Monitoring the patient with transposition of the great arteries: arterial switch versus atrial switch.

Sufficient time has passed that adult congenital heart disease (ACHD) specialists now frequently encounter survivors born with complete transposition of the great arteries and palliated with an atrial or arterial switch procedure. To ensure the ongoing health of these patients, it is of paramount importance that their surgeries are understood and that physicians are aware of and remain vigilant for potential late complications. Adult survivors should be assessed annually in a regional ACHD center. Clinical assessment, electrocardiogram, and multimodality imaging are the mainstay of routine monitoring. Doppler echocardiography is the first-line imaging modality; other diagnostic tests are tailored to seek specific long-term complications. Clinicians, specialists in cardiovascular imaging, nurses and others involved in the delivery of care need special training and expertise. Care for these complex patients is best provided by multidisciplinary teams located in regional ACHD centers with access to adequate human and structural resources.