Transposition of the great vessels natural History, complications & prognosis: Difference between revisions

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{{CMG}}
{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com]; {{CZ}}; [[User:KeriShafer|Keri Shafer, M.D.]] [mailto:kshafer@bidmc.harvard.edu]; [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@elon.edu]


'''Associate Editors-In-Chief:''' [[User:KeriShafer|Keri Shafer, M.D.]] [mailto:kshafer@bidmc.harvard.edu]; Atif Mohammad, M.D., [[Priyamvada Singh]], [[MBBS]]
==Overview==
If left untreated, over 50 percent of infants with transposition of the great arteries will die in the first month of life. 90 percent will die in the first year. Common complications of TGA include [[congestive heart failure]], [[arrhythmia]], [[pulmonary artery stenosis]] and [[aortic regurgitation]]. The prognosis for patients with TGA is generally excellent following surgical correction with survival rates greater than 90%. Without treatment, 30% of infants die within the first week of life, 50% will die in the first month, 70% will die in the first 6 months and 90% of infants will die before the end of the first year.


===== Prognosis =====
==Natural History==
If left untreated, over 50 percent of infants with transposition of the great arteries will die in the first month of life. 90 percent will die in the first year.


The prognosis on [[simple d-TGA]] depends mainly on the presence of cardiac shunts such as FO, ASD, VSD, and DA. If one or more of these defects are present, blood will be mixed, allowing a small amount of oxygen to be delivered to the body, giving an opportunity to the newborn to survive long enough to receive corrective surgery.  
==Complications==
Common complications of TGA include:<ref name="pmid10995411">{{cite journal |vauthors=Gatzoulis MA, Walters J, McLaughlin PR, Merchant N, Webb GD, Liu P |title=Late arrhythmia in adults with the mustard procedure for transposition of great arteries: a surrogate marker for right ventricular dysfunction? |journal=Heart |volume=84 |issue=4 |pages=409–15 |date=October 2000 |pmid=10995411 |pmc=1729461 |doi=10.1136/heart.84.4.409 |url=}}</ref>


With '''complex d-TGA''', the infant will fail to thrive and is unlikely to survive longer than a year if corrective surgery is not performed. Generally, if the defect (d-TGA) is not corrected during the first year of life, the patient's condition will deteriorate to the point of inoperability.
* [[Congestive heart failure]]
* [[Arrhythmia]]
Modern repair procedures within the ideal timeframe and without additional complications have a very high success rate.
* [[Eisenmenger's syndrome|Eisenmenger syndrome]] (irreversible and progressive pulmonary vascular obstructive disease)
* [[Pulmonary artery stenosis]]
* Coronary artery ostial obstruction ([[coronary ischemia]])
* Rarely can lead to [[supravalvular aortic stenosis]]
* Aortic root dilation
* [[Aortic regurgitation]]


==Prognosis==


With simple d-TGA, if the foramen ovale and ductus arteriosus are allowed to close naturally, the newborn will likely not survive long enough to receive corrective surgery. With complex d-TGA, the infant will fail to thrive and is unlikely to survive longer than a year if corrective surgery is not performed. In most cases, the patient's condition will deteriorate to the point of inoperability  if the defect is not corrected in the first year.
* Without treatment, 30% of infants die within the first week of life, 50% will die in the first month, 70% will die in the first 6 months and 90% of infants will die before the end of the first year.<ref name="pmid12324738">{{cite journal |vauthors=Hutter PA, Kreb DL, Mantel SF, Hitchcock JF, Meijboom EJ, Bennink GB |title=Twenty-five years' experience with the arterial switch operation |journal=J. Thorac. Cardiovasc. Surg. |volume=124 |issue=4 |pages=790–7 |date=October 2002 |pmid=12324738 |doi=10.1067/mtc.2002.120714 |url=}}</ref><ref name="pmid20620718">{{cite journal |vauthors=Tobler D, Williams WG, Jegatheeswaran A, Van Arsdell GS, McCrindle BW, Greutmann M, Oechslin EN, Silversides CK |title=Cardiac outcomes in young adult survivors of the arterial switch operation for transposition of the great arteries |journal=J. Am. Coll. Cardiol. |volume=56 |issue=1 |pages=58–64 |date=June 2010 |pmid=20620718 |doi=10.1016/j.jacc.2010.03.031 |url=}}</ref>
 
*The prognosis for patients with D-TGA is generally excellent following surgical correction with survival rates greater than 90%.
While the foramen ovale and ductus arteriosus are open after birth, some mixing of red and blue blood occurs allowing a small amount of oxygen to be delivered to the body; if ASD, VSD, PFO, and/or PDA are present, this will allow a higher amount of the red and blue blood to be mixed, therefore delivering more oxygen to the body, but can complicate and lengthen the corrective surgery and/or be [[symptomatic]].
*The ASO has the best long-term survival and functional outcome.
 
*Studies have reported a >95% rate survival at fifteen to twenty-five years following discharge.
Modern repair procedures within the ideal timeframe and without additional complications have a very high success rate.
*The prognosis on [[simple d-TGA]] depends mainly on the presence of cardiac shunts such as FO, ASD, VSD, and DA.
 
**Presence of one or more of the above mentioned defects are present, blood will be mixed, allowing a small amount of oxygen to be delivered to the body, giving an opportunity to the newborn to survive long enough to receive corrective surgery.


==References==
==References==
{{reflist|2}}
{{reflist|2}}


==Acknowledgements and Initial Contributors to Page==
[[Category:Needs content]]
Leida Perez, M.D.
[[Category:Cardiology]]
[[Category:Disease]]
[[Category:Needs content]]


==External links==
*[http://www.kumc.edu/instruction/medicine/pedcard/cardiology/pedcardio/dtgadiagram.gif Diagram at kumc.edu]
*[http://www.med.umich.edu/cvc/mchc/partran.htm Diagram and description at umich.edu]
*[http://www.pediheart.org/practitioners/defects/ventriculoarterial/l-TGA.htm Overview at pediheart.org]
*[http://www.rch.org.au/cardiology/defects.cfm?doc_id=5098 Royal Children's Hospital, Melbourne]
*[http://www.mayoclinic.org/corrected-transposition-great-arteries Mayo Clinic, Arizona - Florida - Minnesota, USA]
[[fr:Transposition des gros vaisseaux]]
[[nl:Transpositie van de grote vaten]]
[[zh:大血管轉位]]
[[Category:DiseaseState]]
[[Category:Cardiology]]
[[Category:Congenital heart disease]]


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Latest revision as of 17:58, 21 February 2020

Transposition of the great vessels Microchapters

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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

If left untreated, over 50 percent of infants with transposition of the great arteries will die in the first month of life. 90 percent will die in the first year. Common complications of TGA include congestive heart failure, arrhythmia, pulmonary artery stenosis and aortic regurgitation. The prognosis for patients with TGA is generally excellent following surgical correction with survival rates greater than 90%. Without treatment, 30% of infants die within the first week of life, 50% will die in the first month, 70% will die in the first 6 months and 90% of infants will die before the end of the first year.

Natural History

If left untreated, over 50 percent of infants with transposition of the great arteries will die in the first month of life. 90 percent will die in the first year.

Complications

Common complications of TGA include:[1]

Prognosis

  • Without treatment, 30% of infants die within the first week of life, 50% will die in the first month, 70% will die in the first 6 months and 90% of infants will die before the end of the first year.[2][3]
  • The prognosis for patients with D-TGA is generally excellent following surgical correction with survival rates greater than 90%.
  • The ASO has the best long-term survival and functional outcome.
  • Studies have reported a >95% rate survival at fifteen to twenty-five years following discharge.
  • The prognosis on simple d-TGA depends mainly on the presence of cardiac shunts such as FO, ASD, VSD, and DA.
    • Presence of one or more of the above mentioned defects are present, blood will be mixed, allowing a small amount of oxygen to be delivered to the body, giving an opportunity to the newborn to survive long enough to receive corrective surgery.

References

  1. ↑ Gatzoulis MA, Walters J, McLaughlin PR, Merchant N, Webb GD, Liu P (October 2000). "Late arrhythmia in adults with the mustard procedure for transposition of great arteries: a surrogate marker for right ventricular dysfunction?". Heart. 84 (4): 409–15. doi:10.1136/heart.84.4.409. PMC 1729461. PMID 10995411.
  2. ↑ Hutter PA, Kreb DL, Mantel SF, Hitchcock JF, Meijboom EJ, Bennink GB (October 2002). "Twenty-five years' experience with the arterial switch operation". J. Thorac. Cardiovasc. Surg. 124 (4): 790–7. doi:10.1067/mtc.2002.120714. PMID 12324738.
  3. ↑ Tobler D, Williams WG, Jegatheeswaran A, Van Arsdell GS, McCrindle BW, Greutmann M, Oechslin EN, Silversides CK (June 2010). "Cardiac outcomes in young adult survivors of the arterial switch operation for transposition of the great arteries". J. Am. Coll. Cardiol. 56 (1): 58–64. doi:10.1016/j.jacc.2010.03.031. PMID 20620718.


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