Multimodality Imaging Guidelines of Patients with Transposition of the Great Arteries: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance and the Society of Cardiovascular Computed Tomography

Commentary: An unusual case of crossing coronaries

“…With the primary goal of preventing sudden death, recent guidelines recommend only that patients undergo coronary imaging once before adulthood. 3 Conversely, in this report Michalak and colleagues 1 advocate for computed tomographic angiography at prescribed intervals, but there is little evidence to support that this changes outcomes. Their group has found postsurgical changes in the coronary origins and geometry, luminal narrowing, and unknown patterns.…”

Recommendations for Multimodality Assessment of Congenital Coronary Anomalies: A Guide from the American Society of Echocardiography

“…The aorta arises from the RV and the PA arises from the LV, resulting in parallel systemic and pulmonary circulations and severe cyanosis at birth. 133 Approximately 40% of cases have a ventricular septal defect (VSD), which may affect the type of surgery performed. The primary surgery for TGA (with intact ventricular septum or with simple types of VSD) is the arterial switch operation (ASO), which entails transfer of the aorta to the pulmonary valve, transfer of the PA to the aortic valve, and translocation of the CAs to the ''neo'' aorta.…”

“…CA imaging recommendations have been previously reviewed in the American Society of Echocardiography imaging guidelines document on TGA published in 2016. 133 Particular variations of CA anatomy have been associated with worse outcomes after the procedure. 135 The most common CA pattern occurs in approximately 65% of TGA cases: the left main CA arises from the left-facing aortic sinus and divides into the LAD and the LCx, and the RCA arises from the right-facing aortic sinus.…”

Echocardiography in Congenital Heart Disease

“…Other imaging modalities which facilitate the diagnostic evaluation of these patients include cardiovascular magnetic resonance (CMR), cardiovascular computed tomography (CCT), nuclear scintigraphy, and cardiac angiography. Multimodality guidelines have been published for both tetralogy of Fallot (TOF) and transposition of the great arteries (TGA) and discussed elsewhere [4,5]. For the purpose of this paper, we will discuss the role of echocardiography in making a diagnosis, evaluate for potential complications and hopefully predict outcomes such as heart failure (HF), sudden cardiac death (SCD) and arrhythmias.…”