Contemporary management and outcomes in congenitally corrected transposition of the great arteries.
Congenitally corrected transposition of the great arteries (ccTGA) can occur in isolation, or in combination with other structural cardiac anomalies, most commonly ventricular septal defect, pulmonary stenosis and tricuspid valve disease. Clinical recognition can be challenging, so echocardiography is often the means by which definitive diagnosis is made. The tricuspid valve and right ventricle are on the systemic arterial side of the ccTGA circulation, and are therefore subject to progressive functional deterioration. The natural history of ccTGA is also greatly influenced by the nature and severity of accompanying lesions, some of which require surgical repair. Some management strategies leave the right ventricle as the systemic arterial pump, but carry the risk of worsening heart failure. More complex 'double switch' repairs establish the left ventricle as the systemic pump, and include an atrial baffle to redirect venous return in combination with either arterial switch or Rastelli operation (if a suitable ventricular septal defect permits). Occasionally, the anatomic peculiarities of ccTGA do not allow straightforward biventricular repair, and Fontan palliation is a reasonable option. Regardless of the approach selected, late cardiovascular complications are relatively common, so ongoing outpatient surveillance should be established in an age-appropriate facility with expertise in congenital heart disease care.
['Kutty|Shelby|S|0000-0001-9428-0979', 'Danford|David A|DA|', 'Diller|Gerhard-Paul|GP|', 'Tutarel|Oktay|O|']
D054537:Atrioventricular Block D013504:Cardiovascular Surgical Procedures D000080041:Congenitally Corrected Transposition of the Great Arteries D003330:Coronary Vessel Anomalies D004452:Echocardiography D006345:Heart Septal Defects, Ventricular D006801:Humans D019028:Magnetic Resonance Imaging, Cine D011183:Postoperative Complications D011666:Pulmonary Valve Stenosis D012127:Respiratory Distress Syndrome, Newborn D059246:Tachypnea D014188:Transposition of Great Vessels D014261:Tricuspid Valve D014694:Ventricular Outflow Obstruction
echocardiography heart failure cardiac magnetic resonance (CMR) imaging complex congenital heart disease congenital heart disease surgery