"Corrected" TGA

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1. Definition

Ventriculo-arterial and atrioventricular discordance

L-TGA - Ao anterior to left of PA = 95%

LV posterior/rightward

RV anterior/leftward

RA to LV to PA

LA to RV to Ao

2. Morphology

No co-existing anomalies = 1%

VSD - Subpulmonary = 85%

Tricuspid valve abnormal = 90%

Significant incompetence = 30%

Left A-V valve

Ebstein's anomaly

Complete heart block = 15%

Pulmonary stenosis = 30-40%

Mitral - pulmonary valve continuity

3. Clinical Presentation/Diagnosis

No specific presentation

Symptoms related to pulmonary blood flow

Diagnosis by echo and catheterization

MRI evolving use

4. Treatment

Physiologic Repair

VSD closure

Relief of pulmonary stenosis

AV valve repair or replacement

5. VSD Closure (2 - 4 years)

Conduction system anterior to PV

Through RA

Through aortic valve

Through LV rarely

A-V Valve Anatomy
Graft Placement

6. Repair of Pulmonary Stenosis

Conduction system anterior to PV

LV to PA valve conduit

Posterior spiral trans-annular patch

Posterior Spiral Patch
Completed Repair

7. AV Valve

Repair may not be feasible

Ring annuloplasty for Ebstein's

Valve replacement via LA

8. Results

Operative mortality 10-20%

Iatrogenic heart block 10-30%

Survival 50-70% at 5 years

Reoperation 20-30% at 5 years

Late left AV valve insufficiency

Late RV failure common

9. Anatomic Repair

"Double Switch Procedure"

Atrial Switch (Senning or Mustard)

Arterial Switch or Rastelli Repair

Results preliminary - 10% operative mortality

Long term result unknown

Systemic LV

Completed Procedure
Flow Following Procedure

CTSNet

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