الفهرس 
Introduction
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Abstract
D-transposition of the great arteries (D-TGA) is a ventriculoarterial discordant lesion, in which the aorta arises from the right ventricle and the pulmonary artery from the left ventricle. The anatomical defect of D-TGA leads to cyanotic heart disease as a result of two parallel circulations. The first sends deoxygenated systemic venous blood to the right atrium and back to the systemic circulation via the right ventricle and aorta, and the second sends oxygenated pulmonary venous blood to the left atrium and back to the lungs via the left ventricle and pulmonary artery.
The survival of patients with D-TGA has dramatically improved from a uniformly fatal disease with introduction of prostaglandin (alprostadil) therapy and balloon atrial septostomy (BAS), and the continued evolution of surgical palliation.
If a prenatal diagnosis of D-TGA is made or suspected, we recommend a maternal transport to a facility that has expertise in managing neonates with cyanotic congenital heart disease including D-TGA. If this is not possible, consultation with a pediatric cardiologist prior to transport is necessary to ensure optimal medical management before and during the transfer.
Initial postnatal management is focused on stabilization of cardiac and pulmonary function and ensuring adequate systemic oxygenation. Therapy is directed towards providing sufficient intercirculatory mixing between the two circulatory systems by maintaining patency of the ductus arteriosus.
We recommend prostaglandin E1 (alprostadil) infusion (0.05 mcg/kg per minute) in all patients with D-TGA to maintain patency of the ductus arteriosus until adequate mixing is achieved either through BAS or surgical intervention
In patients with severe hypoxemia, we recommend BAS to improve systemic oxygenation by providing adequate intercirculatory mixing
We recommend early surgical correction for all patients with D-TGA. In patients with simple D-TGA, we recommend the arterial switch operation (ASO) in the first 2 weeks of life. Preoperative corticosteroid carries no extra benefit for the patients prolonged ischemic time and bypass time carry a big risk for unfavourable outcome. So competent surgeon and improvement of the surgical techniques play a major role to minimize both ischemic and bypass time and also as regarding coronary artery button translocation which resulted in better outcome.
The early mortality of ASO is low, with also low morbidity incidence in the most of D TGA forms. Later complications of the ASO include pulmonary artery stenosis, coronary artery insufficiency, neo-aortic root dilation, and neo-aortic regurgitation. It remains unknown what effect atherosclerotic disease of the coronaries will have on patients who underwent ASO, and these patients require long-term follow-up.
Long-term follow-up care is necessary because of the potential for developing clinically significant complications following surgical repair. It entails a focused history and physical examination, and testing that includes imaging (usually echocardiography), electrocardiography, and angiography, and monitoring for atherosclerotic disease.
Long-term survival is excellent following surgical repair with >90 percent survival after 20 years following ASO repair. But there is an accepted incidence of morbidities.
Although patients following ASO have a slightly reduced exercise capacity, this does not typically restrict their daily level of activity.