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Pregnancy and Congenital Heart Disease pp 113–127Cite as

Transposition of the Great Arteries

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Part of the book series: Congenital Heart Disease in Adolescents and Adults ((CHDAA))

Abstract

In patients born with d-loop transposition of the great arteries (d-TGA) rates of survival to adulthood in the contemporary era are excellent. Currently the majority of women of childbearing age with repaired d-TGA are adult survivors of the atrial switch operation. However, there is now a rapidly growing population who have had the arterial switch operation. The two operative techniques differ fundamentally, both in the resulting cardiac anatomy and in resulting cardiac physiology, and hence carry different risks during pregnancy and peripartum. The Rastelli operation is performed in the subset of newborns with d-TGA and concomitant ventricular septal defect and pulmonary stenosis. Depending on the type of repair technique, affected women may have important residual hemodynamic lesions and sequelae, such as ventricular and valve dysfunction, aortic dilatation, conduit dysfunction or arrhythmias, which may increase the risk of maternal and fetal complications during pregnancy, labour and the postpartum period. Arrhythmias and heart failure are the most frequent pregnancy complications in women after the atrial switch operation. Cardiovascular events complicating pregnancies in women after the arterial switch operation or women repaired with the Rastelli procedure are common as well. Therefore, all women with repaired d-TGA should have comprehensive pre-pregnancy assessment and counselling. Patient education about safe and effective contraception and about pregnancy risks should start in adolescence. Prepregnancy assessment should include a detailed evaluation of potentially modifiable conditions that may decrease the risks of pregnancy. An individualized, detailed follow-up plan for care during pregnancy and a detailed, multidisciplinary delivery plan regarding place and mode of delivery and post-partum care including contingency plans to deal with likely and serious complications is mandatory. This plan will take into account the type of repair and type and severity of residual hemodynamic lesions. A multidisciplinary team approach is key to successful outcomes.

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Abbreviations

BNP:

Brain natriuretic peptide

CHD:

Congenital heart disease

d-TGA:

D-loop transposition of the great arteries

FAC:

Fractional area change

LVOTO:

Left ventricular outflow tract obstruction

NR:

Not reported

NYHA:

New York Heart Association

TGA:

Transposition of the great arteries

VSDs:

Ventricular septal defects

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Acknowledgement

We wish to thank Prof. Jack M. Colman for the thorough review of the manuscript.

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Authors and Affiliations

  1. Department of Cardiology, University Hospital Basel, Petersgraben 4, Basel, CH-4031, Switzerland

    Daniel Tobler MD

  2. University Heart Center, Department of Cardiology, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland

    Matthias Greutmann MD

Authors
  1. Daniel Tobler MD
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  2. Matthias Greutmann MD
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Corresponding author

Correspondence to Daniel Tobler MD .

Editor information

Editors and Affiliations

  1. Erasmus MC University Medical Center, Rotterdam, Gelderland, The Netherlands

    Jolien W. Roos-Hesselink

  2. Chelsea and Westminster Hospital, London, United Kingdom

    Mark R. Johnson

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Tobler, D., Greutmann, M. (2017). Transposition of the Great Arteries. In: Roos-Hesselink, J., Johnson, M. (eds) Pregnancy and Congenital Heart Disease. Congenital Heart Disease in Adolescents and Adults. Springer, Cham. https://doi.org/10.1007/978-3-319-38913-4_8

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  • DOI: https://doi.org/10.1007/978-3-319-38913-4_8

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-38911-0

  • Online ISBN: 978-3-319-38913-4

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