Risk stratification in transposition of the great arteries

This thesis focused on multiple markers to predict clinical complications in adults with transposition of the great arteries after an atrial switch operation. These adults are at high risk of late complications including heart failure, arrhythmias, and premature mortality. In this thesis, we presented the first risk model that provides estimates of absolute risk of these major clinical events. Second, we showed that the use of novel markers, such as myocardial deformation and common genetic variants, can improve risk stratification over the use of basic clinical risk factors alone. Third, studies into the use of medication in adults with congenital heart disease showed that many patients use a multitude of cardiovascular drugs, even though the evidence that supports the use of these drugs is low. Lastly, studies into the genetic architecture of transposition of the great arteries and its late clinical complications provide insights in the molecular and pathophysiological mechanisms that are potentially involved in the occurrence of the congenital defect and its clinical course.