ACC/AHA recommendations for surgical intervention in 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]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [4]

Overview

ACC/AHA recommends different surgical options for patients with congenitally corrected/Levo-transposition of the great arteries

(ACC/AHA) recommendations for surgical intervention in patients with congenitally corrected transposition of the great arteries (CCTGA) [1](DONOT EDIT)

Class I

1. Surgeons with training and expertise in CHD should perform operations for patients with CCTGA for the following indications:

1. Unrepaired CCTGA and severe atrioventricular (AV) valve regurgitation. (Level of Evidence: B)
2. Anatomic repair with atrial and arterial level switch/Rastelli repair in cases in which the left ventricle is functioning at systemic pressures. (Level of Evidence: B)
3. Simple ventricular septal defect (VSD) closure when the VSD is not favorable for left ventricular (LV)-to-aorta baffling or is restrictive. (Level of Evidence: B)
4. LV–to–pulmonary artery conduit in rare cases with LV dysfunction and severe LV outflow obstruction. (Level of Evidence: B)
5. Evidence of moderate or progressive systemic AV valve regurgitation. (Level of Evidence: B)
6. Conduit obstruction with systemic or nearly systemic right ventricular (RV) pressures and/or RV dysfunction after anatomic repair. (Level of Evidence: B)
7. Conduit obstruction and systemic or suprasystemic LV pressures in a patient with nonanatomic correction. (Level of Evidence: B)
8. Moderate or severe aortic regurgitation (AR)/neo-AR and onset of ventricular dysfunction or progressive ventricular dilatation. (Level of Evidence: B)

For ACC/AHA Level of evidence and classes click:ACC AHA Guidelines Classification Scheme

References

  1. Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). "ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (23): e1–121. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.