Transposition of the Great Arteries

Use transthoracic echocardiography as the decisive initial study in suspected D-TGA to establish ventriculoarterial discordance, define ventricular septal and atrial communications, assess outflow anatomy, ventricular performance, and map coronary features relevant to arterial switch planning. Echocardiography also identifies risk factors that affect operative planning. jaccjaccD-Transposition of the Great Arteries: The Current Era of the Arterial Switch Operation

Treat D-TGA as a neonatal surgical condition rather than a lesion for delayed outpatient decision-making. In simple D-TGA, the arterial switch operation (ASO) is the established anatomic corrective procedure; it transects and switches the great arteries and transfers the coronary arteries to the neo-aortic root. jacc+1jaccD-Transposition of the Great Arteries: The Current Era of the Arterial Switch OperationNatureArterial Switch Operation in Congenital Heart Disease | Surgery | Clinical Sciences | Health sciences | Topics | Nature Index

Separate D-TGA from congenitally corrected TGA (CCTGA) because CCTGA commonly coexists with ventricular septal defect, pulmonary stenosis, or atrial septal defect and has a different longitudinal surgical and ventricular-risk framework. Oxford AcademicOxford AcademicCongenitally corrected transposition of the great arteries: one ...

In an infant with D-TGA and inadequate physiologic mixing, use prostaglandin E1 and/or balloon atrial septostomy (BAS) to improve mixing while preparing for definitive repair. The need is physiologic and anatomic, not automatic: expert review concludes that routine use of either BAS or prostaglandin E1 is not indicated for every patient with simple D-TGA. jaccjaccD-Transposition of the Great Arteries: The Current Era of the Arterial Switch Operation

Escalate to BAS when the atrial communication is restrictive or when clinically inadequate mixing persists despite medical stabilization. BAS is a catheter-based procedure that enlarges an atrial septal communication; its purpose is preoperative stabilization, not definitive correction of ventriculoarterial discordance. NatureNatureArterial Switch Operation in Congenital Heart Disease | Surgery | Clinical Sciences | Health sciences | Topics | Nature Index

Once anatomy and coronary pattern are defined and the infant is stabilized, avoid unnecessary delay to definitive surgery. Early ASO improves outcomes and reduces costs in simple D-TGA, with low operative mortality in the contemporary surgical era. jaccjaccD-Transposition of the Great Arteries: The Current Era of the Arterial Switch Operation

For neonatal D-TGA, ASO is the current surgical treatment of choice and the established corrective operation for ventriculoarterial discordance. The procedure includes transection of the aorta and pulmonary artery, coronary reimplantation into the neo-aortic root, and anatomic realignment of the great vessels. Nature+1NatureArterial Switch Operation in Congenital Heart Disease | Surgery | Clinical Sciences | Health sciences | Topics | Nature IndexAHA JournalsNormal Coronary Flow Reserve After Arterial Switch Operation for ...

The dominant technical and prognostic discriminator is coronary anatomy. Single or intramural coronary arteries remain ASO risk factors, so operative planning and subsequent ischemia surveillance should not treat coronary transfer as a completed issue once the neonatal operation ends. jaccjaccD-Transposition of the Great Arteries: The Current Era of the Arterial Switch Operation

Counsel families that contemporary early mortality in experienced centers is reported below 5%, but survival does not eliminate the need for reintervention surveillance. Late targets include pulmonary or neo-aortic valve stenosis, neo-aortic root dilation, coronary complications, and reoperation. Nature+2NatureArterial Switch Operation in Congenital Heart Disease | Surgery | Clinical Sciences | Health sciences | Topics | Nature IndexScienceDirectTwenty-Three-Year Experience With the Arterial Switch Operation: Expectations and Long-Term Outcomes - ScienceDirectOxford AcademicLong-term outcomes of the arterial switch operation for transposition ...

Adults after ASO need longitudinal assessment in adult congenital heart disease care. Major late concerns are coronary insufficiency and myocardial ischemia, ventricular dysfunction, arrhythmias, stenosis at great-artery anastomoses, and aortic or pulmonary regurgitation. AHA Journals+1AHA Journals2018 AHA/ACC Guideline for the Management of Adults With ...jaccACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Adults With Congenital Heart Disease) Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons

Use echocardiography as the routine structural and functional surveillance tool, then add cardiac CT or MR when echocardiographic acoustic windows are poor or when postoperative great-vessel or coronary anatomy requires more complete definition. CT and MR have an increasing role in the late postoperative period. ScienceDirectScienceDirectTransposition of the Great Vessels — The arterial switch operation, the atrial switch operation, the coronaries - ScienceDirect

Treat new exertional symptoms, arrhythmia, ventricular dysfunction, or unexplained clinical deterioration as a coronary-warning phenotype in a patient with prior ASO. Coronary insufficiency and arrhythmias are uncommon but associated with sudden death; the appropriate response is coronary-focused evaluation rather than reassurance from a remote neonatal repair. jaccjaccD-Transposition of the Great Arteries: The Current Era of the Arterial Switch Operation

Before pregnancy, obtain comprehensive anatomic and functional assessment, including coronary anatomy. Pregnancy is generally well tolerated after ASO when important cardiovascular residua are absent, but this assessment determines whether that assumption applies to the individual patient. jaccjaccACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Adults With Congenital Heart Disease) Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons

Confirm whether the patient underwent ASO, atrial switch (Mustard or Senning), Rastelli-type repair, or another anatomy-specific operation before applying an adult surveillance plan. CT and MR reviews distinguish the differing postoperative anatomy and clinical role of imaging after arterial versus atrial switch procedures. ScienceDirectScienceDirectTransposition of the Great Vessels — The arterial switch operation, the atrial switch operation, the coronaries - ScienceDirect

An ASO survivor has coronary-transfer and neo-aortic/great-vessel surveillance priorities. By contrast, atrial-switch survivors have a systemic morphologic right ventricle, and publications of adult reoperations and long-term outcome analyze these populations separately. ScienceDirect+1ScienceDirectTransposition of the Great Vessels — The arterial switch operation, the atrial switch operation, the coronaries - ScienceDirectScienceDirectReoperations in Adolescents and Adults After Prior Arterial Switch Operation: The Society of Thoracic Surgeons Congenital Heart Surgery Database Analysis - ScienceDirect

For D-TGA with ventricular septal defect and pulmonary stenosis, historical and contemporary Rastelli pathways have distinct conduit and outflow considerations; avoid labeling all repaired TGA as an ASO result. jaccjacc2025 ACC/AHA/HRS/ISACHD/SCAI Guideline for the ... - JACC