title: Palliative switch: a surgical decision after hybrid procedure.
abstract: The first-stage palliation of newborns with single-ventricle anatomy and transposed great arteries can be very challenging when associated with systemic ventricular outflow obstruction and aortic arch obstruction. Often, the initial intervention is a stage I Norwood procedure. We present the case of a newborn with double inlet left ventricle, discordant ventriculoarterial connection with restrictive ventricular foramen, and severe aortic arch obstruction. A hybrid procedure was performed initially as a means of addressing hemodynamic instability. Three months later, a palliative arterial switch procedure was performed as an alternative to the combined Norwood-Glenn procedure. Palliative arterial switch combined with arch reconstruction can be an effective surgical option in these complex, challenging patients.
authors.affiliation: Department of Pediatric Cardiac Surgery, Sant Joan de Deu Hospital, Barcelona, Spain.
authors.forename: Carolina
authors.initials: C
authors.lastname: Perez-Negueruela
authors.forename: Javier
authors.initials: J
authors.lastname: Mayol
authors.forename: Sergi
authors.initials: S
authors.lastname: Cesar
authors.forename: Jordi
authors.initials: J
authors.lastname: Muchart
authors.forename: Susana
authors.initials: S
authors.lastname: Segura
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Caffarena-Calvar
mesh_terms: D000015:Abnormalities, Multiple / Q000601:surgery*; D001013:Aorta, Thoracic / Q000473:pathology / Q000601:surgery*; D018729:Fontan Procedure / Q000379:methods; D006330:Heart Defects, Congenital / Q000601:surgery; D006352:Heart Ventricles / Q000002:abnormalities / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D058327:Norwood Procedures / Q000379:methods*; D010166:Palliative Care; D012086:Reoperation; D014188:Transposition of Great Vessels / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal
keywords: hybrid procedure; palliative switch; single ventricle; systemic outflow tract obstruction