# Evaluation of Operated Dextro-Transposition of Great Arteries Patients in Follow-Up: Comparison of Transthoracic Echocardiography and Cardiac CT Angiography

## TL;DR

This study compares echocardiography and CT angiography for monitoring patients after heart surgery for d-TGA, finding that CT provides more complete anatomical assessments.

## Contribution

The study demonstrates that CT angiography is more comprehensive than TTE for post-ASO anatomical evaluation.

## Key findings

- CT detected pulmonary artery stenosis and aortic root dilatation in 65.9% of patients.
- TTE had incomplete assessments in 23.4% of pulmonary artery cases and 27.6% of coronary evaluations.
- CT provided complete pre-intervention assessments for all 10 patients requiring cardiovascular interventions.

## Abstract

Background: Arterial switch operation (ASO) is the standard surgical treatment for dextro-transposition of great arteries (d-TGA). Long-term complications affecting pulmonary arteries, coronary arteries, and aortic root necessitate detailed surveillance, but the optimal imaging strategy remains undefined. Methods: We retrospectively analyzed 47 patients with d-TGA who underwent ASO between January 2023 and June 2025 with at least six months postoperative follow-up. All patients underwent both transthoracic echocardiography (TTE) and ECG-gated cardiac CT angiography (CTA). Anatomical measurements, functional parameters, and diagnostic completeness were compared between modalities. Results: Median age at follow-up was 37.2 months. CT detected pulmonary artery stenosis in 31 patients (65.9%) and aortic root dilatation in 31 patients (65.9%). TTE provided incomplete pulmonary artery assessment in 11 patients (23.4%) and incomplete coronary evaluation in 13 patients (27.6%), while CT successfully evaluated all patients (100%). Strong correlation was found between left pulmonary artery bending angle and aortic root dimensions (r = 0.65, p = 0.016), suggesting mechanical interdependence of post-surgical anatomical changes. Median radiation exposure was 2.684 mSv (IQR: 1.5–4.6). During follow-up, 10 patients (21.3%) required cardiovascular interventions, with CT providing complete pre-intervention assessment in all cases. Conclusions: TTE alone is insufficient for complete anatomical assessment following ASO. An integrated imaging approach utilizing TTE for functional assessment and CT for anatomical evaluation optimizes post-ASO surveillance.