Main»Corrected Transposition

Corrected Transposition

"Corrected" TGA

1. Definition

A. Ventriculo-arterial and atrioventricular discordance
B. L-TGA - Ao anterior to left of PA = 95%
C. LV posterior/rightward
D. RV anterior/leftward
E. RA to LV to PA
F. LA to RV to Ao

2. Morphology

A. No co-existing anomalies = 1%
B. VSD - Subpulmonary = 85%
C. Tricuspid valve abnormal = 90%
1) Significant incompetence = 30%
2) Left A-V valve
3) Ebstein's anomaly
D. Complete heart block = 15%
E. Pulmonary stenosis = 30-40%
F. Mitral - pulmonary valve continuity

3. Clinical Presentation/Diagnosis

A. No specific presentation
B. Symptoms related to pulmonary blood flow
C. Diagnosis by echo and catheterization
D. MRI evolving use

4. Treatment

A. Physiologic Repair
1) VSD closure
2) Relief of pulmonary stenosis
3) AV valve repair or replacement

5. VSD Closure (2 - 4 years)

A. Conduction system anterior to PV
B. Through RA
C. Through aortic valve
D. Through LV rarely

6. Repair of Pulmonary Stenosis

A. Conduction system anterior to PV
B. LV to PA valve conduit
C. Posterior spiral trans-annular patch

7. AV Valve

A. Repair may not be feasible
B. Ring annuloplasty for Ebstein's
C. Valve replacement via LA

8. Results

A. Operative mortality 10-20%
B. Iatrogenic heart block 10-30%
C. Survival 50-70% at 5 years
D. Reoperation 20-30% at 5 years
E. Late left AV valve insufficiency
F. Late RV failure common

9. Anatomic Repair

A. "Double Switch Procedure"
1) Atrial Switch (Senning or Mustard)
2) Arterial Switch or Rastelli Repair
B. Results preliminary - 10% operative mortality
C. Long term result unknown
1) Systemic LV