Dextro-transposition of the great arteries (D-TGA) produces parallel rather than series circulations and accounts for 5–7% of congenital heart defects. The arterial switch operation — anatomically correcting the great arteries and reimplanting the coronaries, usually within the first weeks of life — is the standard surgical correction, and early diagnosis is crucial. Balloon atrial septostomy shortly after birth improves mixing and oxygenation as a stabilizing measure. The older atrial switch procedures (Mustard and Senning) are largely historical but remain relevant to the many adults who underwent them and now require surveillance for systemic (morphologic right) ventricular dysfunction and arrhythmia. The Rastelli and Nikaidoh procedures address complex D-TGA with a VSD and left ventricular outflow tract obstruction. Across all approaches, lifelong follow-up is needed for coronary stenosis, neoaortic root dilation and regurgitation, outflow obstruction, and arrhythmias.
Further reading: pathogenesis and surgical treatment of D-TGA (Zubrzycki et al., 2024); circulatory physiology and treatment strategy in TGA (Sato et al., 2024).