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J Thorac Cardiovasc Surg 2004;128:944-945
© 2004 The American Association for Thoracic Surgery

Brief Communications

Atrioventricular discordance with ventriculoarterial concordance: A remaining indication for the atrial switch operation

Igor E. Konstantinov, MD, PhDa,*, Lillian Lai, MDc, Steven D. Colan, MDc, William G. Williams, MD, FRCSCa, Jia Li, MD, PhDb, Richard A. Jonas, MDd, Richard Van Praagh, MDc

a Division of Cardiovascular Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
b Division of Cardiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
c Division of Cardiology, Children's Hospital, Harvard Medical School, Boston, Mass, USA
d Division of Cardiovascular Surgery, Children's Hospital, Harvard Medical School, Boston, Mass, USA

Received for publication April 12, 2004; revisions received April 19, 2004; accepted for publication April 22, 2004.

* Address for reprints: Igor E. Konstantinov, MD, Division of Cardiovascular Surgery, Hospital for Sick Children, 555 University Ave, Toronto, Ontario M5G 1X8, Canada
igorkonst@hotmail.com

The first 20% of the full text of this article appears below.

Isolated ventricular inversion is a very rare anomaly in which there is atrioventricular (AV) discordance and ventricular-arterial (VA) concordance (AVD-VAC).1 Thus although the aorta arises from the left ventricle and the pulmonary artery (PA) originates from the right ventricle, the systemic and pulmonary circulations are in parallel and not in series. The physiology is that of complete transposition of the great arteries (TGA), but an arterial switch is contraindicated because it would leave the morphologically right ventricle to support systemic circulation.

Six different anatomic types of AVD-VAC have been identified (Figure 1).2 All such patients rely on adequate mixing of pulmonary and systemic circulation through either a patent ductus arteriosus or an intracardiac shunt to survive. These anomalies are one of the few indications for the atrial switch operation in the modern era.3 Herein we describe the anatomy, corrective operation, and long-term follow-up in these rare patients.


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  		Figure 1. Anatomic types of AVD-VAC. In parentheses the first letter denotes the segmental anatomic set of visceroatrial situs (S, situs solitus; I, situs . . . [Full Text of this Article]

 





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