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Medication in adults after atrial switch for transposition of the great arteries: clinical practice and recommendations.

Heart failure is most exceptional in the long term in adults with transposition of the large (TGA), by an atrial switch. The current guidelines do not contain a clear recommendation about heart failure medication in these patients, because there is insufficient data on its usefulness. Prescribing this medication is therefore done on the basis of the doctor's personal experience.

In this study, we examined the use of these patients and examined the use of ACE/AT2 inhibitors and beta-blockers to improve survival.

Methods and results:
We examined the medication use between 2006-2014 of 150 TGA patients (median age 30 [IQR 25-35] years, 63% male) included in the CONCOR registry via 5 university medical centers using MedicijnTab, the Dutch registry of medication use in the CBS. Use of ACE/AT2 inhibitors, beta-blockers and diuretics increased with age but this was not seen in the entire cohort of both symptomatic and asymptomatic patients.

Heart failure medication is often used by patients with transposition of the great vessels and an atrial switch, although the evidence for this is limited. This study of a lower risk of symptomatic patients taking ACE/AT2 inhibitors. This support aids the use of these drugs in symptomatic, but not asymptomatic, patients.


dr. O.I. Woudstra,

Eur Heart J Cardiovasc Pharmacother. 2022 Jan

Heart bank

NHI Hartenbank

Heart bank: saving lives with your own heart
It may sound strange, but even after life you can help improve the diagnosis and treatment of heart disease. This can be done via the Hartenbank. This is where the hearts of deceased people are stored. They are very suitable for research into heart disease.

How does the Heart Bank work?
Researchers all over the world can use the Heart Bank. They use the stored heart tissue for research. They study how a healthy heart works and what exactly goes wrong in various heart diseases. For example, they are working on faster and better ways to detect heart disease and on better treatments. Michiel Henkens (coordinator Hartenbank):
“There is a major shortage of heart tissue to enable research into heart disease. Heart tissue stored at the Heart Bank can be used immediately for research. The Heart Bank forms the bridge between donors and scientists all over the world. This provides a lot of new knowledge for early detection and treatment of heart disease.”

Who can participate?
If you are 18 years or older, you can register. Both people with a healthy heart and with heart disease can register.

How can you participate?
Would you like to contribute in this way to new solutions for heart disease? Then register as a donor at the Hartenbank via www.hartenbank.nl. You then give permission to have your heart recorded in this biobank after death.
More information about the heart bank -> www.hartenbank.nl

Risk stratification in transposition of the great arteries


On 2 november 2021 Odilia  Woudstra succesfully defendend her thesis:" Risk stratification in transposition of the great arteries" .This thesis focuses on several factors to predict complications in adults with transposition of the great vessels who have undergone atrial switch surgery in childhood. In adulthood, these people have a high risk of complications as a result of heart surgery, such as heart failure, cardiac arrhythmias, and death (at a relatively young age). In this thesis, we present the first risk model that estimates the absolute risk for patients for these major complications. We then show that new markers, from echocardiography and from genetic research, can still improve the risk assessment compared to only (simple) factors that are currently used. We also study the medication use of adults with a congenital heart defect. We see that many patients use multiple drugs for their heart disease, despite the fact that the effect of these drugs is not well known in this patient group. Finally, we study the genetic background of transposition of the great vessels. We find leads that common genetic variants may influence the development of transposition of the great vessels and the course with an increased or decreased risk of complications in adulthood.

The digital version of the thesis can be found online: risk stratification in transposition of the great arteries by Odilia Woudstra.