concordance.

Author information

1
Division of Cardiothoracic Surgery, American Family Children's Hospital, University of Wisconsin, Madison, Wisconsin.
2
Division of Pediatric Cardiology, Marshfield Clinic, Marshfield, Wisconsin.
3
Division of Pediatric Cardiology, American Family Children's Hospital, University of Wisconsin, Madison, Wisconsin.

Abstract

OBJECTIVE:

We describe experience treating a patient with atrioventricular (AV) discordance with ventriculoarterial (VA) concordance, ventricular septal defect (VSD), and situs inversus. This is a rare congenital lesion in which closing the VSD would septate D-transposition physiology and performing an arterial switch and VSD closure would produce congenitally corrected transposition of the great arteries physiology. As such, it is the only lesion for which an isolated atrial switch (and VSD closure) remains the preferred correction.

CASE:

A term baby girl born with AV discordance/VA concordance, a large VSD, and situs inversus totalis was palliated with atrial septostomy on day of life 3 to allow for optimal mixing and pulmonary artery banding during the 6th week of life to control symptoms of pulmonary overcirculation and protect the pulmonary vasculature. At 8 months of age, she underwent complete repair with a Senning atrial switch procedure, VSD closure, and pulmonary artery debanding with pulmonary arterioplasty.

RESULTS:

The patient underwent corrective surgery with patch closure of the VSD, and the Senning atrial switch procedure resulting in a total anatomic correction. The patient was discharged on postoperative day 6 and is clinically doing well 12 months later. Follow-up transthoracic echocardiogram shows no pulmonary venous baffle obstruction, mild systemic venous baffle obstruction, and moderate pulmonary stenosis/pulmonary insufficiency.

CONCLUSION:

The isolated atrial switch is rarely employed as its outcomes are inferior to the arterial switch operation in the setting of the dextro-transposition of the great arteries. However, it remains the procedure of choice for AV discordance with VA concordance as it leads to physiologically corrected biventricular circulation.

KEYWORDS:

Senning; atrial switch; atrioventricular discordance; congenital heart disease; isolated ventricular inversion; ventriculoarterial concordance

PMID:
31793037
DOI:
10.1111/jocs.14342

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