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Transposition of the great arteries: anatomy, physiology and surgical outcomes today
Elizabeth Carter1, Lindsay S Rogers
1Children's Hospital of Philadelphia, Division of Cardiology, Philadelphia, Pennsylvania, USA.
Insights
Dextro-transposition of the great arteries (d-TGA), a congenital heart defect, now has improved survival rates due to advancements in diagnosis and surgery. Long-term monitoring for coronary insufficiency is crucial for patients after arterial switch repair.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Dextro-transposition of the great arteries (d-TGA) is a common cyanotic congenital heart disease.
- While often diagnosed prenatally, postnatal diagnosis can present with critical symptoms like cyanosis and circulatory collapse.
- General practitioners must be aware of d-TGA patients requiring post-surgical monitoring.
Purpose of the Study:
- To review current understanding and management of d-TGA.
- To highlight the importance of long-term follow-up after surgical repair.
- To address ongoing research in screening for coronary insufficiency and neurodevelopmental outcomes.
Main Methods:
- Review of current literature on d-TGA diagnosis and treatment.
- Analysis of outcomes following the arterial switch operation.
- Discussion of screening protocols for postsurgical complications.
Main Results:
- Advancements in prenatal diagnosis and surgical techniques have significantly reduced mortality rates for d-TGA.
- The arterial switch operation is the standard surgical treatment, with patients now reaching adulthood.
- Ongoing research focuses on managing coronary insufficiency and understanding neurodevelopmental outcomes.
Conclusions:
- Excellent outcomes are now achievable for d-TGA patients due to improved prenatal diagnosis and surgical management.
- Routine cardiology follow-up is essential for screening postsurgical complications, particularly coronary insufficiency.
- Continued research is vital for optimizing long-term care and neurodevelopmental outcomes.
Purpose Of Review:
Dextro-transposition of the great arteries (d-TGA) is a relatively common form of cyanotic congenital heart disease that is not typically associated with chromosomal abnormalities or extracardiac abnormalities. Most cases of d-TGA are prenatally diagnosed, but there are cases of postnatal diagnosis that may present with cyanosis, acidosis and circulatory collapse. It is important for the general practitioner to be familiar with this patient population, as they require continued monitoring for postsurgical complications following surgical repair.
Recent Findings:
The arterial switch operation was introduced in 1975 and is the current surgical treatment for d-TGA. As patients with arterial switch operation reach mid to late adulthood, we continue to explore the best ways to screen for, and treat, coronary insufficiency. Additionally, we are working to understand more about neurodevelopmental outcomes in this population.
Summary:
Advancements in prenatal diagnosis and surgical management of d-TGA have led to excellent outcomes in pre and postoperative mortality. Patients should be screened after surgical repair for complications related to coronary insufficiency with routine cardiology follow up.
