Pediatric Congenital Heart Disease

What is Arterial Switch for TGA?

In transposition of the great arteries, the aorta arises from the right ventricle and pulmonary artery from the left — incompatible with life at birth. The arterial switch operation transects the great arteries and reimplants them to the correct ventricles — anatomic correction.

Why China?

• Fuwai + Shanghai Children's: Top centers perform 100-200 ASO/year
• Cost: $30,000-$50,000 vs. $150,000-$400,000 in the US
• Early excellence: Ideally performed in first 2 weeks — these centers have dedicated neonatal cardiac ICUs
• Long-term follow-up: 20-30 year outcome data

Who is a candidate?

• Neonates with d-TGA (simple or with VSD)
• TGA with LVOT obstruction (may require Rastelli variant)
• Surgical window: ideally 1-3 weeks old for simple TGA

Outcomes

Early mortality: 2-5% at experienced centers. 10-year survival: 90%+. Need for PA reintervention: 5-15%. Freedom from reoperation at 20 years: 80-85%. Long-term neurodevelopment: mostly normal, close to general population.