Dr.Elamaran.E Senior Resident Dept.

of CTVS,JIPMER

Congenital cardiac anomaly

Atrioventricular concordance and Ventriculo arterial discordance. Aorta arises from the morphologic right ventricle and the pulmonary artery arises from the morphologic left ventricle.

 Morphologic

description of TGA Baillie(1797) Transposition of the aorta and pulmonary artery was coined - Farre (1814)
Surgery

for TGA Atrial septectomy - Blalock and Hanlon(1950) Balloon atrial septostomy - Rashkind and Miller - (1966)

 Partial

physiological correction Lillehei

(1953)
Physiologic

correction at the atrial level Senning(1959) and Mustard(1963) switch procedure Jatene (1975)

Arterial

 Etiology

for transposition of the great arteries is unknown and is presumed to be multifactorial.

association in infants of diabetic

Common

mothers.

 Persistence

of sub Aortic conus and absorption of sub pulmonary conus of the Truncus Arteriosus to septate normally

Failure

 Transposition

of the great arteries (TGA) is the most common cyanotic congenital heart lesion that presents in neonates.
This lesion presents in 5-7% of all patients with congenital heart disease.

Male-to-female

ratio is 2:1. Male predominance increases to 3.3 : 1 (ventricular septum is intact)

Right ventricle Hypertrophied, Sub aortic conus Left ventricle- Normal to thinned out, Pulmonary-Mitral continuity Aorta- Anterior and right of PA Atria Normal (RA>LA) Atrio-Ventricular valves Same level Conduction tissue Normal position and abnormal shape

Normal -2/3 and Abnormal -1/3

 The

pulmonary and systemic circulations function in parallel, rather than in series.

 When

patients with all varieties of TGA are considered

55%

- 1 month 15% - 6 months 10% - 1 year

Transposition of the great arteries with intact ventricular septum Hypoxia

Transposition of the great arteries with ventricular septal defect cardiac failure Transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction- Hypoxia

 Aggressive

medical and surgical management in the neonate has around 90% early and midterm survival

1.

TGA with intact ventricular septum TGA with VSD TGA with VSD and LVOTO TGA with VSD and pulmonary vascular obstructive disease.

2.

3.

4.

 Patent

foramen ovale or Atrial septal defect-

75% Ventricular septal defect- 25% -40% Patent ductus Arteriosus-functionally closes by 1 month Left ventricular outflow obstruction-5% Mitral valve-cleft leaflet/accessory chordal tissue Tricuspid valve regurgitation/dysplasia

 Symptoms

and clinical presentation

Depend on degree of mixing between the two parallel circulatory circuits.

 TGA

with intact ventricular septum Cyanosis within 24 hours

TGA

with VSD congestive heart failure (2 to 4 months) with VSD and LVOTO- similar to TOF

TGA TGA

with VSD and PVOD develop Hypoxia after 6 months

 An

oval-or eggshaped cardiac silhouette with a narrow superior mediastinum Mild cardiac enlargement Moderate pulmonary plethora

 Simple

TGA Neonates- Arterial switch within 1 month Simple TGA after 30 days
Pulmonary artery banding- Arterial switch after 2 weeks Atrial switch

TGA

with VSD- Arterial switch within few weeks TGA with VSD and LVOTO repair - 6 months

 Establishing

Ventriculo-arterial concordance Anatomical correction

 Coronary Neo

artery lesions

Aortic valve regurgitation

RVOTO

and LVOTO obstruction

 Cardiac

failure- Secondary to severe LV dysfunction(imperfect coronary artery transfer to Neoaorta)

dysfunction Progressive pulmonary vascular disease (1%)

RV

Coronary

events

Physiological correction

 Baffle

obstruction and leak disturbances

Rhythm Severe Right

Tricuspid regurgitation

ventricle failure

 Low

output early post op period

RV failure

Systemic

 Aortic

translocation(TGA with VSD & LVOTO) Nikaidoh

with large VSD and

Damus-Kaye-Stansel(TGA

RVOTO)
TGA

with posterior Aorta- Arterial switch procedure without Lecompte maneuver

Thank You