Skip to main content

Advertisement

SpringerLink
Log in

Transposition of the great arteries

  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Opinion statement

  • Transposition of the great arteries (TGA) is a lethal condition without intervention.

  • Cross-sectional echocardiography is the diagnostic investigation of choice.

  • Intravenous infusion of prostaglandin is employed to maintain ductal patency and allow mixing of blood, thus improving tissue oxygenation.

  • Balloon atrial septostomy is recommended once the diagnosis is made.

  • The arterial switch is accepted as the best option for simple TGA.

  • Late follow-up includes survivors of the intra-atrial repair (Mustard and Senning operations), and the emerging cohort of survivors of the arterial switch procedure.

  • Arrhythmia, baffle stenosis, tricuspid valve dysfunction, systemic ventricular dysfunction, and sudden death may occur late during follow-up after the Mustard or Senning procedure.

  • There are less data for late follow-up after arterial switch; however, late death is rare, usually is related to reoperation, and important arrhythmias are uncommon. The long-term fate of the coronary circulation is unknown but coronary arterial obstruction has been reported.

  • Continuing long-term surveillance is essential to detect the development of late problems in all groups of survivors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Baillie M: The morbid anatomy of the most important parts of the human body, edn 2. London: Johnson and Nichol; 1797.

    Google Scholar 

  2. Liebman J, Cullum L, Belloc NB: Natural history of transposition of the great arteries. Anatomy and birth and death characteristics. Circulation 1969, 40:237–262.

    PubMed  CAS  Google Scholar 

  3. Blalock A, Hanlon CR: The surgical treatment of complete transposition of the aorta and the pulmonary artery. Surg Gynaecol Obstet 1950, 90:1.

    CAS  Google Scholar 

  4. Senning A: Surgical correction of transposition of the great vessels. Surgery 1959, 45:966.

    PubMed  CAS  Google Scholar 

  5. Mustard WT, Keith JD, Trusler GA, et al.: The surgical management of transposition of the great vessels. J Thoracic Cardiovasc Surg 1964, 48:953–958.

    CAS  Google Scholar 

  6. Rashkind WJ, Miller WW: Creation of an atrial septal defect without thoracotomy. A palliative approach to complete transposition of the great arteries. JAMA 1966, 196:991–992.

    Article  PubMed  CAS  Google Scholar 

  7. Jatene AD, Fontes VF, Paulista PP, et al.: Successful anatomic correction of transposition of the great vessels. A preliminary report. Arq Bras Cardiol 1975, 28:461–464.

    PubMed  CAS  Google Scholar 

  8. Lecompte Y, Zannini L, Hazan E, et al.: Anatomic correction of transposition of the great arteries. J Thorac Cardiovasc Surg 1981, 82:629–631.

    PubMed  CAS  Google Scholar 

  9. Shinebourne EA, Macartney FJ, Anderson RH: Sequential chamber localization—logical approach to diagnosis in congenital heart disease. Br Heart J 1976, 38:327–340.

    PubMed  CAS  Google Scholar 

  10. Van Praagh R: Terminology of congenital heart disease. Glossary and commentary [editorial]. Circulation 1977, 56:139–143.

    PubMed  Google Scholar 

  11. Anderson RH, Wilkinson JL, Arnold R, et al.: Morphogenesis of bulboventricular malformations. II. Observations on malformed hearts. Br Heart J 1974, 36:948–970.

    PubMed  CAS  Google Scholar 

  12. Anderson RH, Wilkinson JL, Arnold R, Lubkiewicz K: Morphogenesis of bulboventricular malformations. I. Consideration of embryogenesis in the normal heart. Br Heart J 1974, 36:242–255.

    PubMed  CAS  Google Scholar 

  13. Burn J, Brennan P, Little J, et al.: Recurrence risks in offspring of adults with major heart defects: results from first cohort of British collaborative study. Lancet 1998, 351:311–316.

    Article  PubMed  CAS  Google Scholar 

  14. Elliott RB, Starling MB, Neutze JM: Medical manipulation of the ductus arteriosus. Lancet 1975, 1:140–142.

    Article  PubMed  CAS  Google Scholar 

  15. Takeda N, Hiraishi S, Misawa H, et al.: Echocardiographic evaluation of the ductal morphology in patients with refractoriness to lipo-prostaglandin E1 therapy. Pediatr Int 2000, 42:134–138.

    Article  PubMed  CAS  Google Scholar 

  16. Quaegebeur JM, Rohmer J, Brom AG: Revival of the Senning operation in the treatment of transposition of the great arteries. Preliminary report on recent experience. Thorax 1977, 32:517–524.

    Article  PubMed  CAS  Google Scholar 

  17. Gewillig M, Cullen S, Mertens B, et al.: Risk factors for arrhythmia and death after Mustard operation for simple transposition of the great arteries. Circulation 1991, 84(suppl 5):III187-III192.

    PubMed  CAS  Google Scholar 

  18. Deanfield J, Camm J, Macartney F, et al.: Arrhythmia and late mortality after Mustard and Senning operation for transposition of the great arteries. An eight-year prospective study. J Thorac Cardiovasc Surg 1988, 96:569–576.

    PubMed  CAS  Google Scholar 

  19. Paul MH, Wessel HU: Exercise studies in patients with transposition of the great arteries after atrial repair operations (Mustard/Senning): a review. Pediatr Cardiol 1999, 20:49–55.

    Article  PubMed  CAS  Google Scholar 

  20. Reich O, Vorísková M, Ruth C, et al.: Long-term ventricular performance after intra-atrial correction of transposition: left ventricular filling is the major limitation. Heart 1997, 78:376–381. This paper examines ventricular systolic and diastolic function indices in a cohort of patients after intra-atrial repair of TGA, a large subset of whom were also restudied after an interval period. The study documents systemic ventricular dysfunction by radionuceide measurement of ejection fraction, but also identifies left ventricular filling to be the major limitation. This index of ventricular systolic function shows no significant deterioration over a thirteen year period, but left ventricular filling rate deteriorates with time.

    PubMed  CAS  Google Scholar 

  21. Derrick GP, Narang I, White PA, et al.: Failure of stroke volume augmentation during exercise and dobutamine stress is unrelated to load independent indices of right ventricular performance after the Mustard operation. Circulation 2000, in press.

  22. Graham TPJ, Atwood GF, Boucek RJJ, et al.: Abnormalities of right ventricular function following Mustard’s operation for transposition of the great arteries. Circulation 1975, 52:678–684.

    PubMed  Google Scholar 

  23. Hagler DJ, Ritter DG, Mair DD, et al.: Clinical, angiographic, and hemodynamic assessment of late results after Mustard operation. Circulation 1978, 57:1214–1220.

    PubMed  CAS  Google Scholar 

  24. Bull C, Yates R, Sarkar D, et al.: Scientific, ethical, and logistical considerations in introducing a new operation: a retrospective cohort study from paediatric cardiac surgery. BMJ 2000, 320:1168–1173. This article examines the issues surrounding an institutional decision to replace a low risk operation (Senning) with a high-risk operation (arterial switch), based on anticipation of better long-term outlook suggested by detailed actuarial modelling.

    Article  PubMed  CAS  Google Scholar 

  25. Haas F, Wottke M, Poppert H, Meisner H: Long-term survival and functional follow-up in patients after the arterial switch operation. Ann Thorac Surg 1999, 68:1692–1697. This article is one of the first of many expected to be published to describe the mid- and long-term outlook for arterial switch operations performed over a 15-year period.

    Article  PubMed  CAS  Google Scholar 

  26. Daebritz SH, Nollert G, Sachweh JS, et al.: Anatomical risk factors for mortality and cardiac morbidity after arterial switch operation. Ann Thorac Surg 2000, 69:1880–1886.

    Article  PubMed  CAS  Google Scholar 

  27. Imamura M, Drummond-Webb JJ, McCarthy JF, Mee RB: Aortic valve repair after arterial switch operation. Ann Thorac Surg 2000, 69:607–608.

    Article  PubMed  CAS  Google Scholar 

  28. Mavroudis C, Backer CL, Duffy CE, et al.: Pediatric coronary artery bypass for Kawasaki congenital, post arterial switch, and iatrogenic lesions. Ann Thorac Surg 1999, 68:506–512.

    Article  PubMed  CAS  Google Scholar 

  29. Rheuban KS, Kron IL, Bulatovic A: Internal mammary artery bypass after the arterial switch operation. Ann Thorac Surg 1990, 50:125–126.

    Article  PubMed  CAS  Google Scholar 

  30. Kondo C, Nakazawa M, Momma K, Kusakabe K: Sympathetic denervation and reinnervation after arterial switch operation for complete transposition. Circulation 1998, 97:2414–2419.

    PubMed  CAS  Google Scholar 

  31. Yatsunami K, Nakazawa M, Kondo C, et al.: Small left coronary arteries after arterial switch operation for complete transposition. Ann Thorac Surg 1997, 64:746–750.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Grown Up Congenital Heart Unit, The Middlesex Hospital, Goodge Street, 1N 8AA, London, WC, UK

    Graham Derrick BMedSci, BM, BS, MRCP(UK) & Shay Cullen MB, BCH, BAO, MRCP(I), DCH

Authors
  1. Graham Derrick BMedSci, BM, BS, MRCP(UK)
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shay Cullen MB, BCH, BAO, MRCP(I), DCH
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Derrick, G., Cullen, S. Transposition of the great arteries. Curr Treat Options Cardio Med 2, 499–506 (2000). https://doi.org/10.1007/s11936-000-0045-7

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11936-000-0045-7

Keywords

Search

Navigation