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What Is the Arterial Switch Operation?

The Arterial Switch Operation (ASO) is a complex open-heart surgical procedure performed to correct a congenital heart defect known as Transposition of the Great Arteries (TGA). In this condition, the two main arteries carrying blood from the heart—the aorta and the pulmonary artery—are switched in position. This leads to improper oxygenation of the blood. The arterial switch procedure surgically repositions these arteries to their correct anatomical positions, allowing for normal circulation of oxygen-rich blood throughout the body.

Why Is the Arterial Switch Operation Needed?

This surgery is essential for infants born with Transposition of the Great Arteries because, without intervention, the condition can be life-threatening. In TGA, the aorta arises from the right ventricle and the pulmonary artery from the left ventricle, reversing the normal blood flow. This means that oxygen-poor blood circulates through the body, while oxygen-rich blood circulates back to the lungs, resulting in severe oxygen deprivation. The ASO restores proper blood flow and oxygen delivery, making it a lifesaving treatment.

At What Age Is the Arterial Switch Operation Performed?

The Arterial Switch Operation is typically performed within the first two to three weeks of life, ideally in the first 7 to 10 days after birth. Early intervention is critical because the newborn’s heart and lungs are still adapting to life outside the womb. Prompt surgery reduces the risk of complications such as heart failure or irreversible damage to the heart and lungs.

How Is the Arterial Switch Operation Performed?

The surgery is carried out under general anesthesia and involves stopping the heart temporarily while a heart-lung bypass machine supports circulation. The surgeon detaches the incorrectly connected aorta and pulmonary artery and switches them to their correct locations. Additionally, the coronary arteries, which supply blood to the heart muscle itself, must be carefully reimplanted into the new aorta. Precision is vital during this part of the procedure to ensure normal heart function after the switch.

What Happens Before the Operation?

Before the surgery, the baby undergoes several diagnostic tests, including echocardiography, chest X-ray, ECG, and sometimes cardiac MRI or catheterization to confirm the diagnosis and assess heart function. Intravenous medications may be administered to maintain the ductus arteriosus open temporarily to allow some mixing of oxygenated and deoxygenated blood. The medical team closely monitors the baby’s condition and prepares for surgery as soon as it is safe and feasible.