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Transposition of the great arteries (TGA) (Diagnosis (History (FH Heart…
Transposition of the
great arteries (TGA)
Definition
Congenital structural
heart disorder where the
aorta and pulmonary artery
are transposed
Epidemiology
Rare
Pathophysiology
Transposition
Aorta connected to RV
Pulmonary artery connected to LV
Two parallel circulations
Mechanism
Deox blood from the body enters LV
and recirculated to the body
Ox blood from the lungs enters RV and
returned to the lungs
Incompatible with life unless mixing of blood occurs
e.g. co-morbid ASD, VSD or PDA
Clinical
presentation
Cyanosis
(profound, often life threatening)
Diagnosis
Examination
Cardio
Cyanosis, none or systolic murmur, loud S2
Investigations
Bloods
Capillary blood gas, FBC, U+E, LFT
Imaging
CXR: narrow upper mediastinum, 'egg on slide'
appearance of cardiac ahadow, pulmonary vascular markings
ECO + Doppler: diagnostic (abnormal arterial connections)
Bedside
Obs (sats, RR, HR, BP, temp)
ECG: normal
History
FH
Heart conditions
Cosanguinuity
DH
Meds, allergies
PMH
Milestones and development
Vaccinations
Known medical conditions
POH
Antenatal (bloods, scans, growth, complications)
Perinatal (gestation, delivery, weight, complications)
Postnatal (complications)
PC/HPC
Cyanosis
SH
Living arrangements
Management
Initial ABCDE
Oxygen, upright
Definitive
Medical
Prostaglandins
Indication: asap cyanosed neonate
E.g. alprostadil
MOA: PG inhibit closure of DA, allowing
blood mixing to continue
Surgical
Cardiac catheterisation
Indication: life threatening cyanosis
MOA: balloon atrial septostomy; inflatable balloon passed to RA, create hole in the foramen ovale to keep mixing of blood
Correction surgery
Indication: ASAP
MOA: arterial switch procedure; transection
of aorta and pulmonary artery and switch over
Conservative
Cardio/paeds referral ASAP
Complications
Death
Screening
Antenatal screening programme
Foetal anomaly scan
Neonatal examination
Sometimes a murmur
