Transposition of the great vessels medical therapy

Transposition of the great vessels Microchapters
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Dextro-transposition of the great arteries
L-transposition of the great arteries
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3]; Keri Shafer, M.D. [4]; Kristin Feeney, B.S. [5]

Overview

Surgery is the mainstay of treatment for TGA. However, infusion of PGE1 to a newborn diagnosed with TGA is recommended as it prevents the ductus arteriosus from closing, therefore providing an additional shunt through which to provide the systemic circulation with a higher level of oxygen.

Medical Therapy

Surgery is the mainstay of treatment for TGA. However, infusion of PGE1 to a newborn diagnosed with TGA is recommended as it prevents the ductus arteriosus from closing, therefore providing an additional shunt through which to provide the systemic circulation with a higher level of oxygen.

• Prostaglandins (PGE)
  • Prevents the ductus arteriosus from closing, therefore providing an additional shunt through which to provide the systemic circulation with a higher level of oxygen.
• Antibiotics
  • Antibiotics may be administered preventively. However, due to the physical strain caused by uncorrected d-TGA, as well as the potential for introduction of bacteria via arterial and central lines, infection is not uncommon in pre-operative patients.
• Diuretics
  • Diuretics aid in flushing excess fluid from the body, thereby easing strain on the heart.
• Analgesics
  • Analgesics normally are not used pre-operatively, but they may be used in certain cases. They are occasionally used partially for their sedative effects.
• Cardiac glycosides
  • Cardiac glycosides are used to maintain proper heart rhythm while increasing the strength of each contraction.
• Sedatives
  • Sedatives may be used palliatively to prevent a young child from thrashing about or pulling out any of their lines.

Life Style Modifications

Patients with transposition of the great arteries and a large ventricular septal defect who have not undergone repair may require certain life style modifications to control symptoms which include:

• Increased caloric density during infancy (particularly if they have significant congestive heart failure and poor weight gain).
  • Following definitive repair, most patients do not need a special diet.

• Specific activity restrictions are dependent on the patient's residual hemodynamic abnormalities.
• Following the arterial switch procedure, exercise stress testing is necessary in older patients who are interested in participating in competitive sports.

2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Therapeutic Recommendations for d-TGA With Atrial Switch

Class I

1.GDMT with appropriate attention to the need for anticoagulation is recommended to promptly restore sinus rhythm for adults with d-TGA with atrial switch repair presenting with atrial arrhythmia.(Level of Evidence: B-NR)