Sections

Surgical Approach to Corrected Transposition of the Great Arteries

Sections Surgical Approach to Corrected Transposition of the Great Arteries
Overview
Workup
Treatment
Media Gallery
References

Workup

Imaging Studies

Chest radiography

An anteroposterior chest radiograph often reveals the characteristic features, including a straightened upper left heart border caused by the side-by-side great arteries instead of the aorta and the pulmonary arteries twisting around each other, as is observed normally. Cardiomegaly may be observed if associated conditions such as ventricular septal defect (VSD) or tricuspid regurgitation are present. See the image below.

Surgical Approach to Corrected Transposition of the Great Arteries. An anteroposterior chest radiograph reveals the straightened left heart border formed by the aorta, which is more leftward and anterior than usual.

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Echocardiography

Relatively recent advances in the technology of Doppler echocardiography make noninvasively diagnosing this condition possible and allows for great accuracy, not only postnatally but also using fetal echocardiography. Two important, suggested clues have been the presence of a left-sided ventricle with a moderator band and an abnormal parallel orientation of the great arteries.^[27]

Because dextrocardia is present in 25% of these patients, the position of the heart within the thorax should be initially determined. All standard views are essential to assess the atrial and ventricular morphology in detail and to look for the commonly associated malformations.

See the images below.

Surgical Approach to Corrected Transposition of the Great Arteries. A transthoracic echocardiogram in the apical four-chamber view illustrates the moderator band in the left-sided ventricle and the apically displaced left atrioventricular valve, suggesting that it is the morphologic right ventricle.

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Surgical Approach to Corrected Transposition of the Great Arteries. A transthoracic echocardiogram in the parasternal short axis view demonstrates the anterior and leftward aorta. The left coronary artery can be observed at the 10-o'clock position.

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Other Tests

Electrocardiography (ECG) may provide the most significant clue of this condition. The presence of Q waves over the right precordium (because of reverse septal depolarization) with absent Q waves over the lateral precordium in the absence of other criteria for right ventricular hypertrophy should suggest this defect.

Diagnostic Procedures

Angiocardiography is no longer required for the diagnosis because echocardiographic findings are diagnostic. Real danger of causing complete heart block exists during this procedure because the atrioventricular (AV) bundle is located on the left ventricular side of the septum, and because the left ventricle is connected to the right atrium, it is in the direct path of a catheter in a right heart catheterization.^[19]

Treatment & Management

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Media Gallery

Surgical Approach to Corrected Transposition of the Great Arteries. A 12-lead electrocardiogram demonstrates the characteristic features of corrected transposition Q waves in III, in aVF, and in the right precordial leads.
Surgical Approach to Corrected Transposition of the Great Arteries. An anteroposterior chest radiograph reveals the straightened left heart border formed by the aorta, which is more leftward and anterior than usual.
Surgical Approach to Corrected Transposition of the Great Arteries. A transthoracic echocardiogram in the apical four-chamber view illustrates the moderator band in the left-sided ventricle and the apically displaced left atrioventricular valve, suggesting that it is the morphologic right ventricle.
Surgical Approach to Corrected Transposition of the Great Arteries. A transthoracic echocardiogram in the parasternal short axis view demonstrates the anterior and leftward aorta. The left coronary artery can be observed at the 10-o'clock position.

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Author

Prema Ramaswamy, MD Associate Professor of Clinical Pediatrics, New York University; Adjunct Associate Clinical Professor of Pediatrics, St George’s University School of Medicine; Co-Director of Pediatric Cardiology, Maimonides Infants and Children's Hospital of Brooklyn, Lutheran Medical Center, and Coney Island Hospital

Prema Ramaswamy, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology

Disclosure: Nothing to disclose.

Coauthor(s)

Khanh Nguyen, MD Assistant Professor, Department of Cardiothoracic Surgery, Mount Sinai School of Medicine; Chief of Pediatric Cardiac Surgery, Department of Surgery, Mount Sinai Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

John Myers, MD Director, Pediatric and Congenital Cardiovascular Surgery, Departments of Surgery and Pediatrics, Professor, Penn State Children's Hospital, Milton S Hershey Medical Center

John Myers, MD is a member of the following medical societies: American Association for Thoracic Surgery, American College of Cardiology, American College of Surgeons, American Heart Association, American Medical Association, Congenital Heart Surgeons Society, Pennsylvania Medical Society, Society of Thoracic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Suvro S Sett, MD, FRCSC, FACS Professor of Surgery, Dalhousie University Faculty of Medicine; Head, Division of Pediatric Cardiac Surgery, Izaak Walton Killam Hospital for Children, Canada

Suvro S Sett, MD, FRCSC, FACS is a member of the following medical societies: American College of Surgeons, Congenital Heart Surgeons Society, Western Thoracic Surgical Association

Disclosure: Nothing to disclose.

Additional Contributors

Daniel S Schwartz, MD, MBA, FACS Medical Director of Thoracic Oncology, St Catherine of Siena Medical Center, Catholic Health Services

Daniel S Schwartz, MD, MBA, FACS is a member of the following medical societies: American College of Chest Physicians, American College of Surgeons, Society of Thoracic Surgeons, Western Thoracic Surgical Association

Disclosure: Nothing to disclose.

Sections Surgical Approach to Corrected Transposition of the Great Arteries
Overview
Workup
Treatment
Media Gallery
References

Surgical Approach to Corrected Transposition of the Great Arteries Workup

Imaging Studies

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Echocardiography

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