Transposition of the great vessels medical therapy

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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

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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

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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.[1][2]

* 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

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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[3]

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### Therapeutic Recommendations for d-TGA With Atrial Switch

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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)

## References

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1. ↑ Unolt M, Putotto C, Silvestri LM, Marino D, Scarabotti A, Valerio M, Caiaro A, Versacci P, Marino B (June 2013). "Transposition of great arteries: new insights into the pathogenesis". Front Pediatr. 1: 11. doi:10.3389/fped.2013.00011. PMC 3860888. PMID 24400257. Vancouver style error: initials (help)
2. ↑ Shah S, Gupta T, Ahmad R (2015). "Managing Heart Failure in Transposition of the Great Arteries". Ochsner J. 15 (3): 290–6. PMC 4569166. PMID 26413006.
3. ↑ Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM; et al. (2019). "2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines". J Am Coll Cardiol. 73 (12): 1494–1563. doi:10.1016/j.jacc.2018.08.1028. PMID 30121240.CS1 maint: Multiple names: authors list (link)

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