Congenitally corrected transposition of the great arteries (ccTGA) can occur in isolation, or in combination with other structural cardiac anomalies, most commonly ventricular septal defect, pulmonary stenosis and tricuspid valve disease. Clinical recognition can be challenging, so echocardiography is often the means by which definitive diagnosis is made. The tricuspid valve and right ventricle are on the systemic arterial side of the ccTGA circulation, and are therefore subject to progressive functional deterioration. The natural history of ccTGA is also greatly influenced by the nature and severity of accompanying lesions, some of which require surgical repair. Some management strategies leave the right ventricle as the systemic arterial pump, but carry the risk of worsening heart failure. More complex ‘double switch’ repairs establish the left ventricle as the systemic pump, and include an atrial baffle to redirect venous return in combination with either arterial switch or Rastelli operation (if a suitable ventricular septal defect permits). Occasionally, the anatomic peculiarities of ccTGA do not allow straightforward biventricular repair, and Fontan palliation is a reasonable option. Regardless of the approach selected, late cardiovascular complications are relatively common, so ongoing outpatient surveillance should be established in an age-appropriate facility with expertise in congenital heart disease care.
- cardiac magnetic resonance (CMR) imaging
- congenital heart disease surgery
- complex congenital heart disease
- heart failure
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SK and DAD contributed equally.
Contributors SK drafted the manuscript. DAD, GPD and OT contributed to specific sections and made critical revisions. All authors read and approved the final manuscript.
Competing interests None declared.
Provenance and peer review Commissioned; externally peer reviewed.
Correction notice Since this paper was first published online the affiliation Division of Adult Congenital and Valvular Heart Disease has been updated so its location is listed as Munich not Muenster. In the text the sentence '124 patients suggested lower perioperative morality' should read '124 patients suggested lower perioperative mortality'.