75
4.4.1.2. Arterial Switch Operation
COR LOE
Recommendations
erapeutic (cont'd)
2a C-EO
6. In asymptomatic adults with an arterial switch operation who
have moderate or greater supravalvar or branch PA stenosis—
in addition to RV hypertension, RV dysfunction, progressive
tricuspid regurgitation, and/or objective decline in exercise
capacity—intervention can be useful to relieve obstruction.
2b B-NR
7. In adults with an arterial switch operation and severe
neoaortic root dilation who have progressive neoaortic
valve insufficiency and/or rapid root growth or for whom
a neoaortic valve intervention is planned, neoaortic root
replacement may be considered to prevent worsening
neoaortic regurgitation.
Table 37. Patients With d-TGA and Arterial Switch: Routine
Follow-Up and Testing Intervals
Type of Follow-Up
or Testing
Physiological
Stage A* (mo)
Physiological
Stage B* (mo)
Physiological
Stage C* (mo)
Physiological
Stage D* (mo)
Outpatient ACHD
cardiologist
12–24 12
6–12
3–6
Electrocardiogram 12–24 12–24
12 6
Transthoracic
echocardiogram
†
12–24 12–24
12 12
For recommendations about timing of cardiac CT and CMR imaging, see supportive text for
recommendations #1–3.
For suggested frequency of CMR imaging,
‡
see supportive text for recommendation #1.
Modified with permission from Stout et al. Copyright © 2018 American Heart Association, Inc.
and American College of Cardiolog y Foundation.
* See Section 2.2 for details on the ACHD anatomic and physiological classification system.
†
Routine transthoracic echocardiography may be further deferred during an interval when CMR
is performed.
‡
CMR should include assessment of neoaortic size, the origin and proximal course of the
coronary arteries, branch pulmonary arteries, ventricular function, and valvular function.
ACHD indicates adult congenital heart disease; CMR, cardiovascular magnetic resonance;
and CT, computed tomography.
(cont'd)
