Transposition of the great vessels prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3]; Keri Shafer, M.D. [4]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [5]

Transposition of the great vessels Microchapters

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Dextro-transposition of the great arteries
L-transposition of the great arteries

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Overview

The development of a fetal heart starts during the first trimester of pregnancy. Thus, many a times the fetal heart has already developed, by the time the female becomes aware of being pregnant. There are some risk factors that if avoided before and during pregnancy can decrease the occurrence of congenital heart diseases.

Prevention

ACC / AHA 2008 Guidelines- Recommendations for Endocarditis Prophylaxis - Transposition of the Great Vessels[1] (DO NOT EDIT)

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

a. Prosthetic cardiac valve. (Level of Evidence: B) "

b. Previous IE. (Level of Evidence: B) "

c. Unrepaired and palliated cyanotic CHD, including surgically constructed palliative shunts and conduits. (Level of Evidence: B) "

d. 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) "

e. 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:

a. Prosthetic cardiac valve or prosthetic material used for cardiac valve repair. (Level of Evidence: C) " b. Unrepaired and palliated cyanotic CHD, including surgically constructed palliative shunts and conduits. (Level of Evidence: C) "

General

The development of a fetal heart starts during the first trimester of pregnancy. Thus, many a times the fetal heart has already developed, by the time the female becomes aware of being pregnant. Some steps taken before and during pregnancy that can help in preventing the congenital heart diseases are as follow-

  • All females planning for pregnancy should start taking folate (400micrograms/day). This is so because, the birth defects occur most commonly during first trimester of pregnancy even before the female is aware of being pregnant.
  • Avoid medications like lithium, anti-acne drugs (retinoic acid) and some anti-epileptic drugs.
  • Ensuring the female has proper immunity against Rubella (before getting pregnant).
  • Ensure proper and complete treatment of upper respiratory tract infections.
  • Avoid viral infections
  • Avoid intravenous drug abuse
  • Avoid alcohol
  • Avoid strong chemicals (solvents)
  • Avoid X-rays

Specific

  • Women with some diseases like diabetes, seizures etc should consult their physicians before and during pregnancy for special management strategies for these diseases to prevent the occurrence of congenital heart diseases.
  • Females with phenylketonuria may need to follow a special phenylketoneuric diet before pregnancy and during the first trimester.
  • Genetic counselling can be offered to parents who have previous history of a child with birth defect or with family history.

References

  1. Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). "ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (23): e1–121. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.



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