Jan 23, 2016 transposition of great arteries dr amarja sachin nagre md,dm,fca. Tga causes the diversion of normal blood circulation, robbing the body of oxygen and nutrients. Levo or llooped transposition of the great arteries ltga is a rare form of congenital heart disease characterized by atrioventricular and ventriculoarterial discordance. Transposition of the great arteries tga was first recognized and described more than 2 centuries ago. Transposition of the great arteries tga, also called transposition of the great vessels, is a birth defect involving the two main arteries in the heart being switched. The switch means that the aorta, which normally carries oxygenated blood, carries deoxygenated blood. In rare cases, even the chambers of the heart will be swapped. Transposition of the great arteries symptoms and causes. Transposition of the great arteries is usually diagnosed in the hospital shortly after birth, leading to urgent consultation with pediatric cardiologists and cardiac surgeons.
Tga is a congenital heart disease in which the hearts largest arteries, the aorta and the pulmonary arteries, are switched. Transposition of the great arteries tga is a common congenital cardiac anomaly and accounts for 45% of all congenital heart disease. Transposition of the great arteries tga, also referred to as complete transposition, is a congenital cardiac malformation characterised by atrioventricular concordance and ventriculoarterial va discordance. It accounts for up to 7% of all congenital cardiac anomalies 1 and can be assessed with echocardiography. When a d transposition occurs, the blood pathway is impaired because the two arteries are connecting to the wrong chambers in the heart. Transposition of great arteries video khan academy. The aorta is located anteriorly and to the right, and the great arteries run in parallel instead of in their normal perpendicular relation.
A heart in which the two main arteries carrying blood away from the heart are reversed. Transposition of the great arteries tga is a cyanotic congenital heart defect in which the aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle, creating two parallel circuits. Transposition of the great arteries tga is a complex congenital heart defect. Congenitally corrected transposition of the great arteries. Transposition of the great arteries tga, also referred to as complete transposition, is a congenital cardiac malformation characterised by atrioventricular concordance and ventriculoarterial va. The heart forms during the first 8 weeks of fetal development. Facts about dextrotransposition of the great arteries dtga. An image on an egg on a string is superimposed on this chest radiograph to clairfy the appearance of the egg on a string sign of transposition of the great arteries, with enlargement of the cardiac silhouette and atrophy of the thymus leading to narrowing of the upper mediastinum.
Transposition of the great arteries or tga is a potentially fatal congenital heart malformation where the pulmonary artery and the aorta are switched. Otto md, in intraoperative and interventional echocardiography second edition, 2018. Transposition of the great arteries orphanet journal of. The aorta is attached to the rightsided pumping chamber ventricle, instead of the left. 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 hearts anatomy. Blood coming from the lungs gets sent back to the lungs rather than out to the body. Leftuntreated,tgaisassociatedwith from the achildrens national heart institute, childrens national medical center, george washington university, washington. Depending on the type of repair performed in childhood, an adult who was born with this condition needs ongoing followup to screen for abnormal blood diversion and irregular heart rhythms and to assess left and right heart function. The adult congenital and pediatric cardiology council of the american college of cardiology. Overall annual incidence is 2030 per 100,000 live births, tga is isolated in 90% of patients rarely associated with syndromes or extracardiac. If they have had a mustard or senning procedure, the issues have to do with slow heart rates, abnormally fast heart rates, pumping chamber weakness, leaky valves, and technical issues related to the surgical repair. Levo transposition of the great arteries is an acyanotic heart defect in which the primary arteries are transposed, with the aorta anterior and to the left of the pulmonary artery, and the morphological left and right ventricles with their corresponding atrioventricular valves are also transposed.
Transposition of the great arteries childrens memorial hermann. Transposition of the great arteries tga pediatrics msd. Dtransposition of the great arteries henceforth referred to simply as transposition or tga represents 57 % of congenital heart disease and is the second most common cyanotic defect after tetralogy of fallot 1. Transposition of the great arteries requires corrective surgery in the first weeks of life.
Dloop transposition of the great arteries tga is the second most common form of cyanotic congenital disease 3. This paper aims to update clinicians on hot topics in the management of patients with dloop transposition of the great arteries dtga in the current surgical era. In transposition of the great arteries tga, the hearts two major arteries are reversed. Transposition of the great arteries childrens hospital of. Cardiac surgery, kirklin jw, barrattboyes bg eds, churchill livingston, new york 1993. Transposition of the great arteries tga also known as transposition of the great vessels tgv is the most common cyanotic congenital cardiac anomal y presenting during the newborn period, with cyanosis in the first 24 hours of life. The aorta also tends to be on the right and anterior, and the great arteries are parallel rather than crossing as they do in.
Corrected transposition of the great arteries 359 anatomical characteristics and associated lesions notably, in most cases, the interventicular septum has a sagittal orientation with the ventricles at both sides in hearts that tend to mesocardia within the thorax fig. Transposition of the great vessels tgv is a group of congenital heart defects involving an abnormal spatial arrangement of any of the great vessels. Transposition of the great arteries childrens memorial. Aug 11, 2018 transposition of the great arteries is usually detected either prenatally or within the first hours to weeks of life. Read on for information about the characteristics of the defect at birth and the treatment and followup care that is necessary into adulthood. Transposition of the great arteries 0 university of chicago. Transposition of the great arteries tga constitutes 5% of all cyanotic congenital heart defects chds and 10% of all neonatal cyanotic chds 1 and is the most common cyanotic chd in the neonate. In 50% of cases, the va discordance is an isolated finding.
Transposition of the great arteries tga the embryo. Transposition of the great arteries tga is a group of congenital defects in which the position of major blood vessels of the heart are switched. The aorta is connected to the right ventricle, the pulmonary artery to the left ventricle. In cases of transposition of the great arteries aorta and pulmonary artery, these vessels are transposed from their normal position so that the aorta arises from the right ventricle and the. Transposition of the great arteries in this case, dextrotransposition occurs when the aorta arises directly from the right ventricle and the pulmonary artery arises from the left ventricle, resulting in independent, parallel pulmonary and systemic circulations.
Corrective surgery soon after birth is the usual treatment for transposition of the great arteries. It is also commonly referred to as congenitally corrected tga, double discordance, or ventricular inversion. Emergency procedures are often needed to improve your babys oxygen level. Learn for free about math, art, computer programming, economics, physics, chemistry, biology, medicine, finance, history, and more. Transposition of great arteries dr amarja sachin nagre md,dm,fca. Complete transposition of the great arteries is also known as dtga. Transposition of the great arteries cs mott childrens. Transposition of the great arteries diagnosis and treatment.
Tga occurs in about 3% of all congenital heart defects. Transposition of the great arteries tga is the most common cyanotic congenital heart disease chd in newborns, with an incidence of 0. Depending on the type of repair performed in childhood, an adult who was born with this condition needs ongoing followup to screen for abnormal blood diversion and irregular heart rhythms and. Because a baby with this defect may need surgery or other procedures soon after birth, dtga is. A ventricular septal defect is detected in at least 50% of patients. In the majority of patients with tga, the aorta is rightward and anterior to the pulmonary artery, but there can be wide variability in the spatial relationships between the great arteries. May 29, 2015 the recurrence risk in firstdegree relatives of patients with transposition of the great arteries tga is low compared to other conotruncal defects. D transposition of the great arteries is a form of congenital heart disease that must be corrected shortly after birth for survival. Transposition of the great arteries choc childrens. The aorta also tends to be on the right and anterior, and the great arteries are parallel rather than crossing as they do in the normal heart. Oxygenpoor blue blood returns to the right atrium from the body, passes through the right atrium and ventricle, then goes into the misconnected. In this disorder, the two heart vessels, the pulmonary artery. Aug 05, 2014 this paper aims to update clinicians on hot topics in the management of patients with dloop transposition of the great arteries dtga in the current surgical era. Until aroud 1980 this delicate surgery could not be performed safely and an alternative procedure was used, redirecting blood within the atriums.
Transposition of the great arteries radiology reference. A variety of descriptions have been used to characterize tga, but the most precise portrayal is a chd in which the morphologic right ventricle rv. Dextrotransposition of the great arteries or dtga is a birth defect of the heart in which the two main arteries carrying blood out of the heart the main pulmonary artery and the aorta are switched in position, or transposed. Dtransposition of the great arteries is a form of congenital heart disease that must be corrected shortly after birth for survival. First medically described by matthew baillie during the year 1797, transposition of the great arteries tga is a congenital heart defect, and it affects two vital vessels which carry the blood away from the heart.
Congenital heart diseases involving only the primary arteries pulmonary artery and aorta belong to a subgroup called transposition of the great arteries. Transposition of the great arteries after mustardsenning. Although reference was made to malposition of the aorta and pulmonary artery by steno in 1672 and morgagni in 1761, the anatomic description of tga is credited to baillie in 1797. Comparison of late results of arterial switch versus atrial switch mustard procedure operation for transposition of the great arteries all marcs picu cardiology foam can be found on picu doctor and can be downloaded as a handy app for free on iphone or android. Subxiphoid twodimensional echocardiographic identification of tricuspid valve abnormalities in transposition of the great arteries with ventricular septal defect. Transposition of the great arteries childrens hospital.
Transposition of the great arteries tga is the most common cyanotic congenital heart lesion that presents in neonates. Transposition of the great arteries is usually detected either prenatally or within the first hours to weeks of life. Tga may occur as an isolated defect or in association with other cardiac anomalies. Transposition of the great arteries tga pediatrics. In children with tga, these arteries are connected to the heart abnormally. Due to the wedged position of the subpulmonary outflow tract in the morphologically left ventricle, there is gross malalignment between the atrial septum and the inlet. It accounts for up to 7% of all congenital cardiac anomalies 1 and can be assessed with echocardiography, gated cardiac ct, or cardiac mri. In a normal heart, there are two large arteries that carry blood out of the heart. Complete transposition of the great arteries toga occurs when the aorta, which normally comes off the left ventricle and pumps red blood to the body, arises from the right ventricle1 and pumps blue blood returning from the body back to the body bypassing the lungs completely.
Khan academy is a nonprofit with the mission of providing a free, worldclass education for anyone, anywhere. Oct, 2008 transposition of the great arteries tga, also referred to as complete transposition, is a congenital cardiac malformation characterised by atrioventricular concordance and ventriculoarterial va discordance. The hallmark of transposition of the great arteries is ventriculoarterial discordance, in which the aorta arises from the morphologic right ventricle and the pulmonary artery arises from the morphologic left ventricle. Situs solitus or inversus, circ cardiovasc imaging 75. Explaining transposition of the great arteries 1 of 5. Complete transposition of the great arteries request pdf. All patients with transposition of the great arteries require lifelong surveillance by a congenital heart expert. The small coronary arteries, which feed the heart muscle with blood, need to be transferred as well as the two great arteries aorta and pulmonary artery. Between, may of 1973 and may of 1978, patients underwent correction of complete transposition of the great arteries by a modification of the mustard operation specifically designed to avoid. The incidence is estimated at 1 in 3,5005,000 live births, with a maletofemale ratio 1. Anatomy of the coronary arteries in transposition of the.
Transposition is the result of malformation of the conus arteriosus. Introduction tga most common etiology for cyanotic congenital heart disease in the newborn. However, the term transposition was only applied in 1814, by farre, meaning that aorta and pulmonary trunk were placed positio across trans the ventricular. Dextro transposition of the great arteries dtga occurs when the position of the main pulmonary artery and aorta are switched. Transposition of the great arteries disease reference guide.
Transposition of great arteries linkedin slideshare. Transposition of the great arteries tga heart defect. Transposition of great arteries tga radiology case. Transposition of the great arteries is the second most common congenital heart defect that causes problems in early infancy. Transposition of the great arteries in the developing world. Sixty to 70 percent of the infants born with the defect are boys.
Congenitally corrected transposition of the great arteries in an 83yearold asymptomatic patient. The arterial switch operation aso has replaced atrial switch procedures for dtga, and 90% of patients now reach adulthood. Complete transposition of the great arteries is the most common form of neonatal cyanotic heart disease. Transposition of the great arteries in this case, dextro transposition occurs when the aorta arises directly from the right ventricle and the pulmonary artery arises from the left ventricle, resulting in independent, parallel pulmonary and systemic circulations. This complex always has discordant ventriculoarterial alignment, such that the aorta arises entirely or. Tga occurs in 5 to 7 percent of all congenital heart defects.