Preoperative Physiology, Imaging, and Management of Transposition of the Great Arteries

Files, Matthew D.; Arya, Bhawna

doi:10.1177/1089253215581851

Cited by 18 publications

(13 citation statements)

References 55 publications

(69 reference statements)

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“…Generally, higher oxygen saturation in the leg can only occur if oxygen saturation in the pulmonary artery is higher than that in the ascending aorta, which is indicative of d-TGA [1,2]. However, in our patient, oxygen saturation in the right upper limb was higher, even though he demonstrated d-TGA.…”

Section: Discussionmentioning

confidence: 52%

Anomalous Origin of the Right Subclavian Artery in a Patient with D-transposition of the Great Arteries

Park

Song

Huh

et al. 2018

Korean J Thorac Cardiovasc Surg

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This case report concerns a young patient with an extremely rare combination of d-transposition of the great arteries (d-TGA) and anomalous origin of the right subclavian artery. In our patient, the right subclavian artery originated from the pulmonary artery, which is why he did not show reversed differential cyanosis. We conclude that the presence of an aortic arch anomaly should be considered in patients with d-TGA who do not present with reversed differential cyanosis. A further imaging work-up, including computed tomography or magnetic resonance imaging, might be helpful.

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Section: Discussionmentioning

confidence: 52%

Anomalous Origin of the Right Subclavian Artery in a Patient with D-transposition of the Great Arteries

Park

Song

Huh

et al. 2018

Korean J Thorac Cardiovasc Surg

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“…It is vital to accurately assess the coronary artery before surgery. The most “usual” pattern of coronary artery origin presents with the LAD and left circumflex arising from sinus 1, with the RCA arising from sinus 2 [ 22 ]. Similar to previous reports, 80% (20/25) patients presented with this pattern in our study.…”

Section: Discussionmentioning

confidence: 99%

“…We acknowledge the following limitations in our study. First, TGA is a rare congenital heart disease, with a prevalence of 0.2–0.3 per 1000 live births [ 22 ]. Our single-center study collected 25 patients during the past 7 years.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of transposition of the great arteries associated with multiple malformations using dual-source computed tomography

et al. 2017

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PurposeTo determine the value of dual-source computed tomography (DSCT) in depicting the morphological characteristics and diagnosing the associated malformations for patients with transposition of the great arteries (TGA) before surgery.Materials and methodsTwenty-five patients with TGA who underwent DSCT and transthoracic echocardiography (TTE) examination were retrospectively reviewed. The morphological types of TGA, the spatial relationship between the pulmonary artery and the aorta, as well as coronary artery-associated abnormalities were assessed by DSCT. In contrast to TTE, the diagnostic accuracy of associated malformations on DSCT were analyzed and calculated with reference to surgical or digital subtraction angiography (DSA) findings. Effective doses (EDs) were also calculated.ResultsAmong the 25 patients, 12 (48%) had ventricular septal defects and left ventricular outflow tract stenosis. Sixteen patients (16/25, 64%) had great arteries with an oblique spatial relationship on DSCT. In addition, we found seven patients (7/25, 28%) with coronary artery malformation, including five with an abnormal coronary origin and two with signs of a myocardial bridge. According to DSA or surgical findings, DSCT was superior to TTE in demonstrating extracardiac anomalies (sensitivity, anomalies of great vessels: 100% vs. 93.33%, other anomalies: 100% vs. 46.15%). The mean estimated ED for those aged <10 years was <2 mSv (1.59 ± 0.95 mSv).ConclusionsDSCT can achieve an overall assessment of patients with TGA, including any associated malformations as well as the identification of the spatial relationship of the great arteries. DSCT can therefore be considered as an alternative imaging modality for surgical decision making.

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“…Models and interfaces were implemented in C# by the second author. Although a full model validation is not part of this tutorial on the concept of explanatory models, we compared the selected critical model outputs: oxygen saturations and blood pressures to those reported in literature [17, 18]. In the scenario where there is a large PDA (3.5 mm) and a normal, non-restrictive FO (5.5 mm diameter), the oxygen saturations are in the range of the reported normal values for TGA without VSD (75–85%).…”

Section: Transposition Of the Great Arteriesmentioning

confidence: 99%

Explanatory models in neonatal intensive care: a tutorial

Meurs

Antonius

2018

Adv Simul

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BackgroundAcute care providers intervening on fragile patients face many knowledge and information related challenges. Explanation based on causal chains of events has limitations when applied to complex physiological systems, and model-driven educational software may overwhelm the learner with information. We introduce a new concept and educational technology to facilitate understanding, reasoning, and communication in the clinical environment. The aim is to grasp complex physiology in a more intuitive way.Explanatory models (EM)An EM is a representation of relevant physiologic processes that provides insight into the relationships between therapeutic interventions and monitored variables, and their dependency on incidents and pathologies. We systematically analyze types of information incorporated into models and displayed in simulations and consider their explanatory relevance.Transposition of the great arteries (TGA)A conceptual model (diagram) of the normal neonatal cardiorespiratory system is adapted to reflect TGA and implemented in animated, interactive software.Illustration of educational useThe use of this model is illustrated via the explanation to pediatric residents of the relationships between blood pressures, blood flow rates, ventilation, oxygen saturation, and oxygen distribution in a neonate with TGA. Learners explore clinical scenarios and effects of therapeutic interventions.DiscussionExplanatory models hold promise as mental models for clinical practice and could possibly play a role in clinical decision making in neonatal intensive care and beyond.Companion softwareThe software is freely available via the web addendum: https://www.dropbox.com/sh/ciufq5rqxgs9bkt/AAC7oKsvkEr73eYUJkx0pZ1Ya?dl=0

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Preoperative Physiology, Imaging, and Management of Transposition of the Great Arteries

Cited by 18 publications

References 55 publications

Anomalous Origin of the Right Subclavian Artery in a Patient with D-transposition of the Great Arteries

Anomalous Origin of the Right Subclavian Artery in a Patient with D-transposition of the Great Arteries

Assessment of transposition of the great arteries associated with multiple malformations using dual-source computed tomography

Explanatory models in neonatal intensive care: a tutorial

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