Back to Search Start Over

Congenitally Corrected Transposition of the Great Arteries: Anatomic, Physiologic Repair, and Palliation

Congenitally Corrected Transposition of the Great Arteries: Anatomic, Physiologic Repair, and Palliation

Authors :
Christopher A. Caldarone
Zachary A. Spigel
Ziyad M. Binsalamah
Source :
Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual. 22:32-42
Publication Year :
2019
Publisher :
Elsevier BV, 2019.

Abstract

Congenitally corrected transposition of the great arteries (ccTGA) is a lesion that rarely occurs in isolation. The presenting physiology of ccTGA is predominantly secondary to the concurrent cardiac lesions; however, as the child ages, unrepaired ccTGA results in progressive failure of the morphologic right ventricle under the strain of maintaining a systemic pressure. Repair of ccTGA was initially focused on rectification of the underlying physiologic aberrations, but in recent years, the focus of repair has shifted toward anatomic correction to avoid failure of the morphologic right ventricle. This anatomic repair is commonly associated with improved long-term mortality at the cost of increased short-term mortality. Key preoperative considerations such as morphologic left ventricular pressure, tricuspid valve competency, and out flow tract obstructions can assist in determining the optimal repair for individual patients. An alternative, single ventricle, pathway has been proposed for any patient without optimal preoperative anatomy to improve long-term survival. Adjunctive repair options including pulmonary artery banding and one-and-a-half ventricle repairs have also been proposed to augment the survival curves.

Details

ISSN :
10929126
Volume :
22
Database :
OpenAIRE
Journal :
Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual
Accession number :
edsair.doi.dedup.....046f6ea9f62f5286c8ca6a3510906f42
Full Text :
https://doi.org/10.1053/j.pcsu.2019.02.008