Managing Heart Failure in Transposition of the Great Arteries

Transposition of the great arteries (TGA) is a congenital heart defect that is associated with congestive heart failure, tricuspid regurgitation, and arrhythmias.

This review identifies and critiques the existing methods of assessing and managing TGA with a focus on right ventricular function.

Echocardiography with novel strain methods and cardiac magnetic resonance imaging (MRI) are noninvasive imaging options, with cardiac MRI being the gold standard. Cardiopulmonary stress testing can be used to determine the severity of symptoms. For the medical management of right ventricular dysfunction in TGA, a closely monitored dosage of beta blockers and the concomitant use of diuretics for symptomatic relief have the strongest supporting data. Surgical options for patients with TGA include the insertion of a pacemaker to treat arrhythmias, which are more common in this population, or tricuspid valve replacement to alleviate systemic tricuspid regurgitation. If symptoms in a patient with TGA are not alleviated by these management techniques, more advanced options include the use of an Impella device (Abiomed), the insertion of ventricular assist devices, or orthotopic heart transplant.

Physicians managing patients with TGA should take a multidisciplinary specialist approach to decide which route to pursue (medical or surgical) and when more advanced treatment options are necessary.