Question

Discuss long-term follow-up of children with:
Double switch operation for corrected transposition of great arteries.

Hint:

The double switch operation is complex and requires lifelong monitoring for complications like arrhythmias and right ventricular dysfunction.

Answer 1

Step 1: Understanding Double Switch Operation (DSO):
The double switch operation is performed for patients with corrected transposition of the great arteries (CTGA), where the atrioventricular and ventriculo-arterial connections are reversed. The procedure involves two main components: the Mustard or Senning procedure to baffle the venous return and the arterial switch to reposition the aorta and pulmonary artery.
Step 2: Long-Term Follow-Up After DSO:
1. Cardiac Function Monitoring: Long-term follow-up includes regular monitoring of cardiac function, especially the right ventricle, which is responsible for pumping systemic blood after the operation. Echocardiograms and ECGs are used to track function.
2. Right Ventricular Function: The right ventricle, which is the systemic ventricle after a double switch, may be at risk for dysfunction over time. Follow-up includes monitoring for signs of right ventricular failure.
3. Arrhythmias: Patients are at high risk for arrhythmias due to the abnormal atrial and ventricular connections, and they may need pacemaker implantation or other interventions to manage arrhythmias.
4. Pulmonary Function: Regular assessments of pulmonary function are necessary to detect any long-term pulmonary complications.
5. Psychosocial Support: As with the ASO, long-term psychosocial support is vital to help children and families manage the ongoing challenges of living with a congenital heart defect.