Double switch procedures have been brough to subject for the anatomic correction in patients having intracardiac pathologies associated by atrioventricular (AV) discordance to avoid the serious ventricular and systemic AV valvuler dysfunction that occurs in long term after the classic surgical treatment methods. Between July 1995 to March 1996, double switch procedures have been successfully performed on 4 patients in our clinic whose ages ranged from 5.5 months to 12 years having AV discordance as well as ventriculoarterial (VA) discordance or double outlet right ventricular morphology. Three different surgical techniques have been applied on the patients based on their associated intracardiac pathologies. One patient had AV discordance, VA discordance, a large ventricular septal defect, pulmonary hypertension and mild left AV valvular insufficiency. Combined atrial switch (Senning) and arterial switch (Jatene) procedures have been performed on this patient to attain a double switch procedure who had a normal pulmonary valve.

The second patient who also had a normal pulmonary valve had AV discordance, a large ventricular septal defect and double outlet right ventricle. Double switch procedure in this patient was a combination of atrial switch (Senning) procedure and ventriculoarterial switch procedure done by an intracardiac spiral tunnel repair. The remaining two patients one had VA discordance while the other had a double outlet right ventricle. In this group, Senning and Rastelli procedures have been combined to attain a double switch procedure. The patients who have had their early postoperative period without any problems have been followed up 16.5±3.22 months average and they are still in good condition with a functional capacity I according to the NYHA classification. Anatomic correction with double switch procedures that allows the morphologic left ventricle to function as a systemic ventricle in intracardiac pathologies associated by AV discordance seems to be a new surgical approach when the long term results are concerned.