Complete transposition of the great arteries (TGA)CComplete transposition of the great arteries (TGA)Complete transposition of the great arteries (TGA)EnglishCardiologyChild (0-12 years)HeartCardiovascular systemConditions and diseasesAdult (19+)NA2016-07-11T04:00:00ZFraser Golding, MD, FRCPC;Robert Hamilton, MD, FRCPC11.000000000000047.0000000000000542.000000000000Flat ContentHealth A-Z<p>Learn about transposition of the great arteries (TGA). With this condition, the vessels that carry blood away from the heart are improperly positioned.</p><h2>What is transposition of the great arteries?</h2><p>Complete transposition of the great arteries (TGA) is a rare congenital heart defect. Congenital means present at birth. It is a common reason for a newborn to have heart surgery. After surgery, your baby is expected to grow and live a full life.</p><p>In TGA, the two arteries connected to the heart (<a href="/Article?contentid=1577&language=English">the aorta and pulmonary artery</a>) are switched:</p><ul><li>The aorta is connected to the heart’s right ventricle instead of the left ventricle.</li><li>The pulmonary artery is connected to the left ventricle instead of the right ventricle.</li></ul><p>In a normal heart, the blood low in oxygen comes from the body back to the heart’s right side, is pumped to the lungs where it "reloads" oxygen, and goes to the left side of the heart to be sent to the body through the aorta. This way oxygen is distributed to the whole body.</p><p>In TGA, blood that already has oxygen flows back to the lungs, while blood that needs oxygen flows around the body. The body never receives the oxygen that it needs.</p><p>Some children with TGA (about 10%) also have a ventricular septal defect. It is a hole in the wall that separates the two ventricles.</p><h2>Key points</h2><ul><li>Complete transposition of the great arteries (TGA) is a rare congenital heart defect.</li><li>In TGA, the two main arteries connected to the heart (the aorta and pulmonary artery) are switched. The aorta is connected to the heart’s right ventricle instead of the left ventricle. The pulmonary artery is connected to the left ventricle instead of the right ventricle. This creates a situation in which the body never receives the oxygen that it needs. </li><li>A baby with TGA will become very sick very soon after being born and will not survive if they receive no treatment.</li><li>TGA is first treated with medication called prostaglandin. Then a procedure called balloon atrial septostomy is done to allow blood from the right and left sides to mix. These are temporary measures.</li><li>When the baby is strong enough, the heart is repaired by a surgery called arterial switch; this surgery puts the aorta and pulmonary arteries back to their normal positions.</li><li>After an arterial switch repair, children are expected to grow and develop normally. They can participate in all recreational activities without specific restrictions.</li></ul>
Transposition complète des gros vaisseauxTTransposition complète des gros vaisseauxComplete Transposition of the Great Arteries (TGA)FrenchCardiologyChild (0-12 years)HeartCardiovascular systemConditions and diseasesAdult (19+)NA2009-12-04T05:00:00ZFraser Golding, MD, FRCPC11.000000000000047.0000000000000542.000000000000Flat ContentHealth A-ZInformez-vous sur la transposition complète des gros vaisseaux. Cette anomalie fait en sorte que les vaisseaux qui transportent le sang depuis le cœur sont mal disposés.<p>Cette anomalie fait en sorte que la position des vaisseaux qui amènent le sang du cœur aux poumons et au corps est interversée : l’aorte sort du ventricule droit et l’artère pulmonaire sort du ventricule gauche. Cela signifie que le sang qui renferme déjà de l’oxygène se rend aux poumons, et que le sang qui a besoin d’oxygène circule dans le corps. </p><h2> À retenir </h2> <ul><li> La transposition complète des gros vaisseaux fait en sorte que le sang qui a besoin d’oxygène circule dans le corps au lieu des poumons. </li> <li>Cette anomalie est fatale à moins qu’il existe une autre anomalie qui permet au sang de se mélanger entre deux systèmes circulatoires pour que le corps reçoive l’oxygène dont il a besoin. </li> <li>Les bébés nés avec une transposition complète des gros vaisseaux montrent des symptômes, habituellement la cyanose, immédiatement après la naissance. </li> <li>Ces bébés devront subir une chirurgie à coeur ouvert dans les premières semaines suivant la naissance. </li></ul>

 

 

Complete transposition of the great arteries (TGA)1611.00000000000Complete transposition of the great arteries (TGA)Complete transposition of the great arteries (TGA)CEnglishCardiologyChild (0-12 years)HeartCardiovascular systemConditions and diseasesAdult (19+)NA2016-07-11T04:00:00ZFraser Golding, MD, FRCPC;Robert Hamilton, MD, FRCPC11.000000000000047.0000000000000542.000000000000Flat ContentHealth A-Z<p>Learn about transposition of the great arteries (TGA). With this condition, the vessels that carry blood away from the heart are improperly positioned.</p><h2>What is transposition of the great arteries?</h2><p>Complete transposition of the great arteries (TGA) is a rare congenital heart defect. Congenital means present at birth. It is a common reason for a newborn to have heart surgery. After surgery, your baby is expected to grow and live a full life.</p><p>In TGA, the two arteries connected to the heart (<a href="/Article?contentid=1577&language=English">the aorta and pulmonary artery</a>) are switched:</p><ul><li>The aorta is connected to the heart’s right ventricle instead of the left ventricle.</li><li>The pulmonary artery is connected to the left ventricle instead of the right ventricle.</li></ul><p>In a normal heart, the blood low in oxygen comes from the body back to the heart’s right side, is pumped to the lungs where it "reloads" oxygen, and goes to the left side of the heart to be sent to the body through the aorta. This way oxygen is distributed to the whole body.</p><p>In TGA, blood that already has oxygen flows back to the lungs, while blood that needs oxygen flows around the body. The body never receives the oxygen that it needs.</p><p>Some children with TGA (about 10%) also have a ventricular septal defect. It is a hole in the wall that separates the two ventricles.</p><h2>Key points</h2><ul><li>Complete transposition of the great arteries (TGA) is a rare congenital heart defect.</li><li>In TGA, the two main arteries connected to the heart (the aorta and pulmonary artery) are switched. The aorta is connected to the heart’s right ventricle instead of the left ventricle. The pulmonary artery is connected to the left ventricle instead of the right ventricle. This creates a situation in which the body never receives the oxygen that it needs. </li><li>A baby with TGA will become very sick very soon after being born and will not survive if they receive no treatment.</li><li>TGA is first treated with medication called prostaglandin. Then a procedure called balloon atrial septostomy is done to allow blood from the right and left sides to mix. These are temporary measures.</li><li>When the baby is strong enough, the heart is repaired by a surgery called arterial switch; this surgery puts the aorta and pulmonary arteries back to their normal positions.</li><li>After an arterial switch repair, children are expected to grow and develop normally. They can participate in all recreational activities without specific restrictions.</li></ul><h2>How does transposition of the great arteries affect your baby?<br></h2><h3>In the womb</h3><p>Despite TGA, your baby can develop safely in the womb because the <a href="/Article?contentid=1579&language=English">fetal heart</a> works differently than the heart after birth.</p><p>Your baby’s oxygen comes from the mother and blood can go from the right side of the heart to the left side because of two "shortcuts" called the foramen ovale and the arterial duct. Thus the baby’s body receives the oxygen that it needs.</p><h3>After birth</h3><p>At birth, your baby starts using their lungs and breathing on their own. As the foramen ovale and the arterial duct start closing, the blood can no longer freely flow from the heart’s right side of the left side.</p><p>Because blood flows in two parallel circulations—the oxygen-rich ("red") blood flows only to the lungs while the oxygen-poor ("blue") blood circulates through the heart and the body—no oxygen is added to the blood going to the newborn’s body. Because of the lack of oxygen, the baby will become blue (<a href="/Article?contentid=896&language=English">cyanosis</a>) and the body’s organs will stop working.</p><p>Without proper treatment, a baby with TGA will become very sick very soon after being born and will not survive.</p><p>Fortunately, TGA can be treated.</p><h2>How is transposition of the great arteries diagnosed?<br></h2><p>TGA is sometimes detected in the womb before birth on a routine ultrasound during pregnancy. In this case, your doctor will make a referral for a fetal <a href="/Article?contentid=1274&language=English">echocardiogram</a>. A fetal echocardiogram is an ultrasound that only looks at the baby’s heart and is performed by a health-care provider with specialized training.<br></p><p>However, TGA is not always diagnosed before birth because it can be very difficult to see some of the differences in the heart during a routine pregnancy ultrasound.<br></p><p>All babies who have been diagnosed with TGA before birth and any baby who becomes very blue (cyanosis) will have an echocardiogra​m of their heart right after birth. This will help the <a href="/Article?contentid=1591&language=English">health-care team</a> make sure the diagnosis is correct and better look after your baby.</p><h2>How is transposition of the great arteries treated?</h2><h3>Planning for the birth</h3><p>Your obstetrician and you will plan for the birth based on how far you live from the hospital and your medical history (for example if you already gave birth and how it went or if you have other conditions that may affect the delivery). Expecting a baby with a heart condition does not make you more likely to have a C-section.</p><p>When possible, the team favours natural onset of labour and vaginal delivery. However your delivery may be induced close to the due date if you live far away or if your condition requires it.</p><p>Address any question about your delivery and its planning to your obstetrician. </p><h3>Prostaglandin</h3><p>At first, your baby will be given a drug called prostaglandin to keep the ductus arteriosus open and help oxygen get to the body.</p><p>Prostaglandin may have some side effects on your baby. The most common side effects when babies are given this medication for short periods include:</p><ul><li>short periods of not breathing (apnea)</li><li>redness of the face</li><li>fever</li><li>lower blood calcium levels.</li></ul><p>However, the benefits of prostaglandin--helping keep your baby alive--outweigh the side effects.</p><p>If apnea is a problem for your baby, a <a href="/Article?contentid=1653&language=English">breathing tube and ventilator</a> will be used to help the baby’s breathing.</p><h3>Balloon atrial septostomy</h3><p>Almost all babies with TGA will need to undergo a procedure called <a href="/Article?contentid=1668&language=English">balloon atrial septostomy</a>.</p><p>This procedure makes the naturally occurring hole (called the foramen ovale) between the left and right atria bigger. Because blood from both sides of the heart can mix together, more oxygen goes to your baby’s body.</p><p>After this procedure, depending on how your newborn is doing, the medication called prostaglandin may be stopped.</p><p>This is only a temporary measure until your child is ready for the surgery called arterial switch.</p><h3>Arterial switch procedure</h3><p>Your baby will need a type of surgery called an <a href="/Article?contentid=1656&language=English">arterial switch procedure</a> within the first few weeks of life. This open heart procedure will correct the blood flow. It involves "switching" the pulmonary artery and the aorta back to their normal positions and attaching the coronary arteries to the new aorta in the correct positions.</p><h2>Short and long-term follow-up care</h2><h3>Going home after the surgery</h3><p>Your baby will likely spend a few days in the cardiac critical care unit (CCCU) before being transferred to the cardiac inpatient unit to finish their recovery. The team will monitor and manage your baby’s pain, wounds and overall health and feeding. </p><p>Your baby will be ready to go home when they are breathing comfortably and can feed well by mouth. During the recovery, you will be taught how to <a href="/Article?contentid=1212&language=English">care for your child at home</a>.</p><h3>First clinic appointment after the surgery</h3><p>An appointment with a post-operative nurse is usually scheduled within five to 10 days of discharge.</p><p>Before going home after surgery, and after each visit, the team will explain what to expect and setup the next appointment. They will also review any reasons why it might be important to contact the team before the next appointment.</p><p>After an arterial switch repair, children are expected to grow and develop normally. They can participate in all recreational activities without specific restrictions.</p><h3>Long-term monitoring</h3><p>Children do very well after an arterial switch procedure. It is important to remember that all children are monitored after heart surgery, even though the problem has been corrected.</p><p>In a small number of children, the pulmonary artery may become narrow, requiring balloon dilatation (also called balloon angioplasty) to enlarge this vessel. When any part of the heart's circulation system becomes narrowed, balloon dilation can help open up the narrowed area and improve blood flow. Less commonly the narrowing of the pulmonary artery is corrected by another surgery.</p><p>Much more rarely, a coronary artery, which was re-implanted to its new location, may not grow as expected or become deformed and cause reduced blood flow to the heart. In this case another procedure may be necessary.</p><h3>Regular follow-up visits until adulthood</h3><p>Your child will have routine follow-up visits with a cardiologist​ until the age of 18 years. Older children and teens may have visits every two years for a check-up. The medical team will talk to you, any other caregiver and your child to find out how your child is doing after surgery and as they grow-up.</p><p>An <a href="/Article?contentid=1276&language=English">electrocardiogram</a> (ECG) and echo​cardiogram are usually performed at each visit. An exercise test on a <a href="/Article?contentid=1289&language=English">treadmill</a> may be used in older children to look at how some parts of the heart are doing during activity.</p><h3>Communication with your health-care team</h3><div class="asset-group" style="float:right;"> <img src="/En/Assets/dr_listening_to_boys_chest_BRAND-PHO_EN.jpg" alt="" style="margin:5px;" />  </div><p>It is important that you understand everything that is hapenning, from the diagnosis to the care at home. If after speaking with the doctor you still do not understand something, ask again. Do not be embarrassed. Many conditions or procedures are quite complicated and need to be explained a few times.</p><p>If English is not your first language, the services of an <a href="http://www.sickkids.ca/patient-family-resources/child-family-centred-care/interpreters-services/index.html" target="_blank">interpreter</a> can be arranged.</p><p>It is your right to be informed. The more you understand your child’s condition, the better the decisions you can make about treatment and the more comfortable you will be with the course of treatment.</p><p>Because the cardiologist has many patients to see, they may not always be available to talk. Your clinic nurse​ is a good contact and can help answer your questions.</p><p>To make sure you understand everything fully, read this information carefully and ask questions. Some questions you could ask the doctor include:</p><ul><li>What is the condition? (Be sure to write down the formal name.)</li><li>How is it affecting my child physically? (For a heart defect, for example, a drawing would be helpful.)</li><li>What kind of treatment will my child need, and when?</li><li>Will you or another specialist provide the treatment?</li><li>Who else will be involved in my child’s care?</li><li>What can I do to help my child in the meantime?</li><li>What does the future hold?</li></ul><p>You may be overwhelmed and confused by the information, which makes it difficult to listen carefully. Write down the information as the doctor discusses it with you. Having written information means that you can reflect on it later, once you have come to terms with the news.</p><h2>When to see a doctor</h2><p>After discharge, you should call your doctor or nurse, or go to the emergency room if:</p><ul><li>Your baby develops unexpected changes in incisions (cuts), such as swelling, redness, oozing, discharge, bleeding, new or worsening pain.</li><li>You suspect that something happened to your baby’s breastbone (sternum). Protect your baby’s chest for at least two weeks after the heart surgery and until the incision is healed.</li><li>Your baby develops new symptoms, such as <a href="/Article?contentid=30&language=English">fever</a>, shortness of breath, fast heartbeat, sweating, increasing difficulty with feeding, or failure to gain weight.</li><li>You have any new concerns about your baby’s heart.​</li></ul>Complete transposition of the great arteries (TGA)False

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