Dextro-Transposition of the great arteries

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Dextro-Transposition of the Great Arteries (d-TGA) is a congenital heart defect in which the aorta and the pulmonary artery are transposed. This condition is a type of cyanotic heart defect and is characterized by the aorta arising from the right ventricle and the pulmonary artery arising from the left ventricle, which is the opposite of the normal heart anatomy.

Pathophysiology

In d-TGA, the normal flow of blood is disrupted. Oxygen-poor blood from the body returns to the right atrium, flows into the right ventricle, and is then pumped into the aorta and out to the body without being oxygenated in the lungs. Conversely, oxygen-rich blood from the lungs returns to the left atrium, flows into the left ventricle, and is then pumped back to the lungs via the pulmonary artery. This results in two parallel circulations, which can lead to severe hypoxemia and cyanosis.

Diagnosis

d-TGA is typically diagnosed through a combination of physical examination, echocardiography, and other imaging techniques such as cardiac MRI or CT scan. Prenatal diagnosis can be made using fetal echocardiography.

Symptoms

Newborns with d-TGA often present with severe cyanosis shortly after birth. Other symptoms may include difficulty breathing, poor feeding, and failure to thrive. Without intervention, d-TGA can be life-threatening.

Treatment

The primary treatment for d-TGA is surgical correction. The most common procedure is the arterial switch operation, which involves switching the aorta and pulmonary artery to their correct positions. This surgery is typically performed within the first few weeks of life. In some cases, a temporary procedure called a balloon atrial septostomy may be performed to improve oxygenation before the arterial switch operation.

Prognosis

With timely surgical intervention, the prognosis for infants with d-TGA has improved significantly. Most children who undergo the arterial switch operation go on to lead healthy lives, although they require lifelong follow-up with a cardiologist to monitor for potential complications.

See also

• Congenital heart defect
• Cyanotic heart defect
• Arterial switch operation
• Balloon atrial septostomy