Post-operative care for levo-transposition of the great arteries


 * 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
ACC/AHA guidelines recommend certain groups of patient with levo-transposition of the great arteries to have antibiotic prophylaxsis against infective endocarditis

==(ACC/AHA) recommendations for Postoperative Care for levo-transposition of the great arteries (DONOT EDIT)==

Class I

1. Patients with prior repair of CCTGA should have regular follow-up with a cardiologist with expertise in ACHD. (Level of Evidence: C)

2. Echocardiography-Doppler study and/or MRI should be performed yearly or at least every other year by staff trained in imaging complex CHD. (Level of Evidence: C)

Recommendations for Endocarditis Prophylaxis

Class IIa

1. Antibiotic prophylaxis before dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa is reasonable in those with the following indications:
 * 1. Prosthetic cardiac valve. (Level of Evidence: B)
 * 2. Previous IE. (Level of Evidence: B)
 * 3. Unrepaired and palliated cyanotic CHD, including surgically constructed palliative shunts and conduits. (Level of Evidence: B)
 * 4. Completely repaired CHD with prosthetic materials, whether placed by surgery or by catheter intervention, during the first 6 months after the procedure. (Level of Evidence: B)
 * 5. Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device that inhibit endothelialization. (Level of Evidence: B)

2. It is reasonable to consider antibiotic prophylaxis against IE before vaginal delivery at the time of membrane rupture in select patients with the highest risk of adverse outcomes. This includes patients with the following indications:
 * 1. Prosthetic cardiac valve or prosthetic material used for cardiac valve repair. (Level of Evidence: C)
 * 2. Unrepaired and palliated cyanotic CHD, including surgically constructed palliative shunts and conduits. (Level of Evidence: C)

Class III

1. Prophylaxis against IE is not recommended for nondental procedures (such as esophagogastroduodenoscopy or colonoscopy) in the absence of active infection. (Level of Evidence: C)

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