Transposition of the great vessels medical therapy: Difference between revisions
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{{Template:Transposition of the great vessels}} | {{Template:Transposition of the great vessels}} | ||
{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto: | {{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com]; {{CZ}}; [[User:KeriShafer|Keri Shafer, M.D.]] [mailto:kshafer@bidmc.harvard.edu]; [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@elon.edu] | ||
==Overview== | ==Overview== | ||
Surgery is the mainstay of treatment for TGA. However, infusion of PGE1 to a newborn diagnosed with TGA is recommended as it prevents the ductus arteriosus from closing, therefore providing an additional shunt through which to provide the systemic circulation with a higher level of oxygen. | |||
==Medical Therapy== | ==Medical Therapy== | ||
Surgery is the mainstay of treatment for TGA. However, infusion of [[Prostaglandin|PGE1]] to a newborn diagnosed with TGA is recommended as it prevents the [[ductus arteriosus]] from closing, therefore providing an additional shunt through which to provide the systemic circulation with a higher level of [[oxygen]].<ref name="pmid24400257">{{cite journal |vauthors=Unolt M, Putotto C, Silvestri LM, Marino D, Scarabotti A, Valerio Massaccesi, Caiaro A, Versacci P, Marino B |title=Transposition of great arteries: new insights into the pathogenesis |journal=Front Pediatr |volume=1 |issue= |pages=11 |date=June 2013 |pmid=24400257 |pmc=3860888 |doi=10.3389/fped.2013.00011 |url=}}</ref><ref name="pmid26413006">{{cite journal |vauthors=Shah S, Gupta T, Ahmad R |title=Managing Heart Failure in Transposition of the Great Arteries |journal=Ochsner J |volume=15 |issue=3 |pages=290–6 |date=2015 |pmid=26413006 |pmc=4569166 |doi= |url=}}</ref> | |||
*[[Prostaglandin]]s (PGE) | |||
**Prevents the [[ductus arteriosus]] from closing, therefore providing an additional shunt through which to provide the systemic circulation with a higher level of oxygen. | |||
*[[Antibiotics]] | |||
**Antibiotics may be administered preventively. However, due to the physical strain caused by uncorrected d-TGA, as well as the potential for introduction of bacteria via arterial and central lines, infection is not uncommon in pre-operative patients. | |||
*[[Diuretics]] | |||
**[[Diuretics]] aid in flushing excess fluid from the body, thereby easing strain on the [[heart]]. | |||
*[[Analgesics]] | |||
**Analgesics normally are not used pre-operatively, but they may be used in certain cases. They are occasionally used partially for their sedative effects. | |||
*[[Cardiac glycosides]] | |||
**Cardiac [[glycosides]] are used to maintain proper heart rhythm while increasing the strength of each contraction. | |||
*[[Sedatives]] | |||
**[[Sedatives]] may be used palliatively to prevent a young child from thrashing about or pulling out any of their lines. | |||
== Life Style Modifications == | |||
Patients with transposition of the great arteries and a large [[ventricular septal defect]] who have not undergone repair may require certain life style modifications to control symptoms which include: | |||
* Increased caloric density during infancy (particularly if they have significant [[congestive heart failure]] and [[poor weight gain]]). | |||
** Following definitive repair, most patients do not need a special diet. | |||
* Specific activity restrictions are dependent on the patient's residual hemodynamic abnormalities. | |||
* Following the arterial switch procedure, exercise stress testing is necessary in older patients who are interested in participating in competitive sports. | |||
== 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines<ref name="pmid30121240">{{cite journal| author=Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM | display-authors=etal| title=2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2019 | volume= 73 | issue= 12 | pages= 1494-1563 | pmid=30121240 | doi=10.1016/j.jacc.2018.08.1028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30121240 }}</ref> == | |||
=== Therapeutic Recommendations for d-TGA With Atrial Switch === | |||
{| class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | |||
|- | |||
| bgcolor="LightGreen" |'''1.'''GDMT with appropriate attention to the need for anticoagulation is recommended to promptly restore sinus rhythm for adults with d-TGA with atrial switch repair presenting with atrial arrhythmia.''(Level of Evidence: B-NR)'' | |||
|} | |||
==References== | ==References== | ||
Latest revision as of 08:42, 16 December 2022
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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]; Kristin Feeney, B.S. [5]
Overview
Surgery is the mainstay of treatment for TGA. However, infusion of PGE1 to a newborn diagnosed with TGA is recommended as it prevents the ductus arteriosus from closing, therefore providing an additional shunt through which to provide the systemic circulation with a higher level of oxygen.
Medical Therapy
Surgery is the mainstay of treatment for TGA. However, infusion of PGE1 to a newborn diagnosed with TGA is recommended as it prevents the ductus arteriosus from closing, therefore providing an additional shunt through which to provide the systemic circulation with a higher level of oxygen.[1][2]
- Prostaglandins (PGE)
- Prevents the ductus arteriosus from closing, therefore providing an additional shunt through which to provide the systemic circulation with a higher level of oxygen.
- Antibiotics
- Antibiotics may be administered preventively. However, due to the physical strain caused by uncorrected d-TGA, as well as the potential for introduction of bacteria via arterial and central lines, infection is not uncommon in pre-operative patients.
- Diuretics
- Analgesics
- Analgesics normally are not used pre-operatively, but they may be used in certain cases. They are occasionally used partially for their sedative effects.
- Cardiac glycosides
- Cardiac glycosides are used to maintain proper heart rhythm while increasing the strength of each contraction.
- Sedatives
- Sedatives may be used palliatively to prevent a young child from thrashing about or pulling out any of their lines.
Life Style Modifications
Patients with transposition of the great arteries and a large ventricular septal defect who have not undergone repair may require certain life style modifications to control symptoms which include:
- Increased caloric density during infancy (particularly if they have significant congestive heart failure and poor weight gain).
- Following definitive repair, most patients do not need a special diet.
- Specific activity restrictions are dependent on the patient's residual hemodynamic abnormalities.
- Following the arterial switch procedure, exercise stress testing is necessary in older patients who are interested in participating in competitive sports.
2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines[3]
Therapeutic Recommendations for d-TGA With Atrial Switch
| Class I |
| 1.GDMT with appropriate attention to the need for anticoagulation is recommended to promptly restore sinus rhythm for adults with d-TGA with atrial switch repair presenting with atrial arrhythmia.(Level of Evidence: B-NR) |
References
- ↑ Unolt M, Putotto C, Silvestri LM, Marino D, Scarabotti A, Valerio M, Caiaro A, Versacci P, Marino B (June 2013). "Transposition of great arteries: new insights into the pathogenesis". Front Pediatr. 1: 11. doi:10.3389/fped.2013.00011. PMC 3860888. PMID 24400257. Vancouver style error: initials (help)
- ↑ Shah S, Gupta T, Ahmad R (2015). "Managing Heart Failure in Transposition of the Great Arteries". Ochsner J. 15 (3): 290–6. PMC 4569166. PMID 26413006.
- ↑ Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM; et al. (2019). "2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines". J Am Coll Cardiol. 73 (12): 1494–1563. doi:10.1016/j.jacc.2018.08.1028. PMID 30121240.