Truncal Half Turn and Senning Operation: Anatomical Correction of Congenitally Corrected Transposition of Great Arteries (IDD) with Pulmonary Stenosis, Ventricular Septal Defect, Situs Inversus, and Levocardia

Objectives: Anatomical correction of congenitally corrected transposition of great arteries (ccTGA) with pulmonary stenosis (PS), malalignment ventricular septal defect (VSD) in situs inversus and levocardia presents significant surgical challenge. Reoperations due to recurrent obstruction of both outflow tracts following the Senning-Rastelli operation are serious long-term issues. A novel approach using truncal half turn and Senning operation was used to prevent these known late complications.

Methods: A 5-year-old boy with complex ccTGA, progressing cyanosis and exercise intolerance underwent anatomical correction with truncal half turn and modified Senning operation. Bicaval cannulation of both left sided caval veins, full flow bypass and mild hypothermia (32°C) were used. First, the Senning atrial switch was accomplished from the left side due to situs inversus and levocardia. After explantation of the coronaries, the arterial trunk was harvested en bloc and rotated by 180°. The coronary arteries were re-implanted and the Lecompte maneuver was performed. A pericardial patch was used for VSD closure and reconstruction of the left and right ventricular outflow tracts.

Results: The patient was weaned from ventilator 3 days later and discharged home on the 8^th postoperative day with excellent postoperative Results and without residuals.

Conclusion: Truncal half turn as a part of the anatomical correction of ccTGA is feasible even in situs inversus with levocardia. Translocation of the aortic root above the left ventricle and the avoidance of conduit insertion for the right ventricular outflow minimize the risk of frequent recurrent outflow tract obstructions.