Dextro-transposition of the great arteries cardiac catheterization


 * Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [mailto:psingh@perfuse.org]; ; Keri Shafer, M.D. [mailto:kshafer@bidmc.harvard.edu]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [mailto:kfeeney@perfuse.org]

Overview
Cardiac catheterization is not frequently done to diagnose transposition of the great vessels, as it could be done confidently with echocardiography. It is in conditions when the echo findings are inconclusive. It can be used to determine the coronary anatomy.

==(ACC/AHA) recommendations for cardiac catheterization in patients of dextro-transposition of the great arteries (DONOT EDIT)==

Recommendation for Cardiac Catheterization after Arterial Switch Operation

Class IIa

1. Coronary angiography is reasonable in all adults with d-TGA after ASO to rule out significant coronary artery obstruction. (Level of Evidence: C)

Recommendation for Diagnostic Catheterization for Adults With Repaired Dextro-Transposition of the Great Arteries

Class I

1. Diagnostic catheterization of the adult with d-TGA should be performed in centers with expertise in the catheterization and management of ACHD patients. (Level of Evidence: C)

Class IIa

1. For adults with d-TGA after atrial baffle procedure (Mustard or Senning), diagnostic catheterization can be beneficial to assist in the following:
 * 1. Hemodynamic assessment. (Level of Evidence: C)
 * 2. Assessment of baffle leak. (Level of Evidence: B)
 * 3. Assessment of superior vena cava or inferior vena cava pathway obstruction. (Level of Evidence: B)
 * 4. Assessment of pulmonary venous pathway obstruction. (Level of Evidence: B)
 * 5. Suspected myocardial ischemia or unexplained systemic RV dysfunction. (Level of Evidence: B)
 * 6. Significant left ventricular (LV) outflow obstruction at any level (LV pressure greater than 50% of systemic levels, or less in the setting of right ventricular [RV] dysfunction). (Level of Evidence: B)
 * 7. Assessment of pulmonary arterial hypertension (PAH), with potential for vasodilator testing. (Level of Evidence: C)

2. For adults with d-TGA, ventricular septal defect (VSD), and pulmonary stenosis (PS), after Rastelli-type repair, diagnostic catheterization can be beneficial to assist in the following:
 * 1. Coronary artery delineation before any intervention for right ventricular outflow tract (RVOT) obstruction. (Level of Evidence: C)
 * 2. Assessment of residual VSD. (Level of Evidence: C)
 * 3. Assessment of PAH, with potential for vasodilator testing. (Level of Evidence: C)
 * 4. Assessment of subaortic obstruction across the left ventricle-to-aorta tunnel. (Level of Evidence: C)

Recommendations for Interventional Catheterization for Adults with Dextro-Transposition of the Great Arteries

Class IIa

1. Interventional catheterization of the adult with d-TGA can be performed in centers with expertise in the catheterization and management of ACHD patients. (Level of Evidence: C)

2. For adults with d-TGA after atrial baffle procedure (Mustard or Senning), interventional catheterization can be beneficial to assist in the following:
 * 1. Occlusion of baffle leak. (Level of Evidence: B)
 * 2. Dilation or stenting of superior vena cava or inferior vena cava pathway obstruction. (Level of Evidence: B)
 * 3. Dilation or stenting of pulmonary venous pathway obstruction. (Level of Evidence: B)

3. For adults with d-TGA after ASO, interventional catheterization can be beneficial to assist in dilation or stenting of supravalvular and branch pulmonary artery stenosis. (Level of Evidence: B)

4. For adults with d-TGA, VSD, and PS, after Rastelli-type repair, interventional catheterization can be beneficial to assist in the following:
 * 1. Dilation with or without stent implantation of conduit obstruction (RV pressure greater than 50% of systemic levels, or peak-to-peak gradient greater than 30 mm Hg; these indications may be lessened in the setting of RV dysfunction). (Level of Evidence: C)
 * 2. Device closure of residual VSD. (Level of Evidence: C)

For ACC/AHA Level of evidence and classes click:ACC AHA Guidelines Classification Scheme