Description

Transposition of the great arteries (TGA) is a serious and rare heart problem in which the two main arteries leaving the heart are reversed. The condition is present at birth, which means that it is a congenital defect of the heart.

Types of

There are two types of transposition of the great arteries:

  • Complete transposition of the great arteries , also called dextro-transposition of the great arteries (D-TGA). This type reduces the amount of oxygen-rich blood to the body. The symptoms are usually seen during pregnancy, immediately after birth or within a few weeks of birth. Without treatment, serious complications or death may occur.
  • Congenitally corrected transposition , also called levo-transposition of the great arteries (L-TGA). This is a less common type. Symptoms may not be immediately noticed. The treatment depends on the specific problems of the heart.

The surgery to correct the positions of the arteries, is the usual treatment. The surgery is usually done shortly after birth.

Symptoms

Transposition of the great arteries (TGA) can be seen in a baby before the birth, during a routine pregnancy ultrasound.

But some people with congenitally corrected type of TGA may not have symptoms for many years.

The symptoms of transposition of the great vessels after birth are:

  • Blue or gray skin. Depending on the baby's skin color, these color changes may be more difficult or more easy to see.
  • Weak pulse.
  • The lack of appetite.
  • Poor weight gain.

The color of the skin changes may not be noticed right away if a baby with TGA also have other heart problems. This is because of the other problems of the heart may stop the oxygen-rich blood moves through the body. But as the baby becomes more active, less blood flows through the body. Blue or gray skin color, then it becomes more noticeable.

When to see a doctor

Always seek emergency medical help if you notice that someone develops a blue or gray color of the skin.

Causes

Transposition of the great arteries occurs during pregnancy, when the baby's heart is developing. The cause is most often unknown.

To understand the transposition of the great arteries, can be useful to know how the heart normally pumps blood.

  • Generally, the artery that carries blood from the heart to the lungs, called the pulmonary artery — are connected with the heart in the bottom right of the camera. That camera is called the right ventricle.
  • The oxygen-rich blood is pumped from the lungs to the heart of the upper-left of the camera, also called the left atrium.
  • The blood flows in the bottom left of the camera, known as the left ventricle.
  • The body's main artery, called the aorta, is normally connected to the left ventricle. Carries oxygen-rich blood from the heart to the rest of the body.

Complete transposition of the great arteries (D-TGA)

In a complete transposition of the great arteries (also called dextro-transposition of the great arteries), the two arteries leaving the heart have swapped positions. The pulmonary artery connects to the lower left chamber of the heart. The aorta connects to the right lower chamber of the heart.

The switching of the arteries cause changes in the blood flow. The oxygen-poor blood now flows through the right side of the heart. It returns to the body without passing through the lungs. The oxygen-rich blood now flows through the left side of the heart. Goes directly to the lungs without being pumped to the rest of the body.

Congenitally corrected transposition (L-TGA)

In this less common type, also called levo-transposition of the great arteries (L-TGA), the two lower chambers of the heart are reversed.

  • The lower left chamber of the heart called the left ventricle, which is in the heart of the right-hand side. It receives blood from the right upper heart chamber.
  • The lower right part of the heart of the camera is in the heart of the left side. It gets blood from the left upper chamber of the heart.

The blood usually still flows correctly through the heart and body. But the heart can have long-term problems of pumping of the blood. People with L-TGA may also have problems with the tricuspid valve (heart).

Risk factors

Several things can increase the baby's risk of transposition of the great arteries, including:

  • A history of German measles (rubella) or other infection by a virus during pregnancy.
  • Drinking alcohol or taking certain medications during pregnancy.
  • Smoking during pregnancy.
  • Poorly controlled diabetes during pregnancy.

Complications

Complications depend on the type of transposition of the great arteries (TGA).

The possible complications of complete transposition of the great arteries ( D-TGA ) can include:

  • There is not enough oxygen to the tissues of the body. Unless there is some mixing of oxygen-rich blood and oxygen-poor blood in the body, this complication causes of death.
  • Heart failure. Heart failure is a condition in which the heart is unable to pump enough blood to meet the body's needs. It can develop over time due to the right lower chamber of the heart is to pump under greater pressure than usual. Stress can cause the muscle at the bottom right of the camera, rigid or weak.

The possible complications of the transposition congenitally corrected ( L-TGA ) can include:

  • Reduction of pumping of the heart. In L-TGA , the right lower chamber of the heart pumps blood to the body. This work is different from what the camera was designed to do. This can cause changes in how well the heart pumps blood.
  • Complete heart block. The changes in the structure of the heart due to the L-TGA can change the electrical signals that tell the heart to beat. A complete heart block occurs if all the signals are blocked.
  • Heart valve disease. In L-TGA , the valve that lies between the upper and lower chambers of the heart — tricuspid valves — may not close completely. The blood can move backward through the valve. This condition is called regurgitation of the tricuspid valve. Eventually, you can reduce the heart's ability to pump blood.

Pregnancy and TGA

If you had transposition of the great arteries and wish to become pregnant, talk with a health care provider first. It is possible to have a healthy pregnancy, but special care may be needed.

Complications of the TGA , such as the changes in the heart of signaling, or of serious muscle problems of the heart, can make pregnancy risky. Pregnancy is not recommended for people who have severe complications of the TGA , even if you underwent a surgery to correct the TGA .

Prevention

If you have a family history of heart problems present from birth, consider talking with a genetic counselor and a physician with experience in congenital heart defects before you get pregnant.

It is important to take measures to have a healthy pregnancy. Before you get pregnant, it is recommended vaccines and to start taking a multivitamin with 400 micrograms of folic acid.

Diagnosis

Transposition of the great arteries is most often diagnosed after the baby is born. But sometimes, the condition may be seen prior to birth, during a routine pregnancy ultrasound. If so, an ultrasound of the baby before it is born of the heart may be done to confirm the diagnosis. This test is called a fetal echocardiogram.

After birth, a health care provider can think about a diagnosis of TGA if the baby has blue or gray skin, weak pulse, or difficulty breathing. The care provider may hear a sound of the heart, called a murmur, while listening to the baby's heart.

Tests

Evidence is needed to confirm a diagnosis of transposition of the great arteries. They may include:

  • The echocardiogram. This test uses sound waves to create moving images of the beating heart. Shows how blood flows through the heart, the valves of the heart and blood vessels. You can display the positions of the two main arteries leaving the heart. An echocardiogram may also show if there are other problems with the heart present at birth, such as a hole in the heart.
  • X-ray of the chest. An x-ray of the chest shows the condition of the heart and the lungs. You can't diagnose TGA by itself, but that helps the doctor to see the heart of the size.
  • Electrocardiogram (ECG or EKG). This simple, painless test records the electrical activity of the heart. Sticky patches called electrodes are placed on the chest and sometimes the arms and legs. The wires connect the electrodes to a computer, which displays the results of the test. An EKG can show if the heart is beating too fast, too slow or not at all.

Treatment

All infants with complete transposition of the great arteries ( D-TGA ) need surgery to correct the heart problem. The treatment for transposition congenitally corrected ( L-TGA ) depends on whether the condition is diagnosed, and what other conditions of the heart there's.

Drugs

Before the surgery is performed to correct the switching of the arteries, a medicine called alprostadil (Caverject, Edex, other) may be given to the baby. This medicine increases the flow of blood. Helps the oxygen-poor and oxygen-rich blood that best blend.

Surgery or other procedures

Surgery for transposition of the great arteries (TGA) is usually performed within the first days or weeks after birth. The options depend on the type of TGA . Not all people with congenitally corrected transposition of the need of surgery.

Surgeries and other treatments used to treat transposition of the great arteries may include:

  • Septostomy headset. This treatment can be carried out with urgency as a temporary solution before the surgery. Uses thin tubes and small cuts to extend a natural connection between the upper chambers of the heart. It helps to mix oxygen-rich and oxygen-poor blood, improve oxygen levels in the baby's body.
  • Arterial switch operation. This is the most common surgery used to correct transposition of the great arteries. During this surgery, the two main arteries leaving the heart are moved to their correct positions. Other problems with the heart present at birth can be repaired during this surgery.
  • Atrial switch operation. The surgeon divides the flow of blood between the heart's two upper chambers. After this surgery, the right lower chamber of the heart must pump blood to the body, instead of only to the lungs.
  • Rastelli procedure. This surgery can be done if a baby with TGA also has a hole in the heart called a ventricular septal defect. The surgeon patches the hole, and redirects the flow of blood from the left lower chamber of the heart into the aorta. This allows oxygen-rich blood going to the body. An artificial valve connects the right lower chamber of the heart to the pulmonary artery.
  • Double switch procedure. This complex surgery is used to treat transposition congenitally corrected. Redirects the flow of blood coming into the heart. Change the large artery connections of the left lower chamber of the heart can pump oxygen-rich blood to the aorta.

Babies who are born with TGA often have other heart problems. Other surgeries may be needed to solve the problems of the heart. Surgery may also be necessary to treat complications of the TGA . If TGA, causes changes in the beating of the heart, a device called a pacemaker may be recommended.

After surgery to correct TGA , all of life is necessary to take care with a provider who is qualified in problems with the heart present at birth. This type of health care provider is called a congenital cardiologist.

Coping and support

Caring for a baby with a serious heart condition, such as transposition of the great arteries, can be a challenge. Here are some tips that might be useful:

  • Seek support. Request the assistance of family members and friends. Talk with your baby's health care providers about support groups and other types of assistance that are available near you.
  • Registration of the baby's health history. Write down the diagnosis, medications, surgery, and other treatments. Include dates of treatment or surgery and the health care providers of names and numbers. This record will be useful for health care providers who are not familiar with your baby's health history.
  • Promote the safety of the activities. After surgery to correct TGA , some high-energy activities may need to be avoided. Talk with a health care provider about what exercises or activities are safe.

Every situation is different. But due to advances in surgical treatment, the majority of infants with transposition of the great arteries grow and lead an active life.

Preparing for your appointment

If your baby has transposition of the great arteries (TGA), it is likely that you will have appointments with various types of health care providers. For example, you see a provider trained in issues of the heart that are present at birth, called congenital cardiologist. Here's some information to help you prepare for appointments.

What you can do

  • To obtain a complete family history for both sides of his family. Ask if anyone in your family was born with a heart problem.
  • Have a family member or friend with you, if possible. Sometimes it can be difficult to remember all the information provided to you. Someone who goes with you may be able to recall the details.
  • Write questions for the health care professional.

For transposition of the great arteries, some basic questions to ask the health care provider include:

  • Does my baby need surgery?
  • What other treatments are available, and which do you recommend?
  • How often are checks required after surgery?
  • After the surgery, will there be any other health concerns?
  • Are there any activity restrictions?
  • Are there brochures or other printed material that I can take my house? What sites do you recommend?

Don't hesitate to ask other questions you have.

What to expect from your doctor

Your health care provider is likely to ask a series of questions, such as:

  • There is a family history of heart problems at birth?
  • He had known pregnancy complications?
  • Does that person have the blue or the gray skin, difficulty feeding, or trouble breathing?
  • Did the person has difficulty breathing, swelling of the legs or irregular heartbeats?
Symptoms and treatment of Transposition of the great arteries