**10. Long term outcomes in adult survivors**

In the adult survivors of DTGA who undergo atrial switch procedure, RV failure and TR are common as the morphological RV functionally supports the highpressure systemic circulation instead of the physiological low-pressure pulmonary circulation as it is supposed to [34]. More common long term complications are cardiac arrhythmias, which can result in sudden death due to atrial flutter. In the longer living survivors, sinus node dysfunction with the eventual need for pacemaker placement has been noted. In the adult survivors of ASO recipients, pulmonary arterial stenosis and distortion, neoaortic root dilatation, and aortic regurgitation are the reported complications.

In the patients with LTGA, the congenitally corrected transposition, the systemic high-pressure circulation is supported by the morphological RV and a weak tricuspid valve. In these patients, TR is common which progressively worsens with age, eventually leading to RV failure. Additional surgical interventions may be required if RV dilatation or dysfunction appear. Almost 90% of cases of LTGA are associated with other cardiac defects, such as VSD (70–80%), PA (30–60%), mitral valve anomalies (straddling valve, additional cusps, dysplasia, 55%), and TR (90%). Rhythm disorders, like heart block or atrial arrhythmias, are common in them. Some of these patients may eventually require cardiac transplantation. Appropriate followup with periodic hemodynamic and functional assessment is an integral part of these patients' subsequent specialized management for best outcomes [35].
