Transposition of Great Arteries with Pulmonary Valve Stenosis After Jatene Procedure

Abstract

Transposition of the great arteries (TGA) is the most common cyanotic congenital heart lesion that presents in neonates. It’s a malformation that occurs with the inversion of the position between the two great vessels in the base of the heart, the aorta, and pulmonary arteries. It’s requiring that communications between the systemic and pulmonary circulation remain in the postnatal period through a patent foramen ovale, atrial communication, ventricular septal defect (VSD), or patent ductus arteriosus, so that there is initial survival of the patient. In case report, an infant was diagnosed with TGA at 28 days of age. This anomaly was associated with persistent ductus arteriosus, atrial septal defect (ASD), and ventricular septal defect (VSD), despite negative screening for gestational serial fetal echocardiography. At 45 days of life, the patient was submitted to Jatene correction surgery, and with 5 postoperative months, moderate pulmonary valve stenosis was diagnosed. The surgical treatment of choice currently in neonates diagnosed with TGA is Jatene procedure, which provides both restoration of the anatomy and function of the heart adequately. However, there are long-term complications associated with surgery such as stenosis in the region of the pulmonary valve that should be recognized for follow-up. It is also important to emphasize that fetal echocardiography is the most recommended method for the prenatal diagnosis of congenital heart diseases. However, it is an operator-dependent exam, which requires good experience, caution, and well-developed technique, which is unfortunately not yet available in all prenatal services.