Complete transposition of the great arteries with borderline tricuspid valve: how small is too small? A case report

Previous studies have mostly focused on the maintenance of left ventricular function after corrective surgery for transposition of the great arteries (TGA), with limited research on the recovery of postoperative right ventricular dysfunction.

In April 2025, our hospital admitted a neonate with complete transposition of the great arteries complicated with ventricular septal defect (TGA/VSD) and hypoplastic right ventricle (RV). The arterial switch operation (ASO) was performed on the eighth day after birth, followed by delayed sternal closure. The neonate developed refractory right ventricular dysfunction and was treated with inotropic agents, diuretics, anti-inflammatory agents, peritoneal dialysis support, inhaled nitric oxide, and thoracic drainage. The patient recovered successfully, and follow-up echocardiography at 6 months postoperatively showed normalization of right ventricular function.

We conclude that for patients with TGA/VSD, preoperative evaluation should not only focus on left ventricular development but also fully emphasize the status of right ventricular development. A borderline RV is not an absolute contraindication to ASO, although it may complicate postoperative management and necessitates long-term close follow-up of right ventricular function.