Arterial Switch, Ventricular Septation, and Fontan Takedown for Double Inlet Left Ventricle

A patient with double inlet left ventricle with transposition of great arteries and severe coarctation of the aorta received aortoplasty and pulmonary artery banding, followed by bidirectional Glenn shunt and extracardiac total cavopulmonary connection (TCPC). Severe subaortic stenosis and increased atrioventricular valve regurgitation were noted 4 years after TCPC. Surgery included alleviation of the subaortic stenosis, ventricular septation through the tricuspid valve approach, and an arterial switch with the main pulmonary artery reopened. The TCPC was taken down with both caval veins reconnected to the right atrium; the neopulmonary artery was reconstructed. Biventricular conversion from TCPC was achieved.