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Management considerations in the adult with surgically modified d-transposition of the great arteries
  1. Lasya Gaur1,
  2. Ari Cedars2,
  3. Gerhard Paul Diller3,
  4. Shelby Kutty1,
  5. Stefan Orwat3
  1. 1 Pediatrics, Division of Pediatric Cardiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
  2. 2 Division of Adult Congenital Cardiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
  3. 3 Department of Cardiology and Angiology, Adult Congenital and Valvular Heart Disease Center, University Hospital Muenster, Muenster, Germany
  1. Correspondence to Dr Lasya Gaur, Pediatrics, Division of Pediatric Cardiology, Johns Hopkins Hospital, Baltimore, MD 21287, USA; lgaur1{at}


Dextro-transposition of the great arteries (D-TGA) has undergone a significant evolution in surgical repair, leading to survivors with vastly different postsurgical anatomy which in turn guides their long-term cardiovascular morbidity and mortality. Atrial switch repair survivors are limited by a right ventricle in the systemic position, arrhythmia and atrial baffles prone to obstruction or leak. Functional assessment of the systemic right ventricle is complex, requiring multimodality imaging to include specialised echocardiography and cross-sectional imaging (MRI and CT). In the current era, most neonates undergo the arterial switch operation with increasing understanding of near-term and long-term outcomes specific to their cardiac anatomy. Long-term observations of the Lecompte manoeuvre or coronary stenoses following transfer continue, with evolving understanding to improve surveillance. Ultimately, an understanding of postsurgical anatomy, specialised imaging techniques and interventional and electrophysiological procedures is essential to comprehensive care of D-TGA survivors.

  • congenital abnormalities
  • transposition of great vessels
  • heart defects
  • congenital

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  • Correction notice Since this article was published Online First, a typographical error in the Abstract has been corrected from 'arterial' to 'atrial'.

  • Contributors LG and SO drafted the manuscript. AC made critical contributions and revisions. SK and GPD made critical revisions. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; internally peer reviewed.