Transposition of the great vessels other diagnostic studies

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3]; Keri Shafer, M.D. [4]; Kristin Feeney, B.S. [5]

Overview

Cardiac catheterization is not frequently done to diagnose transposition of the great vessels, as it could be done confidently with echocardiography. It is in conditions when the echo findings are inconclusive. It can be used to determine the coronary anatomy. Cardiac catheterization can also be used as interventional while performing balloon atrial septostomy. This operation helps to increase mixing between the two circulatory systems.

Other Diagnostic Studies

Cardiac catheterization

Diagnostic

Cardiac catheterization is not frequently done to diagnose transposition of the great vessels, as it could be done confidently with echocardiography. It is in conditions when the echo findings are inconclusive. It can be used to determine the coronary anatomy.

Interventional

Used while performing balloon atrial septostomy. This operation helps to increase mixing between the two circulatory systems.

ACC/AHA Guideline:Recommendation for Diagnostic Catheterization for Adults With Repaired Dextro-Transposition of the Great Arteries (DO NOT EDIT)^[1]

Class I
“1. *Diagnostic catheterization of the adult with d-TGA should be performed in centers with expertise in the catheterization and management of ACHD patients.(Level of Evidence: C) ”

Class IIa
“1. For adults with d-TGA after atrial baffle procedure (Mustard or Senning), diagnostic catheterization can be beneficial to assist in the following: Hemodynamic assessment.(Level of Evidence: C) Assessment of baffle leak.(Level of Evidence: B) Assessment of superior vena cava or inferior vena cava pathway obstruction.(Level of Evidence: B) Assessment of pulmonary venous pathway obstruction.(Level of Evidence: B) Suspected myocardial ischemia or unexplained systemic RV dysfunction.(Level of Evidence: B) Significant left ventricular (LV) outflow obstruction at any level (LV pressure greater than 50% of systemic levels, or less in the setting of right ventricular [RV] dysfunction).(Level of Evidence: B) Assessment of pulmonary arterial hypertension (PAH), with potential for vasodilator testing.(Level of Evidence: C) “
“1. For adults with d-TGA, ventricular septal defect (VSD), and pulmonary stenosis (PS), after Rastelli-type repair, diagnostic catheterization can be beneficial to assist in the following: Coronary artery delineation before any intervention for right ventricular outflow tract (RVOT) obstruction.(Level of Evidence: C) Assessment of residual VSD.(Level of Evidence: C) Assessment of PAH, with potential for vasodilator testing.(Level of Evidence: C) Assessment of subaortic obstruction across the left ventricle-to-aorta tunnel.(Level of Evidence: C) “

ACC/AHA Guideline:Recommendations for Interventional Catheterization for Adults with Dextro-Transposition of the Great Arteries (DO NOT EDIT)^[1]

Class IIa
“1.Interventional catheterization of the adult with d-TGA can be performed in centers with expertise in the catheterization and management of ACHD patients.(Level of Evidence: C) For adults with d-TGA after atrial baffle procedure (Mustard or Senning), interventional catheterization can be beneficial to assist in the following: Occlusion of baffle leak. (Level of Evidence: B) Dilation or stenting of superior vena cava or inferior vena cava pathway obstruction.(Level of Evidence: B) Dilation or stenting of pulmonary venous pathway obstruction.(Level of Evidence: B) For adults with d-TGA after ASO, interventional catheterization can be beneficial to assist in dilation or stenting of supravalvular and branch pulmonary artery stenosis.(Level of Evidence: B) For adults with d-TGA, VSD, and PS, after Rastelli-type repair, interventional catheterization can be beneficial to assist in the following: Dilation with or without stent implantation of conduit obstruction (RV pressure greater than 50% of systemic levels, or peak-to-peak gradient greater than 30 mm Hg; these indications may be lessened in the setting of RV dysfunction). (Level of Evidence: C) Device closure of residual VSD.(Level of Evidence: C) “

Electrophysiology Testing

ACC/AHA Guideline:Recommendations for Electrophysiology Testing/Pacing Issues in Dextro-Transposition of the Great Arteries(DO NOT EDIT)^[1]

Class I
“1.Clinicians should be mindful of the risk of sudden arrhythmic death among adults after atrial baffle repair of d-TGA. These events usually relate to ventricular tachycardia (VT) but may be caused in some cases by rapidly conducted intra-atrial reentrant tachycardia (IART) or progressive atrioventricular (AV) block. (Level of Evidence: B) ”
“2.Consultation with an electrophysiologist who is experienced with CHD is recommended to assist with treatment decisions.(Level of Evidence: B) ”
“3.Pacemaker implantation is recommended for patients with d-TGA with either symptomatic sinus bradycardia or sick sinus syndrome. (Level of Evidence: B) ”

Class IIa
“1.Routine surveillance with history, electrocardiogram (ECG), assessment of RV function, and periodic Holter monitoring can be beneficial as part of routine follow-up. (Level of Evidence: B) ”

References

↑ ^1.0 ^1.1 ^1.2 Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). “ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons”. J Am Coll Cardiol. 52 (23): e1–121. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.

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[pmid19038677-1] 1.0 ^1.1 ^1.2 Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). “ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons”. J Am Coll Cardiol. 52 (23): e1–121. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.

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