Tuesday, April 16, 2024

Transposition Of The Great Arteries Surgery

Symptoms Of Transposition Of The Great Arteries

Transposition of the Great Arteries (TGA): Stabilizing Your Baby After Delivery (3 of 5)

Most babies with transposition of the great arteries are cyanotic soon after birth due to a low oxygen level. They may also seem to be working hard to breathe and have trouble feeding. A few babies may appear quite normal and healthy for the first day or 2 after birth.

If their ductus arteriosus is helping oxygen-rich and oxygen-poor blood mix so that some oxygen can get to their body, their symptoms will get worse as the ductus begins to close . If they have a patent ductus arteriosus , some oxygen-rich blood will continue to get through.

If they have a large ASD or VSD, their symptoms may be less severe. This hole between chambers of the heart provides a path for some oxygen-rich blood to get from their lungs to the rest of their body.

Transposition Of The Great Arteries Treatment

Babies with D TGA need surgery to repair the defect and restore normal blood flow through the heart and lungs. Without treatment, most children with D TGA will not survive the first year of life.

Some infants receive medication or other treatments, such as cardiac catheterization, to help the heart work better until they are ready for surgery.

What Can I Expect From The Transposition That Was Repaired In Childhood

As an infant you may have had a procedure in the catheterization laboratory to “buy time” and delay the surgery until you could handle it better. The procedure enlarged the naturally occurring connection between the right and left upper chambers . This lets the blood mix so some oxygen-rich and oxygen-poor blood can be pumped to the correct side. This communication is repaired when further surgery is done.

Two major types of surgery can correct the transposition. The first, developed in the late 1950s, creates a tunnel between the atria. This redirects the oxygen-rich blood to the right ventricle and aorta and the oxygen-poor blood to the left ventricle and the pulmonary artery. This operation is called an atrial or venous switch. It’s also called the Mustard procedure or the Senning procedure.

The second type is called the arterial switch operation. It wasn’t done routinely until the mid-1980s. The aorta and pulmonary arteries are switched back to their normal positions. The aorta is connected to the left ventricle, and the pulmonary artery is connected to the right ventricle. The coronary arteries, which carry the oxygen-rich blood that nourishes the heart muscle, also need to be re-attached to the new aorta. The arterial switch is now the preferred operation.

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What Are The Surgical Options For Transposition Of The Great Arteries

D-TGA is corrected by an arterial switch procedure that should be performed within the first week of life. This surgery involves switching the positions of your babys aorta and pulmonary artery to restore a typical pathway for blood to flow through their heart and out to their body. If there is a VSD present, this will also be repaired at the same time using a synthetic patch.

Your surgeon:

  • Removes the coronary arteries from your babys native aorta, which comes off of their right ventricle in d-TGA.
  • Moves your babys aorta and pulmonary artery to their correct positions.
  • Connects their aorta to their left ventricle.
  • Connects the pulmonary artery to the right ventricle.
  • Reattaches their coronary arteries to their new aorta.
  • What Is The Long

    Transposition of the Great Arteries

    The Benderson Family Heart Center team continues to refine their management of TGA and incorporate the latest innovations and research. Most children who’ve had TGA surgery recover and grow normally. Even so, your child will need periodic monitoring, since he or she may be at increased risk for arrhythmias, leaky valves, narrowing of the arteries and other heart issues.

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    Caring For Your Child At Home Following A Tga Surgical Repair

    Pain medications, such as acetaminophen or ibuprofen, may be recommended to keep your child comfortable at home. Your child’s physician will discuss pain control before your child is discharged from the hospital.

    If any special treatments are to be given at home, the nursing staff will ensure that you are able to provide them, or a home health agency may assist you.

    You may receive additional instructions from your child’s physicians and the hospital staff.

    About Transposition Of The Great Arteries

    In babies with transposition of the great arteries, abnormal development of the fetal heart takes place during the first eight weeks of pregnancy. The large vessels that take blood away from the heart to the lungs, or to the body, are improperly connected.

    Normally, oxygen-poor blood returns to the right atrium from the body, travels to the right ventricle, then is pumped through the pulmonary artery into the lungs where it receives oxygen. Oxygen-rich blood returns to the left atrium from the lungs, passes into the left ventricle, and then is pumped through the aorta out to the body.

    In transposition of the great arteries, the aorta is connected to the right ventricle, and the pulmonary artery is connected to the left ventricle – the exact opposite of a normal heart’s anatomy.

    • Oxygen-poor blood returns to the right atrium from the body, passes through the right atrium and ventricle, then goes into the misconnected aorta back to the body.
    • Oxygen-rich blood returns to the left atrium from the lungs, passes through the left atrium and ventricle, then goes into the pulmonary artery and back to the lungs.

    Two separate circuits are formed – one that circulates oxygen-poor blood from the lungs back to the lungs, and another that recirculates oxygen-rich blood from the body back to the body.

    What Causes Tga Heart Defects

    The heart is forming during the first 8 weeks of fetal development. The problem occurs in the middle of these weeks, allowing the aorta and pulmonary artery to be attached to the incorrect chamber.

    Some congenital heart defects may have a genetic link, either occurring due to a defect in a gene, a chromosome abnormality, or environmental exposure, causing heart problems to occur more often in certain families. Most of the time this heart defect occurs sporadically , with no clear reason for its development.

    When Should I See A Healthcare Provider For Transposition Of The Great Arteries

    Transposition of the Great Arteries (Vessels) | Congenital Heart Defects Nursing NCLEX Pediatrics

    See a healthcare provider if your baby has:

    • Trouble breathing.
    • Weak pulse.
    • Bluish or whitish skin around their mouth.

    If you had transposition surgery as a child, you should see a cardiologist with experience caring for adults with congenital heart disease. You need routine care and evaluation throughout your life.

    How Does Transposition Of The Great Arteries Affect Blood Flow

    TGA disrupts the way blood flows through the heart and lungs. In a normal heart, the pulmonary artery pumps blood to the lungs, where it gathers oxygen. Then the aorta moves that oxygen-rich blood from the lungs to the rest of the body. However, TGA causes oxygen-poor blood to go to the body instead of the lungs, and oxygen-rich blood to go to the lungs instead of the body. TGA can cause infants to have dangerously low blood oxygen levels.

    When To Call The Doctor

    After heart surgery, call the doctor right away if your child has any of the following:

    • Increased redness, draining, swelling, or bleeding at the incision site

    • Fever 100.4°F or higher, or as advised

    • Trouble feeding, poor appetite, or weight loss

    • Tiredness

    • Cough that wont go away

    • Nausea or vomiting that continues

    • Irregular heartbeat

    • No noticeable improvement

    Will My Child Need More Surgery

    Some patients need more surgery to help their heart pump better, repair abnormal valves or control heart rhythm disturbances. Patients who’ve had the Mustard or Senning operation may need surgery to correct abnormalities of the tunnel in the atria, repair abnormal valves or control rhythm disturbances.

    Patients who had the arterial switch operation may need more surgery to relieve narrowings in the aorta or pulmonary artery where the original surgery was done, or to fix leaky valves.

    Diagnosing Transposition Of The Great Arteries

    Transposition of the Great Arteries

    Sometimes doctors can diagnose transposition of the great arteries in a developing baby before birth. They might first see something different about your babys great arteries on standard prenatal ultrasound. To learn more, you might have a fetal echocardiogram . Seattle Childrens Fetal Care and Treatment Center team can care for you when you are pregnant if your developing baby has a known or suspected problem.

    Most babies who are not diagnosed prenatally are diagnosed as newborns, before they go home from their birth center, because they show symptoms. A small number of newborns do not have clear symptoms right away, but a simple newborn screening test shows their body is not getting as much oxygen as it needs. If this screening test shows a concern, more detailed testing will be done.

    To diagnose this condition after birth, your babys doctor will examine your child and use a stethoscope to listen to their heart.

    The doctor will consider your babys symptoms, their health history and your family health history.

    Your baby will also need tests that provide information about how their heart and blood vessels look and work. These may include:

    • Pulse oximetry
    • Before your baby has surgery, they may need other steps. These may include:

    • Getting medicine to keep their ductus arteriosus from closing
    • Having cardiac catheterization to enlarge a small hole between the atria that normally closes shortly after birth using a balloon

    Pediatric Cardiology Treatment At Johns Hopkins

    • Advanced expertise in treating all forms of pediatric and congenital heart disease.
    • Your childs care team includes pediatric cardiologists, surgeons and child life specialists.
    • Care for the whole family to support you, your child and your childs siblings.

    Can Further Repair Be Done In Adulthood

    In rare cases, an adult patient who had an atrial switch operation may be a candidate for a takedown of their original operation and conversion to an arterial switch operation. This is more complicated than it sounds because this operation changes the main pumping chamber of the heart from the right to the left ventricle. Special additional procedures need to be done to prepare the left ventricle for this operation and they add considerable risk. This operation is only being done at a limited number of centers and usually only in adolescents or young adults.

    How Can I Prevent Transposition Of The Great Arteries

    There is no known way to prevent transposition of the great arteries. Good prenatal care matters. Be sure your immunizations are up to date, take a multivitamin as prescribed by your provider and attend prenatal appointments.

    If you have a history of heart defects in your family or a child with a congenital heart defect, talk to your provider. They may recommend genetic testing and counseling before you get pregnant.

    Key Points About Tga In Children

    Transposition of the Great Arteries (TGA): After Surgery (5 of 5)

    In TGA, your childs aorta is connected to the right ventricle, and the pulmonary artery is connected to the left ventricle. This is the reverse of a normal heart.

    • A newborn with TGA will usually have gray or bluish skin color in the first days of life.

    • All children with a TGA will need to have surgery to fix it.

    • Most children who have surgery for this condition will grow and develop normally. Your child will still need checkups and may require more surgery in the future.

    Transposition Of The Great Vessels

    From Wikipedia the free encyclopedia

    Transposition of the great vessels
    Other names d-TGA, Congenital heart defect – transposition
    Illustration of transposition of the great vessels
    Medical genetics

    Transposition of the great vessels is a group of congenitalheart defects involving an abnormal spatial arrangement of any of the great vessels: superior and/or inferiorvenae cavae, pulmonary artery, pulmonary veins, and aorta. Congenital heart diseases involving only the primary arteries belong to a sub-group called transposition of the great arteries , which is considered the most common congenital heart lesion that presents in neonates.

    What Are The Symptoms Of Tga In A Child

    Many babies with TGA have a bluish or gray color to the skin in the first hours or days of their lives.

    Other symptoms that can occur include:

    • Fast breathing

    • Fast heart rate

    • Poor feeding

    The symptoms of TGA may be similar to symptoms of other conditions. Make sure that your child sees their healthcare provider for a diagnosis.

    How Is Tga Diagnosed

    If your child has signs of TGA after birth, a pediatric cardiologist or neonatologist will check him or her. A pediatric cardiologist is a doctor with special training in treating heart problems in babies and children. A neonatologist is a doctor with special training in treating problems in newborns. These doctors will be part of your babys heart care team.

    Your childs doctor may do tests to confirm the diagnosis. The tests your child has depends on his or her age and condition, and the doctors preferences.

    How Is Tga Diagnosed In A Child

    Transposition Of The Great Arteries

    If your child has signs of TGA after birth, a pediatric cardiologist or neonatologist will check your child. A pediatric cardiologist is a healthcare provider with special training in treating heart problems in babies and children. A neonatologist is a healthcare provider with special training in treating problems in newborns. These providers will be part of your babys heart care team.

    Your child will likely have tests to confirm the diagnosis. The tests your child has depend on your child’s age and condition, and the providers preferences.

    Why Is Tga A Concern

    Babies with TGA have two separate circuits – one that circulates oxygen-poor blood from the lungs back to the lungs, and another that recirculates oxygen-rich blood from the body back to the body. Without an additional heart defect that allows mixing of oxygen-poor and oxygen-rich blood, such as an atrial or ventricular septal defect, infants with TGA will have oxygen-poor blood circulating through the body – a situation that is fatal. Even with an additional defect present that allows mixing, babies with transposition of the great arteries will not have enough oxygen in the bloodstream to meet the body’s demands.

    Even when a good bit of mixing of oxygen-poor and oxygen-rich blood can occur, other problems are present. The left ventricle, which in TGA is connected to the pulmonary artery, is the stronger of the two ventricles since it normally has to generate a lot of force to pump blood to the body. The right ventricle, connected to the aorta in TGA, is the weaker of the two ventricles. Because the right ventricle is weaker, it may not be able to pump blood efficiently to the body, and it will enlarge under the strain of the job. The left ventricle may pump blood into the lungs more vigorously than needed, leading to strain in the blood vessels in the lungs.

    How Can My Child Best Live With D

    Your child can live a long, enjoyable life after treatment for transposition of the great arteries. Their heart needs lifelong follow-up care, including:

    • Regular appointments with a cardiologist with expertise in this condition.
    • Medications.
    • Regular, noninvasive heart function tests, which may include EKGs, Holter monitors, exercise stress tests and echocardiograms.

    What Type Of Problems Might My Child Have

    Heart function problems

    Patients who’ve had an atrial switch may have a serious decline in heart muscle or heart valve function. This is because the right ventricle is pumping blood to the entire body instead of just the lungs. Medications to help the heart pump better, control fluid accumulation and control blood pressure may help. Patients who’ve had the arterial switch operation don’t seem to have as great a risk of heart muscle decline. They may have valve leakage or coronary artery problems, however.

    Heart rhythm problems

    People with repaired transposition, especially those who’ve had the Mustard or Senning operation, are at risk of developing heart rhythm abnormalities . These arrhythmias often arise in the heart’s upper chambers. Your child’s heart rate may be too slow or too fast. If the heart rate is too slow, an artificial pacemaker can speed it up. If your child’s heart rate is too fast, medication can slow it down. At times, your child may need a cardiac catheterization to study and treat these rhythm disturbances.

    What Will My Child Need In The Future

    The Arterial Switch Operation to Treat Transposition of the Great Arteries (TGA) – CHOP

    Patients with transposition will require lifelong follow-up with a cardiologist trained to care for patients with congenital heart disease. Your child may need to take medications to improve how his or her heart works. The cardiologist will track your child with a variety of non-invasive tests. These include electrocardiograms, Holter monitors, exercise stress tests and echocardiograms.

    Signs And Symptoms Of Tga

    The obvious TGA symptom is a newborn who becomes cyanotic in the transitional first day of life when the maternal source of oxygen is removed. Cyanosis is noted in the first hours of life in about half of the infants with TGA, and within the first days of life in 90 percent of them. The degree of cyanosis is related to the presence of other defects that allow blood to mix, including a patent ductus arteriosus – a fetal connection between the aorta and the pulmonary artery present in the newborn, which usually closes in the first few days after birth.

    The following are the other most common TGA heart symptoms. However, each child may experience symptoms differently. Symptoms may include:

    • Rapid breathing
    • Rapid heart rate
    • Cool, clammy skin

    The symptoms of TGA may resemble other medical conditions or heart problems. Always consult your child’s physician for a diagnosis.

    Experts In Treating Transposition Of The Great Arteries

    Transposition of the great arteries can be life-threatening, so infants born with TGA will likely be admitted to the cardiac intensive care unit immediately after delivery. Surgery is a required treatment for TGA and usually takes place within one or two weeks of birth. Ideally, babies will have been diagnosed with TGA before birth and delivered in a hospital with the expertise to care for babies with critical congenital heart defects.

    The Herma Heart Institutes pediatric cardiologists and heart surgeons have extensive experience in treating children with transposition of the great arteries and offer excellent surgical outcomes. Their expertise in all congenital heart defects that may impact your child, along with an onsite Birth Center and our advanced cardiac intensive care specialization, makes the Herma Heart Institute team a trusted partner in your childs care.

    The Herma Heart Institute consistently achieves outstanding outcomes for congenital heart surgery for even the most complex types of heart disease, as evaluated by the Society of Thoracic Surgeons. Learn more about our heart surgery outcomes.

    Note: Data is provided from the Society of Thoracic Surgeons . New data is not available beyond June 2019, as STS is in the process of refining their reporting methodologies. Hospitals are also limited in providing updated data due to the demands of the COVID-19 pandemic.

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