With accumulated experience and modification of procedures, the outcome of anatomic repair has improved. One-and-a-half modification of anatomic repair using hemi-Mustard procedure can reduce technical demands. However, anatomic repair has a high risk of morbidity and mortality due to complexity of the procedure, even in high-volume centers. Anatomic repair includes atrial switch (Senning/Mustard) operation plus arterial switch (Janene) operation or Rastelli operation.

Because of disappointing results of physiologic repair, 2), 3), 4) the anatomic repair was developed for improvement of long-term results by restoring the left ventricle (LV) and the mitral valve to the systemic circulation, especially in ccTGA patients with mRV failure or TR.

In physiologic repair, the systemic right ventricle (RV) eventually fails with the time. The classical physiologic (or conventional) repair is directed toward the associated cardiac anomalies, such that the mRV serves as the systemic ventricle and the tricuspid valve (TV) serves as the systemic atrioventircular valve. Systemic ventricular dysfunction can also be caused by volume overload such as tricuspid regurgitation (TR) and associated shunt lesions. Chronic systemic pressure overload increases wall stress in the mRV, which results in myocardial hypertrophy and ischemia, and eventually abnormal regional myocardial function in the third or fourth decade. 1) Although the blood circulation is physiologic because of the combination of duplicated discordances, systemic ventricular dysfunction develops frequently because the systemic circulation is supported by a morphologic right ventricle (mRV). Congenitally corrected transposition of the great arteries (ccTGA) is a rare disease that is characterized by atrioventricular and ventriculoarterial discordance.

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