Senning repair

Case contributed by Dr Matt A. Morgan


History of congenital heart disease, treated as an infant. Mostly asymptomatic with occasional sharp exertional chest pain.

Patient Data

Age: 35 years
Gender: Male

Axial sequence demonstrating a Senning repair for transposition of the great arteries.  Instead of switching the circulation at the level of the arteries (arterial switch procedure), the circulation is switched at the level of the atria.

Note how the aorta arises anteriorly (as with transposition) and how the right ventricle has become thicker and trabeculated, assuming the morphology of the left ventricle.

Oxygenated blood flow (red arrow); deoxygenated blood flow from the SVC and IVC (blue arrow). The green arrow points to the baffle formed from the right atrial free wall and atrial septal flap.


Coronal view of the same case. Typically in transposition, systemic deoxygenated blood flows toward the tricuspid valve, enters the right ventricle, and then is sent out through the transposed aorta; oxygenated blood enters the left atrium, enters the left ventricle, and then is sent out the main pulmonary artery. The systemic and pulmonary circulations are separate.

With the Senning repair, systemic deoxygenated blood flow is redirected to the mitral valve --> left ventricle --> main pulmonary artery.

Case Discussion

The Senning repair is one of two "atrial switch" procedures used to functionally correct transposition of the great arteries (the other being the Mustard repair). 

The two share a similar fundamental principle.  Systemic blood flow is redirected away from the RV and toward the LV.  Essentially "two wrongs make a right."

The main adverse effect of these atrial switch procedures is arrhythmia.  During creation of the baffle and redirected atrial flow, the sinoatrial node is often injured. The Senning repair has a lower rate of arrhythmia than the Mustard repair, but the arterial switch procedure is now preferred to correct transposition, partly to avoid this complication.

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