Transposition of Great Vessels
Transposition of Great Vessels
Transposition of great vessels (TGV) is a group of congenital heart defects involving an abnormal spatial arrangement of any of the great vessels: superior and/or inferior venae cavae, pulmonary artery, pulmonary veins, and aorta. Congenital heart diseases involving only the primary arteries (pulmonary artery and aorta) belong to a sub-group called transposition of the great arteries.
Transposition of Great Vessels
Characteristics of Transposition of Great Vessels
Aorta is anterior and to right of pulmonary artery, arising from right ventricle
Pulmonary artery arises from left ventricle
Males affected more than females
Cyanosis from birth
Dysponea
Congestive failure
Incompatible with life in absence of ASD, VSD, PDA
Diagnosis of Transposition of Great Vessels
Physical Examination
CHF and cyanosis
S2 (second heart sound) single and loud (anterior aorta close to chest – wall)
Nondiagnostic murmurs in 1/3
X-Ray Chest
Transposition of Great Vessels X-Ray
Heart shape, egg on side, with narrow vascular pedicle
Pulmonary plethora
E.C.G.
RA and RV enlargement
Right axis deviation
Echo
Transposition of Great Vessels Echo
Defines the relation of great arteries to ventricles and associated defects
Catheterisation in Transposition of Great Vessels
To Confirm the diagnosis
Systemic Pressure in RV
O2 saturation pulmonary artery > aorta.
Variants in Transposition of Great Vessels
Transposed vessels can present a large variety of atriovenous, ventriculoarterial and/or arteriovenous discordance. The effects may range from a change in blood pressure to an interruption in circulation, depending on the nature and degree of the misplacement and which vessels are involved.
Although “transposed” literally means “swapped”, many types of Transposition of great vessels involve vessels that are in abnormal positions, while not actually being swapped with each other. The terms TGV and TGA are most commonly used in reference to dextro-TGA – in which the arteries are in swapped positions; however, both terms are also commonly used, though to a slightly lesser extent, in reference to levo-TGA – in which both the arteries and the ventricles are swapped; while other defects in this category are almost never referred to by either of these terms.
Dextro-Transposition of the great arteries
Normal heart anatomy compared to d-TGA
In dextro-Transposition of the great arteries (dextro-TGA) deoxygenated blood from the right heart is pumped immediately through the aorta and circulated to the body and the heart itself, bypassing the lungs altogether, while the left heart pumps oxygenated blood continuously back into the lungs through the pulmonary artery. In effect, two separate “circular” (parallel) circulatory systems are created. It is called a cyanotic congenital heart defect (CHD) because the newborn infant turns blue from lack of oxygen.
Levo-Transposition of the great arteries.
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 are also transposed.
Treatment for Transposition of Great Vessels
Balloon septostomy to improve mixing correction after wards with
a) Mustard procedure
Atrial baffle resoutes flow to appropriate ventricles
b) Rastelli Procedure
Ventricular baffle connects LV to aorta
Prosthetic conduit connects RV to PA
Associated Defects, PDA,VSD, ASD, Mitral valve anomalies.
Truncus (High VSD associated)
1. Sys.thrill, murmur at base
2. S2 loud and single
3. Cardiomegaly gross with wide shadow
