Levo-transposition of the great arteries natural history, complications and prognosis

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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]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [5]

Overview

The prognosis on simple levo-TGA depends mainly on the presence of cardiac shunts such as fossa ovalis, atrial septal defect, ventricular septal defect, and ductus arteriosus. With complex l-TGA, the infant will fail to thrive and is unlikely to survive longer than a year if corrective surgery is not performed.

Natural History, Complications and Prognosis

Simple l-TGA

• The prognosis on simple l-TGA depends mainly on the presence of cardiac shunts such as fossa ovalis, atrial septal defect, ventricular septal defect, and ductus arteriosus.
• If one or more of these defects are present, blood will be mixed, allowing a small amount of oxygen to be delivered to the body, giving an opportunity to the newborn to survive long enough to receive corrective surgery.
• With simple l-TGA, if the foramen ovale and ductus arteriosus are allowed to close naturally, the newborn will likely not survive long enough to receive corrective surgery.
• While the foramen ovale and ductus arteriosus are open after birth, some mixing of red and blue blood occurs allowing a small amount of oxygen to be delivered to the body; if ASD, VSD, PFO, and/or PDA are present, this will allow a higher amount of the red and blue blood to be mixed, therefore delivering more oxygen to the body, but can complicate and lengthen the corrective surgery and/or be symptomatic.

Complex

• With complex l-TGA, the infant will fail to thrive and is unlikely to survive longer than a year if corrective surgery is not performed.
• Generally, if the defect (levo-TGA) is not corrected during the first year of life, the patient's condition will deteriorate to the point of inoperability.
• Modern repair procedures within the ideal time-frame and without additional complications have a very high success rate.