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Senning Procedure of AV Discordance / VA Concordance (atrial situs solitus) in a 4 Month Old Female
*Ross M. Ungerleider1, Robert Hanfland1, Sara Pittenger2, Rob Hartman3, Neptali Bocanegra3, Anne Anderson1, Elisabeth Leong3, John Cotton3, Elman Franz3, James R. Shea3, Scott Buck3, Pamela S. Ro3, Timothy Hoffman3
1Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States, 2Anesthesiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States, 3Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
Background: The Senning atrial switch (SAS) procedure was commonly employed for the surgical management of Transposition of the Great Arteries (TGA) until the evolution of the arterial switch operation (ASO) replaced it as a standard option for TGA. Consequently, current day trainees and younger surgeons have limited, if any, exposure to techniques for performing the SAS. There are still occasional patients who would benefit from a SAS and this video presents the technique for performing a SAS without the need for patch augmentation of either the systemic or pulmonary venous baffle. Methods: The patient is a 4 month old female with AV Discordance / VA Concordance (and a VSD) presenting with transposition physiology as a neonate managed with a balloon atrial septostomy shortly after birth. She presented with increasing cyanosis at 4 months of age (4.2 kg). An atrial switch procedure, such as a SAS (along with VSD closure) provides anatomic correction for her defect by restoring AV concordance. The procedure is performed on cardiopulmonary bypass with moderate hypothermia (32 degrees C) with bicaval cannulation. The techniqes demonstrated were learned in part from Paul Ebert who was an expert at performing the SAS. Results: The procedure (SAS and VSD closure) restored normal circulation and physiology resulting in normal oxygen saturations. The patient recovered without complication and was discharged home 11 days after surgery. Conclusion: There are occasional patients who might require a SAS for surgical treatment of their congenital heart defect (older patients with TGA who are not candidates for ASO; patients requiring a "double switch"; patients with isolated AV discordance, etc.). This video presents a resource to augment illustrations in atlases and help guide contemporary surgeons as a learning tool when they are confronted with a patient who might benefit from a SAS.
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