ECHO 2013 / Approach to Congenital Heart Disease The Postoperative Adult
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TRANSPOSITION OF THE GREAT ARTERIES
TRANSPOSITION OF THE GREAT ARTERIES
PATHOPHYSIOLOGY
AORTA FROM THE RIGHT
VENTRICLE
PULMONARY ARTERY FROM
THE LEFT VENTRICLE
PARALLEL CIRCULATIONS
REQUIRES MIXING AT ATRIAL,
VENTRICULAR, OR ARTERIAL
LEVEL
TRANSPOSITION OF THE GREAT ARTERIES
PATHOPHYSIOLOGY
Circulation
Series |
Parallel |
TRANSPOSITION OF THE GREAT ARTERIES
ATRIAL LEVEL CORRECTION: MUSTARD/SENNING
Atrial level switch (1954)
SVC and IVC flow directed to left ventricle
Pulmonary vein flow directed right ventricle
Pericardial/prosthetic baffles vs. atrial tissue primary distinction between Mustard and Senning
Gaca et al Radiology 2008
TRANSTHORACIC ECHCOARDIOGRAM
RV/LV size and function
AV valve function
Baffle obstruction or leak
Subpulmonic stenosis Aortic size
ECHOCARDIOGRAM
PULMONARY VENOUS CHANNEL
ECHOCARDIOGRAM
SYSTEMIC VENOUS CHANNEL
TRANSPOSITION OF THE GREAT ARTERIES
ARTERIAL LEVEL CORRECTION:
JATENE/LECOMPTE
Arterial level switch (1975)
Restores the LV as systemic ventricle
Switch coronary arteries to
“neo-aorta.”
Now done in first few days of life
TRANSTHORACIC ECHOCARDIOGRAM
LV/RV function
Branch pulmonary stenosis
Aortic dimension and neoaortic valve function
Brickner et al NEJM 2000
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