# Arterial Switch Operation > Jatene arterial switch, coronary transfer, Lecompte manoeuvre and late outcomes in NEET-SS Paediatric Cardiology. - Canonical URL: https://prepelephant.com/topics/neet-ss/paediatric-cardiology/arterial-switch-operation - Exam / course: NEET-SS · Subject: Paediatric Cardiology - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Arterial Switch Operation", PrepElephant, https://prepelephant.com/topics/neet-ss/paediatric-cardiology/arterial-switch-operation ## Direct answer The Jatene arterial switch operation, first performed successfully in 1975, is the anatomical correction of d-transposition: the aorta and pulmonary artery are divided, the great arteries are swapped so each ventricle drives its correct circuit, and the coronary ostia are transferred as buttons onto the neoaortic root. Timing is dictated by the left ventricle — with an intact ventricular septum the switch must occur within roughly the first two weeks of life, before the left ventricle deconditions to low-pressure pumping. The Lecompte manoeuvre brings the branch pulmonary arteries anterior to the newly reconstructed aorta, and long-term survival in experienced centres now exceeds 95 per cent, making it one of the transformative operations of paediatric cardiac surgery. ## What you must remember - Steps in order: transect both great arteries, harvest coronary ostia as buttons with surrounding aortic wall, anastomose the proximal aorta to the distal pulmonary trunk (neoaorta), transfer the coronaries, and reconstruct the neopulmonary root, usually with a pantaloon pericardial patch. - The Lecompte manoeuvre: the pulmonary bifurcation is brought anterior to the ascending aorta — the reason branch pulmonary artery stenosis is a recognised late sequela. - Coronary anatomy is classified by the Leiden convention (usual, inverted, single, intramural); intramural coronaries and some single-coronary patterns are the high-risk transfers. - Early complications: coronary insufficiency with ST changes and ventricular dysfunction, bleeding, and supra-neoaortic valve stenosis; late ones include neoaortic root dilation with regurgitation, branch pulmonary stenosis, and arrhythmia. - Compare atrial switch (Mustard or Senning): those operations redirect venous flow at atrial level, leaving the right ventricle as the systemic pump — late failure, baffle obstruction and atrial arrhythmias are why the arterial switch replaced them. - With a large VSD or a duct, the left ventricle stays pressure-prepared and the switch can be done later; a late presenter with an unprepared left ventricle may need a two-stage approach with pulmonary artery banding to retrain it. - Post-operative surveillance is lifelong: echo for root and valve, ECG for ischaemia, and in some centres routine myocardial perfusion imaging, since coronary events can be silent. ## Anatomy to outcome: the switch pathway Before the chest is opened, the decision has already been made by the echo: ductal and atrial mixing stabilised on prostaglandin, a Rashkind septostomy if atrial mixing was restrictive, coronaries mapped — the usual pattern, origin from the facing sinuses, is favourable; an intramural coronary needs an unroofing plan. On bypass and cardioplegic arrest, the arteries are transected above the sinuses; the coronary buttons are excised with a rim of aortic wall and reimplanted into the facing sinuses of the neoaorta, and any tension or kinking at this step is what later becomes myocardial infarction in the ICU. The pulmonary trunk is connected to the right ventricular outflow, and the Lecompte manoeuvre drapes the bifurcation anterior to the aorta — elegant, but it sets up the late branch stenosis that brings a share of these children back for balloon or stent. Come off bypass watching the ECG: new ST elevation or regional hypokinesis means coronary kinking, and the instinct to return to bypass immediately saves myocardium. The ICU phase treats the baby as a post-ischaemic heart: modest inotropy, avoidance of tachycardia, and a low threshold for re-exploration of bleeding. Discharge on aspirin in most protocols, with follow-up that never truly ends for valve, root and coronaries. ## Where students slip The commonest confusion is mixing up the arterial switch with the atrial switch in stem questions about "which ventricle is the systemic pump after correction" — after Mustard or Senning it remains the right ventricle, which is precisely the physiological flaw the Jatene operation removes. A second slip is timing: candidates answer "switch anytime in infancy" and lose the item; the intact-septum window is about two weeks, with a VSD extending it. Third is the coronary question: when asked the gravest technical determinant of early mortality, the answer is the coronary transfer — patterns like intramural coronaries, not the VSD closure. Finally, the late-presenting toddler: the reflex answer "immediate switch" is wrong; the left ventricle must be retrained by banding first or an atrial switch accepted in selected cases. ## Frequently asked questions ### What is the Lecompte manoeuvre? Bringing the pulmonary artery bifurcation anterior to the reconstructed ascending aorta during the arterial switch, which predisposes to late branch pulmonary artery stenosis. ### Why did the atrial switch operations fall out of favour? Mustard and Senning repairs leave the right ventricle as the systemic ventricle, leading to late right ventricular failure, atrial arrhythmias and baffle obstruction. ### What is the ideal age for arterial switch in simple transposition? Within the first two weeks of life, while the left ventricle still carries near-systemic pressure and can assume the systemic role. ### Which coronary pattern makes the arterial switch high risk? Intramural coronary arteries and certain single-coronary ostium patterns, which are prone to kinking or occlusion after transfer. ### What are the principal late complications after arterial switch? Neoaortic root dilation and regurgitation, branch pulmonary artery stenosis, and coronary insufficiency, mandating lifelong cardiology surveillance.