Key result
Senning procedure improves oxygen saturation to ~91% in late-presenting d-TGA.
Why the study?
Late-presenting d-TGA-IVS patients with regressed left ventricles face high-risk or infeasible arterial switch operations, necessitating alternative surgical options such as the Senning atrial switch, especially in resource-limited settings.
Case Report (n=1)
No
The Senning procedure remains a viable and life-saving salvage option for very late-presenting adolescents with d-TGA-IVS and preserved pulmonary hemodynamics when left ventricular regression precludes an arterial switch operation.
May support Senning as salvage in select late d-TGA-IVS; leaves open need for larger series on durability and selection.
Background: d-Transposition of the Great Arteries with an Intact Ventricular Septum (d-TGA-IVS) is a severe congenital cardiac anomaly typically necessitating an Arterial Switch Operation (ASO) during the neonatal stage. In late presenters with a regressed Left Ventricle (LV), ASO becomes high-risk or infeasible, making atrial switch procedures such as the Senning procedure a potential salvage option, particularly in resource-limited settings. Case Illustration: We report a 13-year-old boy with lifelong cyanosis who developed progressive exertional dyspnea. Echocardiography and cardiac catheterization confirmed d-TGA-IVS with secundum atrial septal defect, severe Right Ventricular Hypertrophy (RVH), and preserved Pulmonary Vascular Resistance (PVR) (1.93 WU). Due to LV regression and the limited feasibility of late ASO, a Senning atrial switch was performed. Postoperative recovery was clinically stable, with oxygen saturation improving from 73% to 91%. Early postoperative echocardiography showed reduced systemic Right Ventricular (RV) function (Tricuspid Annular Plane Systolic Excursion [TAPSE] 7 mm), which subsequently improved on follow-up. Conclusion: The Senning procedure remains a valuable salvage option for very-late presenting d-TGA-IVS with favorable pulmonary hemodynamics when ASO is not feasible. This case underscores the importance of periodic reassessment of operability in patients initially deemed inoperable and highlights the need for lifelong follow-up to monitor systemic RV function, arrhythmia risk, and baffle integrity.
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Mulawarman et al. (2026) conducted a case report in d-Transposition of the Great Arteries with an Intact Ventricular Septum (n=1). Senning procedure was evaluated on Oxygen saturation. The Senning atrial switch procedure successfully improved oxygen saturation from 73% to 91% and stabilized hemodynamics in a 13-year-old boy with late-presenting d-TGA-IVS.
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