Contemporary management and outcomes in congenitally corrected transposition of the great arteries

Heart. 2018 Jul;104(14):1148-1155. doi: 10.1136/heartjnl-2016-311032. Epub 2018 Jan 11.


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.

Keywords: cardiac magnetic resonance (CMR) imaging; complex congenital heart disease; congenital heart disease surgery; echocardiography; heart failure.

Publication types

  • Review

MeSH terms

  • Atrioventricular Block / etiology
  • Cardiovascular Surgical Procedures / adverse effects
  • Congenitally Corrected Transposition of the Great Arteries
  • Coronary Vessel Anomalies / complications
  • Coronary Vessel Anomalies / diagnostic imaging
  • Echocardiography
  • Heart Septal Defects, Ventricular / complications
  • Heart Septal Defects, Ventricular / diagnostic imaging
  • Humans
  • Magnetic Resonance Imaging, Cine
  • Postoperative Complications
  • Pulmonary Valve Stenosis / complications
  • Pulmonary Valve Stenosis / diagnostic imaging
  • Respiratory Distress Syndrome, Newborn / etiology
  • Tachypnea / etiology
  • Transposition of Great Vessels / complications
  • Transposition of Great Vessels / diagnosis*
  • Transposition of Great Vessels / surgery*
  • Tricuspid Valve / abnormalities
  • Tricuspid Valve / diagnostic imaging
  • Ventricular Outflow Obstruction / etiology

Supplementary concepts

  • Congenitally corrected transposition of the great arteries