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transposition of the great arteries

Alternative Names
transposition of the great vessels, TGA

Transposition of the great arteries (TGA) is an abnormality of the heart vessels that is present at birth, causing congenital heart disease. This is a serious heart defect that usually requires open heart surgery for the baby to survive.

What is going on in the body?
In a normal heart, the main artery of the body, called the aorta, is attached to the left side of the heart. The main lung artery, called the pulmonary artery, is attached to the right side of the heart. In the birth defect known as transposition of the great arteries, these arteries are reversed. When this happens, the wrong blood goes to the wrong area.

Normally, blood with low oxygen levels is sent to the lungs through the main lung artery to get oxygen. Next, this blood is pumped out through the aorta to the rest of the body. In TGA, blood with low oxygen levels is pumped through the aorta to the rest of the body.

What are the signs and symptoms of the disease?
The average birth weight and size of the newborn is larger than normal. Symptoms and signs may include: What are the causes and risks of the disease?
The cause of TGA is unknown. Males are more commonly affected than females. Children born to mothers with diabetes are also at higher risk.

What can be done to prevent the disease?
In most cases, nothing can be done to prevent TGA. A pregnant woman who has diabetes may be able to prevent TGA by controlling their blood sugar levels during pregnancy.

How is the disease diagnosed?
Diagnosis begins with the physical examination. A chest x-ray may reveal an abnormal shape of the heart. A heart tracing, called an electrocardiogram or ECG, may also be abnormal. The doctor may order an echocardiogram, which uses ultrasound waves to see the beating heart. This test can show most of the defects in the heart and how they affect the heart's function.

A special procedure called a cardiac catheterisation may also be done. This procedure involves inserting a tube though the skin and into a blood vessel, usually in the groin. The tube can then be advanced through the blood vessel into the heart. A contrast agent can be squirted through the tube and pictures taken while it is inside the heart and main blood vessels. This can help better define the defects in the heart. This procedure also allows tools to be passed through the tube and into the heart. These tools can make special holes in the heart to improve circulation until surgery can be done.

What are the long-term effects of the disease?
The long-term effects of TGA are related to the exact nature and severity of the heart defects. Children with TGA often have other heart defects. This can make treatment more complicated and reduce the chance of long-term survival. Death is common in those with TGA, especially when severe or complex defects of the heart are present. In those who undergo surgery, congestive heart failure may occur years later and cause disability or even death.

What are the risks to others?
There are no risks to others because TGA is not contagious.

What are the treatments for the disease?
A baby with TGA needs to be treated in a hospital that specialises in the treatment of children with congenital heart disease. Medications are used to help keep the child alive until surgery can be done. Cardiac catheterisation may also be used to place a small hole in the heart to improve circulation. This is usually only done only to keep the child alive until surgery.

In some cases, open heart surgery may be done hours after birth. In other settings, surgery may be delayed for a few weeks. There are many different types of surgery, depending on the exact heart defects that are present. The goal of surgery is to make the circulation as close to normal as possible.

What are the side effects of the treatments?
There are many different medications that may be used before surgery. These may cause allergic reactions, salt imbalances, or kidney damage. Surgery may cause bleeding, infection, and even death.

What happens after treatment for the disease?
The long-term outlook for a child with TGA usually depends on the severity of the heart defects before surgery. Children will need close monitoring after surgery to make sure the heart is functioning well. Heart medications may be needed after surgery. These medications can help the heart pump better or stop irregular heartbeats, called arrhythmias.

How is the disease monitored?
A child with transposition of the great arteries will need long-term monitoring. It is important for the parents to watch for any return of heart symptoms, and report any change in the child's condition to the doctor.

Author: Eric Berlin, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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