The Prevalence of Associated Congenital Cardiac Anomalies (Shunt‑Dependent Lesions) in Children with Transposition of Great Artery

Abstract

Background: Transposition of the great arteries (TGA) is a rare cyanotic heart disease associated with congenital cardiac anomalies;  often called shunt-dependent lesions. Transposition of the great arteries is also linked to syndromic correlates. 

Aim: This study was to  document the prevalence of TGA and various forms of shunt-dependent lesions in children with TGA. 

Methods: This was a descriptive study where one thousand and five echocardiography were carried out in two health institutions over 9 years. 

Results: Data were  analyzed with IBM statistical software version 20. The prevalence of children with TGA was 1.7%. The majority of the infants, 73.3%, had  ASD as shunt-dependent lesion. All the infants, 100.0%, presented with cyanosis, breathlessness, and poor weight gain. Less than one- tenth of the infants, 6.7%, had an intact septum. The highest proportion of the infants, 80.0%, has more than one congenital cardiac  anomaly (shunt-dependent lesions). Infants with TGA have lower left ventricular mass (LVM) of 119.1 ± 116.5 compared with control (18.8  ± 12.6). This was statistically significant, Mann– Whitney U test (11.024), P < 0.001. The under‑filled left ventricular mass was found in  73.3% of the infants. Infants with TGA co‑existing with Teratology of Fallot (TOF) was (1/15) 6.7%; large Ostium secundum atrial septal  defect was (OS ASD) (1/15) 6.7% and cases of ventricular septal defect (VSD) with associated ASD were (1/15) 6.7%. All infants had left  aortic arch, which is a normal variant. None (0/15) had any surgical intervention as most were lost to follow-up. 

Conclusion: The  prevalence of TGA was low in this setting. There were several shunt-dependent lesions associated with TGA. Atrial septal defect is the  commonest. Poor management outcome was due to late presentation.