Managing the regressed left ventricle in late presenting TGA
Dhananjay Prakash Malankar1, Rajesh Sharma2
1Department of Paediatric Cardiac Surgery, Fortis Paediatric and Congenital Heart Centre, Fortis Hospital, Room No 113, Paediatric Cardiology OPD, Mulund Goregaon Link Road, Mumbai, Maharashtra 400078 India.
Summary
For late-presenting transposition of great arteries (TGA) with a regressed left ventricle (rLV), left ventricular retraining is the most effective treatment. Other methods may offer temporary solutions but ultimately require corrective surgery.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Cardiovascular Physiology
Background:
- The arterial switch operation (ASO) is standard for neonates with transposition of great arteries (TGA).
- Management of late-presenting TGA with intact ventricular septum and regressed left ventricle (rLV) remains debated.
- Left ventricular retraining has emerged as a key strategy for this patient subset.
Purpose of the Study:
- To review the pathophysiology and treatment options for late-presenting TGA with intact ventricular septum and rLV.
- To evaluate the effectiveness of different surgical approaches.
- To inform clinical decision-making for this complex pediatric cardiac condition.
Main Methods:
- Comprehensive literature review utilizing Pubmed and Scopus databases.
- Identification and analysis of studies on pathophysiology and treatment strategies.
- Synthesis of findings to provide a review of the subject.
Main Results:
- Various treatment options exist, including single-stage and multi-stage procedures.
- Most reported outcomes are from small case series with limited mid- or long-term data.
- Left ventricular retraining shows promise as a feasible and effective method.
Conclusions:
- Left ventricular retraining is the most practical and effective approach for late-presenting TGA with rLV.
- Alternative low-risk techniques may be temporary solutions, necessitating future corrective surgery.
- These alternative strategies represent cost-shifting rather than cost-saving measures.
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