Switch after Switch. Ventricular retraining as alternative to heart transplant

Abstract

Transposition of the great arteries (Dextro-TGA), repaired with physiological correction techniques (atrial switch - Mustard or Senning surgery), can present as a complication the failure of the right ventricle that acts as systemic and, at the same time, deconditioning of the left ventricle, leading to congestive heart failure. In these patients, treatment and recovery options are very limited.

Objective: To describe successful late anatomical correction after ventricular retraining.

Clinical Case: Patient diagnosed with Dextro-TGA, with multiple perinatal complications, treated in another institution with Mustard surgery at seven months, who developed refractory heart failure in the postoperative period. Given the option of a heart transplant, pulmonary banding was decided at 11 months of age as a stabilization measure, which subsequently allowed retraining of the left ventricle and led to anatomical correction with removal of the Mustard procedure and successful large artery switch at six years of age. Three years after surgery, the patient maintains good quality of life and functional class II.

Conclusions: In selected cases, such as the one described, ventricular retraining can be a valid option for patients with transposition of the great arteries who have had a previous physiological correction and have developed right ventricular dysfunction (systemic).