The place of instrumental methods in making diagnosis of different types of congenitally corrected transposition of the great arteries and in determining indications for certain surgical operations of the congenital heart disease

Abstract

The goal of the research. To evaluate the ability of instrumental methods to determine indications for certain operations of congenitally corrected transposition of the great arteries (ccTGA).

Materials and Methods. Methods of the research were data of patients with ccTGA which were examinated or underwent surgery at UCCC from 1993 to December 2018. Transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), diagnostic heart catheterization, computed tomography (CT), magnetic resonance imaging (MRI) were used for diagnostics.

Results. From 1993 to December 2018 124 children with ccTGA were examinated or underwent surgery at UCCC. Heart catheterization, CT and MRI were used in 69 (55.6%) patients. The isolated form was revealed in 27 (21.8%) patients, 97 (78.2%) patients were diagnosed with concomitant heart anomalies, 103 (83.0%) patients had situs solitus. The associated defects, diagnosed in 97 patients were as follows: ventricular septum defect (VSD) in 79 (81.4%) patients, pulmonary artery stenosis (PS) — 35 (36.1%), pulmonary artery atresia (PA) — in 18 (18.6%), coarctation of the aorta (CoA) — in 10 (10.3%), Ebsteinlike tricuspid valve dysplasia — in 19 (19.6%), severe tricuspid valve insufficiency — in 12 (12.4%), one patient had a total anomalous pulmonary vein drainage (TAPVC), supracardiac form, and two patients had large aorto-pulmonary collateral arteries (MAPCA's). Additional instrumental diagnostic methods were used in 69 (55.6%) patients with ccTGA. Heart catheterization was performed in 61 (49.2%) patients, CT in 33 (26.6%) patients, and MRI in 24 (19.4%) patients. TEE was used in 18 patients.

Conclusions. Congenitally corrected transposition of the great arteries is a complex heart defect which is combined in majority of cases with other intracardiac abnormalities. The variety of anatomical variants of the disease require a comprehensive approach in diagnosis with engagement of a wide range of instrumental methods, which allow to evaluate the anatomy of the heart and great vessels, other organs and to determine the treatment course and results of operations.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee or National Bioethics Committee of all participating institution. The informed consent of the patient was obtained for conducting the studies.