Cardiovascular Imaging

Arterial switch operation

single stage anatomical correction of transposition of the great arteries. The operation consists of transection of the aorta and pulmonary artery above the sinus region and anastomosis of the pulmonary artery to the aortic sinus and the ascending aorta to the pulmonary sinus. Both coronary arteries are removed from the aortic sinuses of Valsalva and transposed to the posterior artery. The operation can be complicated by coronary arterial stenosis, stenosis of the pulmonary artery, and stenosis of the proximal right and left pulmonary arteries.

Imaging after this operation is usually done with two-dimensional echocardiography. MRI is also used for evaluation of the surgery and has an advantage over echocardiography in its ability for displaying the severity and extent of stenosis of the right and left pulmonary arteries. (Fig.1). Selective coronary arteriography is infrequently used to assess possible coronary arterial stenosis.

CBH

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Fig.1

ECG-gated spin-echo images at level of left (a) and right (b) pulmonary arteries show aorta interposed between the two pulmonary arteries and stenoses at the origin of both pulmonary arteries. This configuration of aorta and pulmonary arteries is characteristic for the arterial switch (Jatene) procedure.
Arterial switch operation, Fig.1 (a)
Arterial switch operation, Fig.1 (b)