Arterial Switch Operation (ASO)
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This was first undertaken successfully by Jatene in the 1975. It is used when the great arteries are connected to the reverse ventricles (ie discordant arterial connection). It is most commonly performed in simple transposition but it is also used in patients with complex heart problems. The first diagram shows the aorta (Ao) lying anterior to the pulmonary artery. The great vessels are divided above the coronary origins. The coronary arteries are then removed on a button of tissue from the original aorta and stitched in place on the original PA (second diagram). Finally the PA is moved anterior to the aorta and both great vessels sewn into place the correct way around. |
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It is the movement of the coronary arteries that is the critical part of the operation. If they are left in their original position then they will receive venous blood. They therefore have to be moved backwards so that they come from the aorta and have oxygenated blood. The switch operation has to be undertaken within the first month of life otherwise the LV which is emptying into the low resistance pulmonary circuit atrophies and cannot manage to support the systemic circulation after the switch procedure. The mortality for this procedure in most centres is now considerably less than 5% with an excellent long term prognosis. |
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This page was last edited 22/3/2004 |
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