Transposition of the great arteries: Rationale for tailored preoperative management

Abstract

As preoperative morbi-mortality remains significant, care of newborns with transposition of the great arteries is still challenging. In this review of the literature, we discuss the different treatments that could improve the patient's condition into the preoperative period. Instead of a standardized management, we advocate personalized care of these neonates. Considering the deleterious effects of hypoxia, special attention is given to the use of non-invasive technologies to assess oxygenation of the tissues. As a prolonged preoperative time with low cerebral oxygenation is associated with cerebral injuries, distinguishing neonates who should undergo early surgery from those who could wait longer is crucial and requires full expertise in the management of neonatal congenital heart disease. Finally, to treat these newborns as soon as possible, we support a planned delivery policy for foetuses with transposition of the great arteries.

Keywords: Arterial switch operation; Atrioseptostomie; Balloon atrial septostomy; Near-infrared spectroscopy; Prostaglandin; Prostaglandine; Spectroscopie dans le proche infra-rouge; Switch artériel; Transposition des gros vaisseaux; Transposition of the great arteries.