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Published on: January 27, 2023
Complete Transposition of the Great Arteries in the Pediatric Field: A Multimodality Imaging Approach
Sara Moscatelli1,2,3, Martina Avesani4, Nunzia Borrelli5
1Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK.
Insights
Early detection of complete transposition of the great arteries (C-TGA) relies on multimodal imaging. Integrating fetal echocardiography, TTE, CMR, and CCT improves diagnosis and patient outcomes.
Area of Science:
- Cardiology
- Medical Imaging
- Pediatrics
Background:
- Complete transposition of the great arteries (C-TGA) is a critical congenital heart defect requiring timely diagnosis.
- Optimal outcomes depend on early detection and precise management strategies.
Purpose of the Study:
- To review the role of multimodal imaging in diagnosing and managing C-TGA.
- To highlight the benefits of integrating various imaging modalities for C-TGA patient care.
Main Methods:
- Review of current literature on imaging techniques for C-TGA.
- Emphasis on fetal echocardiography, transthoracic echocardiography (TTE), cardiovascular magnetic resonance (CMR), and cardiac computed tomography (CCT).
Main Results:
- Fetal echocardiography enables prenatal detection, though detection rates vary.
- TTE is essential for initial diagnosis, surgical planning, and postoperative assessment.
- CMR and CCT provide complementary anatomical and functional information, crucial for complex cases and coronary assessment.
Conclusions:
- A multimodal imaging approach integrating TTE, CMR, and CCT is vital for accurate C-TGA diagnosis and management.
- This integrated strategy enhances therapeutic guidance and long-term patient monitoring.
- Improved diagnostic accuracy through multimodal imaging leads to better patient care and prognoses for C-TGA.
Abstract:
The complete transposition of the great arteries (C-TGA) is a congenital cardiac anomaly characterized by the reversal of the main arteries. Early detection and precise management are crucial for optimal outcomes. This review emphasizes the integral role of multimodal imaging, including fetal echocardiography, transthoracic echocardiography (TTE), cardiovascular magnetic resonance (CMR), and cardiac computed tomography (CCT) in the diagnosis, treatment planning, and long-term follow-up of C-TGA. Fetal echocardiography plays a pivotal role in prenatal detection, enabling early intervention strategies. Despite technological advances, the detection rate varies, highlighting the need for improved screening protocols. TTE remains the cornerstone for initial diagnosis, surgical preparation, and postoperative evaluation, providing essential information on cardiac anatomy, ventricular function, and the presence of associated defects. CMR and CCT offer additional value in C-TGA assessment. CMR, free from ionizing radiation, provides detailed anatomical and functional insights from fetal life into adulthood, becoming increasingly important in evaluating complex cardiac structures and post-surgical outcomes. CCT, with its high-resolution imaging, is indispensable in delineating coronary anatomy and vascular structures, particularly when CMR is contraindicated or inconclusive. This review advocates for a comprehensive imaging approach, integrating TTE, CMR, and CCT to enhance diagnostic accuracy, guide therapeutic interventions, and monitor postoperative conditions in C-TGA patients. Such a multimodal strategy is vital for advancing patient care and improving long-term prognoses in this complex congenital heart disease.
