Patients with palliated congenital heart disease may present later in life for major, non-cardiac surgical procedures. Although alternative surgical techniques are now available for the treatment of the transposition of the great arteries (TGA), an atrial level baffle (Mustard or Senning procedure) was previously performed. Long-term adverse effects of the atrial level switch include myocardial dysfunction, rhythm disturbances requiring pacemaker placement, pulmonary hypertension and baffle obstruction.

We present a 23-year-old woman, who had undergone an atrial level switch during infancy for palliation of TGA and now presents for laparoscopic vertical sleeve gastrectomy for the treatment of obesity.

The long term end-organ effects of an atrial level switch for TGA are reviewed and the perioperative of these patients is discussed.