Atrial-Level Switch Operation

The atrial level switch operation was a breakthrough in treatment of individuals with D- transposition of the great arteries (D-TGA). The Senning and Mustard procedures were widely performed in the 1970s and into the 1980s, they relieved cyanosis and established an in-series circulation. It could be argued that the Mustard/Senning procedures heralded the era of radical correction of complex congenital heart disease. In this issue of Circulation , Vejlstrup and colleagues summarize the entire experience with atrial level correction of D-TGA in Sweden and Denmark1. The story is remarkable from an historic perspective and provides a window into the early years of congenital heart surgery but there are also important lessons for the current era not just related to transposition corrected with a Mustard/Senning procedure but also regarding congenital heart surgery in general. From this experience we can learn from the lessons of; access to care; transparency as well as the limits of physiologic correction of transposition of the great vessels and the systemic right ventricles.