Transposition of the great vessels natural History, complications & prognosis
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]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [5]
Overview
Natural History
Complications
Common complications of TGA include:[1]
- Congestive heart failure
- Arrhythmia
- 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
- 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.
- The prognosis for patients with D-TGA is generally excellent following surgical correction.
- Current survival rates are 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.
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.
Modern repair procedures within the ideal timeframe and without additional complications have a very high success rate.
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.
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.
Modern repair procedures within the ideal timeframe and without additional complications have a very high success rate.
References
- ↑ 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.