Transposition of the Great Arteries With Arterial Switch Recommendations for d-TGA With Arterial Switch Referenced studies that support recommendations are summarized in Online Data Supplement 46. COR LOE Recommendations Diagnostic I C-LD Baseline and serial imaging with either echocardiography or CMR should be performed in adults with d-TGA with arterial switch who have neoaortic dilation, valve dysfunction or PA or branch PA stenosis or I C-EO Coronary revascularization for adults with d-TGA with arterial switch should be planned by surgeons or interventional cardiologists with expertise in revascularization in collaboration with ACHD providers to ensure coronary and pulmonary artery anatomy are understood IIa B-NR It is reasonable to perform anatomic evaluation of coronary artery patency (catheter angiography, or CT or MR angiography) in asymptomatic adults with d-TGA with arterial switch.S4.4.1.2-4,S4.4.1.2-5 IIa C-EO Physiological tests of myocardial perfusion for adults with d-TGA after arterial switch can be beneficial for assessing symptoms suggestive of myocardial ischemia. IIa C-EO GDMT is reasonable to determine the need for coronary revascularization for adults with d-TGA after arterial switch.S4.4.1.2-6 S4.4.1.2-8 Therapeutic IIa C-EO GDMT is reasonable to determine indications for aortic valve replacement in adults with d-TGA after arterial switch with severe neoaortic valve regurgitation.S4.4.1.2-6 IIa C-EO Catheter or surgical intervention for PS is reasonable in adults with d-TGA after arterial switch with symptoms of HF or decreased exercise capacity attributable to PS. Synopsis Complications after the arterial switch include: 1) ste- nosis at the arterial anastomotic sites, most commonly supravalvular PS; 2) neoaortic root dilation; 3) neoaor- tic valve regurgitation (native pulmonary valve); and 4) coronary obstruction. Evaluation for the first 3 com- plications listed is accomplished by usual imaging, in- cluding echocardiography, CCT, and/or CMR. Coronary complications are inadequately evaluated by resting echocardiography, and stress imaging in asymptomatic patients is not sensitive. 