Atrial switch

Atrial switch operation is a surgical procedure used to correct Transposition of the great arteries (TGA), a congenital heart defect in which the two main arteries leaving the heart are reversed (transposed). This operation was a significant advancement in the treatment of congenital heart defects and was widely performed before the development of the arterial switch operation, which is now the standard treatment for TGA.

Overview

The atrial switch operation, also known as the Senning or Mustard procedure, depending on the specific technique used, redirects the flow of blood at the atrial level. In patients with TGA, oxygen-poor blood is circulated to the body, and oxygen-rich blood is recirculated to the lungs, leading to severe cyanosis and heart failure if left untreated. The atrial switch operation corrects this by rerouting the blood flow within the heart, ensuring that oxygen-rich blood is pumped to the body and oxygen-poor blood is sent to the lungs.

History

The first successful atrial switch operation was performed by Dr. Senning in 1958, and the procedure was further refined by Dr. Mustard in the 1960s. These operations marked a significant milestone in cardiac surgery and provided a lifeline for patients with TGA.

Procedure

The atrial switch operation involves creating a baffle within the atria (the upper chambers of the heart) to redirect the blood flow. In the Senning procedure, the surgeon uses the patient's own atrial tissue to construct the baffle, while in the Mustard procedure, a synthetic material is used to create the baffle. The goal of both techniques is to ensure that the oxygen-poor blood is directed to the left ventricle and then to the lungs, while oxygen-rich blood is directed to the right ventricle and then to the rest of the body.

Complications

While the atrial switch operation has saved many lives, it is not without risks. Complications can include arrhythmias, baffle leaks or obstructions, and heart failure. Long-term follow-up care is essential for patients who have undergone this procedure.

Current Status

With the advent of the arterial switch operation, which corrects the defect at the arterial level and preserves the left ventricle's role as the systemic pump, the atrial switch operation has largely been replaced. However, the atrial switch remains an important part of the history of congenital heart disease treatment and is still performed in cases where the arterial switch is not feasible.

See Also

• Congenital heart defect
• Cardiac surgery
• Transposition of the great arteries
• Arterial switch operation