Treatment of transposition of the great arteries.

Today, the arterial switch operation is the treatment of choice for patients with transposition of the great arteries. Midterm follow-up confirms the initial hopes for good systemic ventricular function and lack of arrhythmias. A two-stage operation can be performed in patients seen after 1 month of age or in subjects who have had an atrial switch operation and with late systemic dysfunction. Increasing experience with the arterial switch operation has led to its successful use in more complex lesions. Increased mortality and morbidity after the atrial switch operation has been confirmed, with decreased cardiac output, baffle obstruction, and arrhythmias. In some cases interventional catheterization is useful. In patients with corrected transposition of the great arteries who have associated malformations, the poor midterm results seen with the classical surgical repair make the combined atrial and arterial switch an interesting option.