d-TGA & CC-TGA PDF
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This document provides information on d-Transposition of the Great Arteries (d-TGA) and Congenitally Corrected Transposition of the Great Arteries (CC-TGA), including definitions, anatomy, physiology, etiology, and surgical procedures. It details the issues related to these conditions.
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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.
