74
Specific Conditions
Table 36. Patients With d-TGA and Atrial Switch: Routine
Testing and Follow-Up 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
N/A 12–24
12
3–6
Electrocardiogram N/A 12–24
12 12
Transthoracic
echocardiogram
N/A 12–24
12 12
For recommendations on routine Holter monitoring, see supportive text for recommendation #6.
For recommendations about timing of CMR, 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.
ACHD indicates adult congenital heart disease; CMR, cardiovascular magnetic resonance;
d-TGA, dextro-transposition of the great arteries; and N/A, not applicable.
4.4.1.2. Arterial Switch Operation
COR LOE
Recommendations
Diagnostic
1 B-NR
1. In adults with an arterial switch operation, baseline and serial
imaging with both echocardiography and CMR imaging
should be performed periodically to assess neoaortic size,
valve function, PA or branch PA morpholog y, and ventricular
function.
1 C-LD
2. In adults with an arterial switch operation and symptoms
concerning for myocardial ischemia, coronary evaluation
with coronary angiography, cross-sectional imaging, and/
or functional coronary assessment for an anatomic etiolog y
should be performed.
2a B-NR
3. In asymptomatic adults with an arterial switch operation,
baseline anatomic assessment of coronary artery anatomy and
patency with gated cardiac CT is reasonable to evaluate for
postoperative complications and/or high-risk features.
erapeutic
1 C-EO
4. In adults with an arterial switch operation and evidence of
myocardial ischemia, coronary revascularization should be
performed to reduce symptoms and improve outcomes.
2a C-EO
5. In adults with an arterial switch operation and symptoms
attributable to moderate or greater supravalvar or branch PA
stenosis, intervention is reasonable to improve symptoms and
functional class.
