Transposition of the great arteries Treatment: corrective surgery, medications, balloon atrial septostomy, arterial switch operation, atrial switch operation, intervention surgery, percutaneous – Doctor

Transposition of the great arteries - Treatments

Transposition of the great arteries (TGA) needs to be treated by corrective surgery. Before babies with TGA undergo their corrective surgeries, doctors might give them medications to increase blood flow and improve the mixing of oxygen-poor and oxygen-rich blood.

A balloon atrial septostomy might also be performed before these corrective procedures. This is a minimally invasive procedure which involves inserting a flexible, thin tube (catheter) into the heart to create or increase the size of a hole between the two atria (upper chambers). This allows more blood to mix and thus, more oxygen-rich blood gets pumped around the body. However, this is only a temporary solution and corrective surgeries are still required later on.

Corrective surgery will treat the transposition of the great arteries (TGA) and this treatment can be carried out soon after the child’s birth. While having a baby with this serious condition is alarming, TGA can be alleviated and treated with operation.

There are a few procedures that treat TGA:

1) Arterial Switch Operation

This procedure is usually done within the first month of the baby’s life. The pulmonary artery and aorta are switched back to their correct positions – pulmonary artery connected to the right ventricle and aorta connected to the left ventricle. The coronary arteries that provide blood to the heart will also be reattached to the aorta.

2) Atrial Switch Operation

This procedure is not commonly performed because of the higher risks of complications. In this procedure, a tunnel is created between the two atria (upper chambers) of the heart. This allows oxygen-poor blood to move from the right atrium to the left ventricle and out of the pulmonary artery to the lungs. Oxygen-rich blood then moves through the tunnel from the left atrium to the right ventricle and out of the aorta to the body. Although the arteries are not shifted, this causes the right ventricle to work harder to pump blood to the entire body which can lead to complications in the future.

3) Rastelli procedure

For babies with both TGA and ventricular septal defect (VSD), this procedure might be recommended. The surgeon will close the defect (hole) and redirect blood flow from the left ventricle to the aorta which leads to the rest of the body. The connection between the left ventricle and pulmonary artery is blocked. A connection is then made with a prosthetic (artificial) valve from the right ventricle to the pulmonary artery.

Complications after operation should be monitored for and can be treated. Medications (ACE inhibitors and beta blockers) can be useful in the event of heart failure. Abnormal heart rhythms can be managed with medications or ablation procedures. Baffle or conduit stenosis or regurgitation may require intervention with surgery or percutaneous techniques.