Transposition of the great arteries : Causes - Symptoms- Diagnosis -Treatment
What Is Transposition of the Great Arteries(TGA)?
Dextro-Transposition (pronounced DECKS-tro trans-poh-ZI-shun) of the good Arteries or d-TGA could be a anomaly of the center during which the 2 main arteries carrying blood out of the center – the most arteria pulmonalis and therefore the arterial blood vessel – square measure switched in position, or “transposed.
Dextro-Transposition of the good Arteries or d-TGA could be a anomaly of the center during which the 2 main arteries carrying blood out of the center – the most arteria pulmonalis and therefore the arterial blood vessel – square measure switched in position, or “transposed.” As a result of a baby with this defect may have surgery or different procedures before long once birth, d-TGA is taken into account as a crucial inborn heart defect (CCHD). Inborn suggests that gift at birth.
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| Transposition of the Great Arteries |
In transposition of the good arteries, the arterial blood vessel is before the arteria pulmonalis and is either primarily to the proper (dextro) or to the left (levo) of the arteria pulmonalis. Levo-TGA is rarer than dextro-TGA. Dextro-TGA is usually merely known as “TGA.” However, “TGA” could be a broader term that features each dextro-TGA (d-TGA) and levo-TGA (l-TGA), or congenitally corrected TGA, that isn't mentioned here.
Medical terms
Transposition of the nice arteries (TGA) may be a serious, rare heart drawback during which the 2 main arteries in the center are reversed (transposed). The condition is a gift at birth (congenital heart defect).
and the ductus arteriosus These two heart defects share a number of similarities The treatment options for TOGA and DA are very similar and require open-heart surgery to correct This is performed when the baby is between one month and four months old During this procedure the surgeon reattaches the pulmonary artery to the aorta so blood can circulate through both lungs before circulating out to both arms and legs
Transposition of the great arteries is a congenital heart defect in which the left and right ventricles are transposed Oxygen-poor blood from the body comes into the heart goes through the tricuspid valve to the right atrium and flows to the right ventricle From there it goes through the pulmonary valve to enter the lungs where it picks up oxygen Now oxygen-rich blood goes across to the left side of the heart down into the left atrium and then out into circulation through two major vessels called The Pulmonary Artery and The Aorta that carry it all over your body.
In a baby, while not having an inborn heart defect, the proper facet of the center pumps oxygen-poor blood from the center to the lungs through the arteria pulmonalis. The left facet of the center pumps oxygen-rich blood to the remainder of the body through the arterial blood vessel. The arterial blood vessel is sometimes behind the arteria pulmonalis.
In babies with d-TGA, oxygen-poor blood from the body enters the proper facet of the center. But, rather than attending to the lungs, the blood is wired directly back to resolute the remainder of the body through the arterial blood vessel. Oxygen-rich blood from the lungs coming into the center is wired straight back to the lungs through the most arteria pulmonalis.
Often, babies with d-TGA produce other heart defects, like a hole between the lower chambers of the center (a cavity septate defect) or the higher chambers of the center (an chamber septate defect) that permit blood to combine so some oxygen-rich blood may be wired to the remainder of the body. The patent blood vessel conjointly permits some oxygen-rich blood to be wired to the remainder of the body.
Types Transposition of the great arteries
There are two types of transposition of the great arteries:
Complete transposition of the great arteries, also known as dextro-transposition of the good arteries (D-TGA), causes a shortage of oxygen-rich blood to the body. Symptoms are sometimes noticed throughout gestation, instantly when birth or at intervals a number of weeks of birth. while not treatment, serious complications or death will occur.
- Congenitally corrected transposition, also referred to as levo-transposition of the nice arteries (L-TGA), may be a less common form of this condition. Symptoms might not be noticed at once. Treatment depends on the precise heart defects.Corrective surgery before long when birth is the usual treatment for transposition of the nice arteries.
Symptoms Transposition of the great arteries(TGA)
Signs of transposition of the good arteries is also detected throughout routine screening tests done throughout physiological state.
However, some folks with congenitally corrected transposition of the good arteries might not have symptoms for several years.
Signs and symptoms of transposition of the good arteries when birth include:
Blue color of the skin (cyanosis)
Shortness of breath
Weak pulse
Lack of appetite
Poor weight gain
A blue coloring might not be as noticeable in babies WHO area unit born with transposition of the good arteries and different non heritable heart defects. This can be as a result of these different heart conditions — like chamber congenital heart defect, cavum congenital heart defect or patent blood vessel — could enable some oxygen-rich blood to travel through the body. However, because the baby becomes additional active, the non heritable heart defects will not enable enough blood through and eventually the blue coloring can become obvious.
When to see a doctor
Complete transposition of the nice arteries is sometimes detected before birth, right away once birth or among the primary hours to weeks of life.
Always get emergency medical relief if you notice that anyone develops a blue coloring of the skin.
Causes Transposition of the great arteries(TGA)
The causes of non inheritable heart defects, like d-TGA, among most babies square measure unknown. Some babies have non inheritable heart defects attributable to changes in their genes or chromosomes. Heart defects are thought to be caused by the mix of genes and different risk factors like things the mother comes to bear with in her surroundings, or what the mother grub or drinks, or bound medications she uses.
Transposition of the good arteries happens throughout maternity once the baby's heart is developing. The cause is most frequently unknown.
To understand transposition of the good arteries, it should be useful to grasp however the guts usually pump blood.
Usually, the artery that carries blood from the heart to the lungs (pulmonary artery) connects to the heart's lower right chamber (right ventricle).
Oxygen-rich blood is then pumped from the lungs to the heart's upper left chamber (left atrium).
Blood then flows into the lower left chamber (left ventricle).
The body's main artery (aorta) typically connects to the left ventricle. It carries oxygen-rich blood out of the heart to the rest of the body.
Complete transposition of the great arteries (D-TGA)
In a complete transposition of the good arteries (also known as dextro-transposition of the good arteries), the arterial blood vessels and therefore the arteries have switched positions. The arterial blood vessel connects to the heart ventricle, and therefore the arteria is connected to the proper ventricle.
As a result, oxygen-poor blood flows through the proper facet of the center and back to the body while not passing through the lungs. Oxygen-rich blood flows through the left facet of the center and directly into the lungs while not being pumped up to the remainder of the body.
Congenitally corrected transposition (L-TGA)
In this less common kind, additionally referred to as levo-transposition of the nice arteries (L-TGA), the 2 lower heart chambers (ventricles) square measure switched. The ventricle is on the heart's right aspect and receives blood from the correct atrium, and also the heart ventricle is on the heart's left aspect and receives blood from the atrium cordis.
The blood sometimes flows properly through the guts and body. The right-sided ventricle attaches to the arteria pulmonalis, which delivers oxygen-poor blood to the lungs, whereas the left-sided heart ventricle attaches to the artery that carries oxygen-rich blood to the body. As a result of the 2 chambers not being specifically alike, the guts will have a long-run issue pumping blood. folks with L-TGA may have issues with the angular heart valve.
Risk factors Transposition of the great arteries(TGA)
Several things may increase the risk of a baby being born with transposition of the great arteries, including:
A history of German measles (rubella) or another viral illness in the mother during pregnancy
Drinking alcohol or taking certain medications during pregnancy
Smoking during pregnancy
Poorly controlled diabetes in the mother during pregnancy
Complications Transposition of the great arteries
Transposition of the good arteries will contribute to different health issues later in life. Complications rely on the sort of transposition of the good arteries (TGA).
Potential complications of complete transposition of the good arteries (D-TGA) could include:
Lack of oxygen to tissues. The body tissues receive too little oxygen (hypoxia). Unless there's some mixing of oxygen-rich blood and oxygen-poor blood within the body, this complication causes death.
- Heart failure. Heart failure could be a condition within which the guts cannot pump enough blood to fulfill the body's wants. it should develop over time as a result of the correct lower heart chamber (ventricle) is pumping below higher pressure than usual. The strain might create the muscle of the correct ventricle stiff or weak.Potential complications of congenitally corrected transposition (L-TGA) might include:
Reduced heart pumping function. In L-TGA, the right lower heart chamber (right ventricle) is pumping blood to the body. This work is different from what the right ventricle was designed to do.
Complete heart block. The changes within the structure of the guts thanks to L-TGA will disrupt the electrical signals that tell the guts to beat. a whole atrioventricular block happens if all signals are blocked.
Heart valve disease. Valves within the heart act as doorways to stay blood acquiring in one direction. In congenitally corrected transposition, the valve between the higher and lower heart chambers (tricuspid valve) might not shut utterly, inflicting blood to maneuver backward. This condition is termed right atrioventricular valve regurgitation. Regurgitation will eventually result in reduced heart pumping.
Prevention Transposition of the great arteries
If you've got a case history of non heritable heart defects or if you have already got a toddler with one, take into account talking with a genetic counselor and a medical specialist practiced in non heritable heart defects before obtaining a pregnancy.
It's important to require steps to possess a healthy physiological condition. Before changing into pregnancy, rise thus far on all immunizations and begin taking a vitamin pill with four hundred micrograms of vitamin B.
Diagnosis Transposition of the great arteries(TGA)
Transposition of the good arteries is most frequently diagnosed once a baby is born. However, signs of the condition could also be detected before birth throughout a routine physiological condition ultrasound. If so, a craniate sonogram could also be suggested. A craniate sonogram uses sound waves to make careful pictures of the unhatched baby's heart. It will facilitate a health care supplier to ensure the designation of transposition of the good arteries.
After birth, a health care supplier could suspect a heart defect like transposition of the good arteries if the baby has blue skin, a weak pulse or hassle respiration.
The care supplier might also suspect a heart downside if Associate in Nursing irregular whooshing sound (heart murmur) is detected once taking note of the baby's heart.
Tests
A physical exam alone can't accurately diagnose transposition of the great arteries. One or more of the following tests are necessary for an accurate diagnosis:
Echocardiogram. A sonogram is Associate in Nursing ultrasound of the center. It uses sound waves to make moving pictures of the center in motion. Associate in Nursing sonogram will show the position of the arteria and therefore the arterial blood vessel. The check can even determine different associated innate heart defects, like a cavity congenital heart defect, chamber congenital heart defect or patent blood vessel.
Chest X-ray. Although a chest X-ray does not offer a definitive diagnosis of transposition of the nice arteries, it will permit the supplier to visualize the baby's heart size and verify if blood flow is collected within the lungs.
Electrocardiogram (ECG or EKG). This easy, painless take a look at records the electrical activity of the guts. Sticky patches (electrodes) are placed on the chest and generally the arms and legs. Wires connect the electrodes to a pc, that displays the take a look at results. associate degree ECG will show if the guts is thrashing too quick, too slow or not in the slightest degree.
Treatment Transposition of the great arteries(TGA)
All infants with complete transposition of the good arteries (D-TGA) would like surgery to correct the non inheritable heart defect. Treatment for congenitally corrected transposition (L-TGA) depends on once the condition is diagnosed and what different heart conditions exist.
The baby's care supplier could advocate medications or a tube procedure to assist manage the condition before corrective surgery.
Medications
Before surgery for transposition of the nice arteries, a drug known as alprostadil (Caverject, Edex, others) is also given to extend blood flow and improve admixture of oxygen-poor and oxygen-rich blood.
Surgery or other procedures
Surgery for transposition of the good arteries is typically done inside the primary days to weeks when birth. choices depend upon the kind of transposition. Not all patients with congenitally corrected transposition would like surgery.
Surgeries and procedures accustomed treat transposition of the good arteries might include:
Atrial septostomy. This catheter procedure may be done urgently as a temporary treatment. The procedure, also called balloon atrial septostomy, widens a natural connection between the heart's upper chambers (atria). It helps mix oxygen-rich and oxygen-poor blood, increasing oxygen delivery to the baby's body.
- Arterial switch operation. This is the foremost common surgery accustomed to correct transposition of the good arteries. Throughout associate blood vessel switch operation, the arteria pulmonalis and therefore the arterial blood vessels are affected to their correct positions. The arteria pulmonalis is connected to the correct ventricle, and therefore the arterial blood vessel is connected to the heart ventricle. The guts arteries are reattached to the arterial blood vessel.If your baby conjointly incorporates a cavum congenital heart defect or associate chamber congenital heart defect, those holes sometimes are closed throughout surgery. However generally a heart specialist might leave little cavum body part defects to shut on their own.
- Atrial switch operation. In this surgery, the MD divides blood flow between the heart's 2 higher chambers (atria). Oxygen-rich blood coming to the guts from the lungs is directed to the correct lower chamber (right ventricle), which then pumps the blood to the arteries. The oxygen-poor blood returning to the guts from the body is directed to the left lower chamber (left ventricle), wherever it's pumped-up to the artery.After the chamber switch procedure, the correct ventricle should pump blood to the body, rather than simply to the lungs because it would liquidate a typical heart. attainable complications of the chamber switch operation embody irregular heartbeats, obstructions or leaks, and heart disease because of semi permanent reduced pumping operation.
Rastelli procedure. This procedure is also counseled if a baby contains a chamber congenital heart defect with transposition of the good arteries. The operating surgeon closes the opening (septal defect) within the heart employing an artificial patch and redirects blood from the heart ventricle to the artery, permitting the oxygen-rich blood to travel to the body. The association between the heart ventricle and also the artery is discontinuous . An association is then created with a man-made valve from the correct ventricle to the artery connected to the lungs (pulmonary artery).
- Double switch procedure. This complicated surgical treatment is employed to treat congenitally corrected transposition. It redirects blood flow coming back into the guts and switches the nice artery connections, with the goal of putting the left lower heart chamber (ventricle) within the position to pump gas wealthy blood to the arterial blood vessel.Additional surgeries are also required to correct alternative heart conditions, like cavum congenital heart defect or pulmonic outflow obstruction. A pacemaker is also required if transposition of the nice arteries causes a pause in heart sign (heart block).Some complications of transposition of the nice arteries, like irregular heart rhythms (arrhythmias) or heart valve issues might need extra treatment.
After treatment
After corrective surgery for transposition of the good arteries, the person would like long follow-up care with a heart doctor (cardiologist) . The World Health Organization focuses on innate cardiomyopathy.
Strenuous activity. The cardiologist may recommend avoiding certain activities, such as weightlifting or competitive sports, because they raise blood pressure and may stress the heart. Talk to your or your child's provider about what type and amount of activity is safe.
- Pregnancy. If you are pondering changing into pregnancy, discuss with your heart specialist and specialist before conceiving. If you had surgery to correct transposition of the nice arteries whereas a baby, it should be attainable to own a healthy maternity, however specialized care is also required.Complications of transposition of the nice arteries, like irregular heart rhythms or serious muscular tissue issues, might create maternity risk for each mammy and also the unborn baby. In some things, like for girls, the United Nations agency has severe complications of their heart defect, maternity is not suggested even for those with a repaired transposition.
What drug is given immediately after diagnosis of transposition of the great arteries?
Embolization of the ductus arteriosus also referred to as pulmonary artery banding is a procedure done in newborns where the ductus arteriosus that connects the main artery of the heart (the pulmonary trunk) to one of the major arteries leaving the heart (the aorta) is closed off with an elastic band This surgery is necessary because without it blood would flow from two different sources into two different places rather than through only one source into one place If left untreated this could result in heart failure or other serious health effects for your child The good news is that this surgery can be done.
How successful is TGA surgery?
The TGA Surgery is a surgical procedure where the surgeon repairs the heart This surgery was developed by Dr Mehmet Oz who explained it in the ABC documentary "Heart of a Hospital" The surgery itself is usually only used on babies born with two separate atria and ventricles- but nowadays is also performed on adults with TGV (Tetralogy of Fallot) as well.This operation does not correct ALL defects- only those that involve separating the heart into two sides so both right and left side of your heart must be normal to begin with (as well as the valves) This operation has been found very.
How serious is the transposition of the great arteries?
Transposition of the great arteries also known as TGA or dextro transposition of the great arteries (DGA) is a congenital heart defect in which the two large blood vessels that carry oxygen-rich and oxygen-poor blood from the heart are improperly connected The pulmonary artery carries oxygen-rich blood from the lungs to the left side of your heart The aorta carries oxygen-poor blood from your heart to other parts of your body In people with transposition of the great arteries these major vessels are reversed so that instead of receiving blood rich in oxygen both sides of the heart receive poor quality.
transposition of the great arteries in adults
Transposition of the great arteries is a congenital life-threatening heart defect in which the first and second chambers of the heart are transposed The defect results in oxygenated blood being pumped into the lungs while deoxygenated blood is pumped to body tissues.
How much does arterial switch surgery cost?
The cost of arterial switch surgery depends on where the surgery is performed factors such as the surgeon's and anesthesiologist's fees length of stay at the hospital blood tests/imaging studies/medications that are deemed necessary before or after surgery and your overall health According to a 2011 study in "Plastic & Reconstructive Surgery," total costs were $1.2 million to $1.6 million for each patient over his or her lifetime To foot this bill most families turn to medical insurance (usually through their employer) as well as private funding sources like grants and fundraisers A 2016 study published.
When is an arterial switch operation performed?
Arterial switch operation is performed when one of the branch vessels or arteries supplying blood to the lungs becomes malformed It is a surgical procedure that attempts to restore normal circulation by correcting an abnormal anatomic connection between a pulmonary artery and its corresponding bronchus The surgeon performing the procedure detaches part of the affected branch vessel from its anomalous connection and reattaches it to its proper location in order to improve blood flow through the lung.
Coping and support
Caring for a baby with a heavy cardiovascular disease, like transposition of the nice arteries, is often difficult. Here square measure some ways which will facilitate create it easier:
Seek support. Ask for help from family members and friends. Talk with your child's cardiologist about support groups and other types of assistance that are available near you.
Record your or your baby's health history. Write down the identification, medications, surgery, and alternative procedures and therefore the dates they were performed, in conjunction with any doctor's names and numbers. This record is going to be useful for health care suppliers United Nations agency area units unacquainted with your or your baby's health history.
- Encourage safe activities. After corrective surgery, you or your kid might have to avoid sure forms of vigorous activities. speak with the specialist regarding that activities area unit safe. If some area units are restricted, encourage different pursuits instead of specializing in what cannot be done.Every circumstance is totally different. However, because of advances in surgery, most babies with transposition of the nice arteries develop to guide active lives.
Preparing for your appointment
If a care provider suspects transposition of the arteries, you or your child will be referred to a cardiologist for diagnosis and treatment.
What you can do
Get a complete family history for both sides of your family. Ask if anyone in your family has had a congenital heart defect or congenital heart disease.
Take a family member or friend with you, if doable. generally it will be tough to recollect all of the data provided to you. somebody United Nations agency goes with you'll be ready to recall data if you forget some details.
Write down questions to ask the health care provider.
For transposition of the great arteries, some basic questions to ask the health care provider include:
What treatments are available, and which do you recommend?
After surgery, will there be any lingering health concerns?
Are there any activity restrictions?
Are there any brochures or other printed material that I can take home with me? What websites do you recommend?
In addition to the questions that you've prepared to ask your health care provider, don't hesitate to ask questions during your appointment if you don't understand something.
What to expect from your doctor
Your health care provider is likely to ask you a number of questions, such as:
Is there a family history of heart disease at birth?
Were there any known pregnancy complications?
Have you noticed that your baby has blue skin, difficulty feeding or difficulty breathing?
If you are the patient, have you had shortness of breath, swelling of the legs or irregular heartbeats?
General summary
Transposition of the great arteries is a congenital heart defect in which the two major blood vessels that carry oxygen-rich and oxygen-poor blood are reversed This disorder arises when a fetus receives insufficient amounts of oxygen before birth In some cases transposition of the great arteries can be diagnosed before birth by ultrasound while more severe forms often go undetected until later infancy or early childhood.
