d-TGA & CC-TGA PDF

‭d-TGA & CC-TGA‬ ‭ -Transposition (d-TGA):‬ d ‭Definition:‬‭Ao arises from RV and PA arises from LV‬‭(parallel circulatory systems)‬ ‭Anatomy:‬‭normal AV connections but discordant VA connections;‬‭aorta is anterior/right while PA is‬ ‭posterior/left‬ ‭Etiology:‬‭abnormal septation of the cono...

‭d-TGA & CC-TGA‬ ‭ -Transposition (d-TGA):‬ d ‭Definition:‬‭Ao arises from RV and PA arises from LV‬‭(parallel circulatory systems)‬ ‭Anatomy:‬‭normal AV connections but discordant VA connections;‬‭aorta is anterior/right while PA is‬ ‭posterior/left‬ ‭Etiology:‬‭abnormal septation of the conotruncal region.‬ ‭Physiology:‬‭Parallel circulation occurs, with systemic‬‭venous return re-entering the body without oxygenation.‬ ‭Requires a shunt for life (PFO, ASD, PDA).‬ ‭Typical Presentation:‬‭Cyanosis in the first day of‬‭life due to parallel circulatory systems, often requiring shunts‬ ‭for survival‬ ‭‬ ‭Heart Failure Symptoms: systolic murmur due to VSD or outflow tract obstruction‬ ‭Associated Anomalies in d-TGA‬‭: VSD, coronary artery‬‭anomalies, pulmonary stenosis, LVOTO, ASD, PDA.‬ ‭Echo Features in d-TGA‬‭: Abnormal VA connections, parallel‬‭great arteries, associated shunts.‬ ‭Surgical Procedures for d-TGA‬‭: Balloon septostomy,‬‭atrial switch (Mustard/Senning), arterial switch (Jatene).‬ ‭‬ ‭Initial Stabilization:‬ ‭○‬ ‭Prostaglandin E1 to keep the ductus arteriosus open.‬ ‭○‬ ‭Balloon septostomy to create or enlarge a shunt.‬ ‭‬ ‭Atrial Switch (Mustard or Senning Procedure): Reroutes systemic and pulmonary venous return‬ ‭○‬ ‭Corrects blood flow at the atrial level.‬ ‭○‬ ‭Complications include RV dysfunction, TR, baffle leaks, and arrhythmias.‬ ‭‬ ‭Arterial Switch (Jatene Procedure) **‬‭most preferred‬‭**‬‭switching the aorta and pulmonary artery to‬ ‭restore normal circulation.‬ ‭○‬ ‭Current preferred surgery is where the great arteries are switched to their correct positions,‬ ‭making the left ventricle the systemic ventricle.‬ ‭○‬ ‭Possible complications include coronary artery obstruction and stenosis at anastomosis sites.‬ ‭Cheat Sheet for d-Transposition of the Great Arteries (d-TGA)‬ ‭‬ ‭Definition: A congenital heart defect where the aorta arises from the right ventricle, and the‬ ‭pulmonary artery arises from the left ventricle, causing two separate circulatory loops.‬ ‭‬ ‭Incidence: 3% of all congenital heart defects, 20-22 per 100,000 live births.‬ ‭‬ ‭Key Features:‬ ‭○‬ ‭Parallel circulations with no oxygenation unless a shunt exists.‬ ‭○‬ ‭Profound cyanosis at birth.‬ ‭○‬ ‭Echo: Parallel great arteries, rightward aorta, abnormal ventriculo-arterial connections.‬ ‭‬ ‭Associated Lesions:‬ ‭○‬ ‭VSD, coronary artery anomalies, coarctation, ASD.‬ ‭‬ ‭Treatment:‬ ‭○‬ ‭Medical: Prostaglandin E1 to keep ductus arteriosus open, balloon septostomy.‬ ‭○‬ ‭Surgical: Atrial switch (Mustard or Senning), Arterial switch (Jatene), Lecompte maneuver.‬ ‭ ongenitally Corrected Transposition of the Great Arteries (CC-TGA)‬ C ‭Definition:‬‭AV and VA discordance, correcting circulation‬ ‭Anatomy:‬‭Ventricles are inverted: Right ventricle‬‭(on the left) is systemic, and left ventricle (on the right) is‬ ‭subpulmonary‬ ‭Etiology‬‭:‬ ‭‬ ‭(L-looping) during development, causing the inversion of ventricles.‬ ‭Physiology‬‭: Hemodynamically corrected but structurally‬‭abnormal, leading to possible right ventricular failure.‬ ‭Associated Anomalies‬‭: VSD (60%), tricuspid valve abnormalities‬‭(up to 90%), left ventricular outflow tract‬ ‭obstruction.‬ ‭ chocardiographic Features‬‭: Discordant atrioventricular and ventriculo-arterial connections, with a systemic‬ E ‭RV connected to the aorta.‬ ‭Surgical Procedures‬‭:‬ ‭‬ ‭Double Switch Operation‬‭: Combines an atrial and arterial‬‭switch to redirect blood flow and make the‬ ‭left ventricle the systemic ventricle.‬ ‭Cheat Sheet for Corrected Transposition of the Great Arteries (CC-TGA)‬ ‭‬ ‭Definition: A rare condition where the ventricles and great arteries are switched, but blood flow is‬ ‭corrected.‬ ‭‬ ‭Incidence: 0.5% of all congenital heart defects.‬ ‭‬ ‭Key Features:‬ ‭○‬ ‭Asymptomatic early in life, can be undiagnosed until adulthood.‬ ‭○‬ ‭Echo: Discordant atrioventricular and ventriculo-arterial connections.‬ ‭○‬ ‭Right ventricle becomes systemic and the left ventricle is subpulmonary.‬ ‭‬ ‭Associated Lesions:‬ ‭○‬ ‭VSD, systemic tricuspid valve abnormalities, left ventricular outflow tract obstruction.‬ ‭‬ ‭Treatment:‬ ‭○‬ ‭Medical: Treat heart failure, reduce afterload.‬ ‭○‬ ‭Surgical: Tricuspid valve repair or replacement, Double Switch operation to correct blood flow.‬