Challenges in Diagnosis and Treatment of Transposition of the Great Arteries: A Single-Center Experience in Tunisia

Abstract

Introduction

Surgical management of congenital heart disease, particularly transposition of the great arteries (TGA), remains challenging in resource-limited settings. With predominant postnatal diagnosis and delayed correction, outcomes differ from high-income countries.

The aim of our study was to define the epidemiological and clinical characteristics ofTGA in a Tunisian population, describe its management in our setting, identify factors associated with morbidity and mortality, and evaluate short- and medium-term (one-year) follow-up outcomes in our patients.

Method

This was a retrospective, descriptive, and analytical study conducted over a 9-year period (2014–2022), including 51 patients with TGA hospitalized in the pediatrics, neonatology, and cardiology departments of Hedi Chaker University Hospital in Sfax. Epidemiological, clinical, and cardiac ultrasound data were collected for all patients, along with initial and subsequent surgical management, early and late preoperative mortality and its predictive factors, and patient outcomes.

Results

In hospital frequency of TGA was 1.82 per 1000 admissions, with a male-to-female ratio of 2.92. Prenatal diagnosis was made in 5.9% of cases, with a mean age at detection of 2 days. Simple TGA accounted for 82.4% (42 patients), while complex TGA represented 17.6% (9 patients). During initial management in our country, balloon atrial septostomy (BAS) was performed in 80.4% of cases. Early preoperative mortality was 19.6%, significantly associated with low birth weight and insufficient shunting. Surgical repair was performed in 80.4% of cases at a mean age of 27 days. Only one patient was operated in Tunisia, with a perioperative mortality rate of 4.9% and no late mortality at one year. The arterial switch operation was the preferred technique, performed in 95.1% of operated patients, with a low reintervention rate of 2.6%. Short- and medium-term follow-up outcomes were comparable to those in developed countries.

Conclusion

Despite the lack of appropriate diagnostic and therapeutic resources for early and adequate TGA management in our country, our patients achieved satisfactory outcomes with a high survival rate following often delayed treatment abroad. Improving initial neonatal management, particularly through more frequent prenatal diagnosis, would significantly reduce preoperative mortality and enhance survival rates.