CTICasesDouble Switch Procedure for L-Transposition of the Great Arteries (L-TGA)
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Imaging findings
Initial imaging shows L-transposition of the great arteries (L-TGA) with a left atrium to right ventricle (RV) connection, an Ebstein's anomaly of the tricuspid valve, and severe tricuspid regurgitation, complicated by a membranous VSD covered by the epsteinoid valve. Post-surgical imaging (double switch procedure) shows redirection of systemic venous return (SVC/IVC baffled to left atrium, then to new systemic ventricle) and pulmonary venous return (pulmonary veins baffled to new pulmonary atrium, then to new pulmonary ventricle), with a residual narrow baffle and a small VSD (due to tricuspid valve repair unmasking it).
Key takeaways
L-transposition of the great arteries involves atrioventricular and ventriculoarterial discordance. While some patients can tolerate systemic pressures on the right ventricle, severe tricuspid regurgitation or RV failure often necessitates surgical intervention. A "double switch" procedure involves both atrial (e.g., Senning) and arterial (e.g., Jatene) switches to restore systemic circulation to the left ventricle and pulmonary circulation to the right ventricle. Post-operative complications can include baffle obstruction and residual shunts.
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