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LETTER TO EDITOR Table of Contents   
Year : 2008  |  Volume : 11  |  Issue : 2  |  Page : 141-142
Transoesophageal echocardiography during Senning's operation


Department of Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India

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How to cite this article:
Gadhinglajkar S, Sreedhar R. Transoesophageal echocardiography during Senning's operation. Ann Card Anaesth 2008;11:141-2

How to cite this URL:
Gadhinglajkar S, Sreedhar R. Transoesophageal echocardiography during Senning's operation. Ann Card Anaesth [serial online] 2008 [cited 2020 Jan 20];11:141-2. Available from: http://www.annals.in/text.asp?2008/11/2/141/41598


The Editor,

A 3-year-old male, diagnosed as a case of dextroposed transposition of great arteries (d-TGA) preoperatively, underwent Senning's operation. TOE examination performed after induction of anaesthesia (using Philips Sonos 7500, USA) revealed pulmonary artery (PA) positioned posterior to the aorta [Figure 1] and ventriculoarterial discordance [right ventricle (RV) draining into the aorta and left ventricle (LV) draining into the PA] [Figure 2]. Dynamic left ventricular outflow tract obstruction (LVOTO) was present. Other features were enlarged right atrium and RV; intact interventricular septum (IVS); atrial septal defect (ASD) measuring 7 mm; and normal position of left atrial appendage and coronary arteries. On cardiopulmonary bypass (CPB), after aortic cross-clamping and cardioplegic arrest, Senning's operation was performed in three layers. No flow obstruction was observed in systemic venous chamber and pulmonary venous baffle [Figure 3] after termination of CPB. RV (systemic ventricle) and LV function were good.

Senning's operation is still performed routinely in developing countries. Ventriculoarterial discordance; bulging of IVS toward LV; and the position of PA parallel and posterior to the aorta (double-barrel appearance) are important features associated with d-TGA. During Senning's operation, a baffle is created in the atrium, which redirects systemic venous flow to LV and pulmonary venous flow to RV. Obstruction to the pulmonary and systemic venous pathway [1] may occur postoperatively, which should be ruled out in the post-CPB period. TOE is indicated for the evaluation of intra- or extra-cardiac baffles [2] and ventricular function following the Senning's procedure.

 
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1.Khairy P, Landzberg MJ, Lambert J, O'Donnell CP. Long-term outcomes after the atrial switch for surgical correction of transposition: A meta-analysis comparing the Mustard and Senning procedures. Cardiol Young 2004;14:284-92  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Ayres NA, Miller-Hance W, Fyfe DA, Stevenson JG, Sahn DJ, Young LT, et al . Indications and guidelines for performance of transoesophageal echocardiography in the patient with pediatric acquired or congenital heart disease: Report from the task force of the Pediatric Council of the American Society of Echocardiography. J Am Soc Echocardiogr 2005;18:91-8.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]

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Correspondence Address:
Shrinivas Gadhinglajkar
Department of Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum - 695 011, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.41598

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  [Figure 1], [Figure 2], [Figure 3]



 

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