title: 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.
authors.affiliation: Pediatric and Congenital Cardiology Unit, Bordeaux University Hospital, Bordeaux, France; Pediatric Intensive Care Unit, Bordeaux University Hospital, Bordeaux, France. Electronic address: peseguela@yahoo.fr.
authors.forename: Pierre-Emmanuel
authors.initials: PE
authors.lastname: Séguéla
authors.affiliation: Cardiac Surgery Unit, Bordeaux University Hospital, Bordeaux, France.
authors.forename: François
authors.initials: F
authors.lastname: Roubertie
authors.affiliation: Cardiac Surgery Unit, Bordeaux University Hospital, Bordeaux, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Kreitmann
authors.affiliation: Pediatric Intensive Care Unit, Bordeaux University Hospital, Bordeaux, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Mauriat
authors.affiliation: Pediatric Intensive Care Unit, Bordeaux University Hospital, Bordeaux, France.
authors.forename: Nadir
authors.initials: N
authors.lastname: Tafer
authors.affiliation: Pediatric and Congenital Cardiology Unit, Bordeaux University Hospital, Bordeaux, France.
authors.forename: Zakaria
authors.initials: Z
authors.lastname: Jalal
authors.affiliation: Pediatric and Congenital Cardiology Unit, Bordeaux University Hospital, Bordeaux, France.
authors.forename: Jean-Benoit
authors.initials: JB
authors.lastname: Thambo
mesh_terms: D019468:Disease Management; D006801:Humans; D011300:Preoperative Care / Q000379:methods*; D014188:Transposition of Great Vessels / Q000601:surgery*
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