It is especially suited for double outlet right ventricle with subaortic or doubly-committed ventricular septal defects, but can also be used in the presence of a subpulmonary ventricular septal defect. Pulmonary translocation can also be used for double outlet right ventricle with pulmonary stenosis, as transannular patching in not precluded. The operative approach is through a standard median sternotomy incision. The right and left pulmonary arteries are mobilized as much as possible and encircled with snares. The arterial duct or ligament is controlled and divided.
Cardiopulmonary bypass is established using bicaval cannulation and a single aortic cannulation.
The left ventricle is vented via the right superior pulmonary vein. The heart is arrested with an infusion of cold-blood potassium cardioplegia. Completion of mobilization of the branch left and right pulmonary arteries is now made while on cardiopulmonary bypass in a manner analogous to that in the arterial switch operation. The right pulmonary artery is mobilized on the right side of the superior vena cava, and the left pulmonary artery is mobilized well past the left atrial appendage and fold of Marshall. Both arteries are mobilized well past the take-off of their first parenchymal branches.