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Pathologic anatomy of corrected transposition of the great arteries: medical and surgical implications.
Am Heart J 1998; 135(5 Pt 1):772-85AH

Abstract

BACKGROUND

Because the double-switch operation (atrial switch plus arterial switch) has recently become feasible in selected patients with congenitally physiologically corrected transposition of the great arteries, a detailed understanding of the pathologic anatomy is now mandatory for cardiologists, radiologists, and surgeons.

METHODS

A detailed study of the pathologic anatomy, the clinical implications, and the surgical implications was undertaken on 33 postmortem cases with two ventricles. A companion study was also performed of 44 postmortem cases with functionally only one ventricle. Hence this was an investigation of 77 postmortem cases.

RESULTS

Three main anatomic types of corrected transposition of the great arteries (TGA) with two ventricles were found: (1) TGA with solitus atria (S), L-loop ventricles (L), and L-TGA (L), that is, TGA [S,L,L] in 31 cases (94%); (2) TGA with solitus atria (S), L-loop ventricles (L), and D-TGA (D), that is, TGA [S,L,D] in 1 case (3%); and (3) TGA with inverted atria (I), D-loop ventricles (D), and D-TGA (D), that is, TGA [I,D,D] in 1 case (3%). Associated malformations resulted in 13 anatomic subtypes. In classical corrected TGA [S,L,L] with two ventricles, anomalies of the left-sided systemic tricuspid valve were present in 97%, with malformations of the left-sided systemic right ventricle in 91%.

CONCLUSIONS

The findings in corrected TGA with two ventricles and in cases with single ventricle support the view that anatomic repair such as the double-switch procedure, or left-sided right ventricle bypass such as the modified Norwood procedure followed by the modified Fontan procedure, is indicated in selected patients.

Authors+Show Affiliations

Department of Pathology, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

9588406

Citation

Van Praagh, R, et al. "Pathologic Anatomy of Corrected Transposition of the Great Arteries: Medical and Surgical Implications." American Heart Journal, vol. 135, no. 5 Pt 1, 1998, pp. 772-85.
Van Praagh R, Papagiannis J, Grünenfelder J, et al. Pathologic anatomy of corrected transposition of the great arteries: medical and surgical implications. Am Heart J. 1998;135(5 Pt 1):772-85.
Van Praagh, R., Papagiannis, J., Grünenfelder, J., Bartram, U., & Martanovic, P. (1998). Pathologic anatomy of corrected transposition of the great arteries: medical and surgical implications. American Heart Journal, 135(5 Pt 1), pp. 772-85.
Van Praagh R, et al. Pathologic Anatomy of Corrected Transposition of the Great Arteries: Medical and Surgical Implications. Am Heart J. 1998;135(5 Pt 1):772-85. PubMed PMID: 9588406.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pathologic anatomy of corrected transposition of the great arteries: medical and surgical implications. AU - Van Praagh,R, AU - Papagiannis,J, AU - Grünenfelder,J, AU - Bartram,U, AU - Martanovic,P, PY - 1998/5/20/pubmed PY - 1998/5/20/medline PY - 1998/5/20/entrez SP - 772 EP - 85 JF - American heart journal JO - Am. Heart J. VL - 135 IS - 5 Pt 1 N2 - BACKGROUND: Because the double-switch operation (atrial switch plus arterial switch) has recently become feasible in selected patients with congenitally physiologically corrected transposition of the great arteries, a detailed understanding of the pathologic anatomy is now mandatory for cardiologists, radiologists, and surgeons. METHODS: A detailed study of the pathologic anatomy, the clinical implications, and the surgical implications was undertaken on 33 postmortem cases with two ventricles. A companion study was also performed of 44 postmortem cases with functionally only one ventricle. Hence this was an investigation of 77 postmortem cases. RESULTS: Three main anatomic types of corrected transposition of the great arteries (TGA) with two ventricles were found: (1) TGA with solitus atria (S), L-loop ventricles (L), and L-TGA (L), that is, TGA [S,L,L] in 31 cases (94%); (2) TGA with solitus atria (S), L-loop ventricles (L), and D-TGA (D), that is, TGA [S,L,D] in 1 case (3%); and (3) TGA with inverted atria (I), D-loop ventricles (D), and D-TGA (D), that is, TGA [I,D,D] in 1 case (3%). Associated malformations resulted in 13 anatomic subtypes. In classical corrected TGA [S,L,L] with two ventricles, anomalies of the left-sided systemic tricuspid valve were present in 97%, with malformations of the left-sided systemic right ventricle in 91%. CONCLUSIONS: The findings in corrected TGA with two ventricles and in cases with single ventricle support the view that anatomic repair such as the double-switch procedure, or left-sided right ventricle bypass such as the modified Norwood procedure followed by the modified Fontan procedure, is indicated in selected patients. SN - 0002-8703 UR - https://www.unboundmedicine.com/medline/citation/9588406/Pathologic_anatomy_of_corrected_transposition_of_the_great_arteries:_medical_and_surgical_implications_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002870398002506 DB - PRIME DP - Unbound Medicine ER -