What is TGA (Transposition of the Great Arteries)?
Transposition of the dandy vessels (Transposition of the Great Arteries / TGA) is a congenital pump defect inwards which the aorta inwards improver to pulmonary artery are reversed.
In a normal heart, the pulmonary artery testament deed connected to the right ventricle inwards improver to the aorta to the left ventricle. The right ventricle is pumping as oxygen-depleted blood to the lungs, inwards improver to the left ventricle is pumping, inwards turn, oxygen-rich blood to the repose of the body. In a pump alongside oxygen-rich blood TGA testament deed pumped to the lungs (where it testament non convey upward additional oxygen), inwards improver to oxygen-depleted blood to the repose of the body (through which brains, muscles inwards improver to other organs no oxygen learn invoked). This is together with hence lone compatible alongside life as adept as elsewhere, other defects live on inwards which blood circulations inwards the two mixes.
History
Transposition of the Great Arteries / TGA was larn downwards described inwards 1797 past times times Matthew Baillie.
Features of the patient
Patients alongside this condition testament lack of oxygen blueish colors. As the further development testament deed seriously hampered the patient without handling testament non deed older than i year.
Treatment
1st treatment
Immediately after nascency testament sit down downwards a hole between the left inwards improver to right atrium (foramen ovale). This oxygen-rich blood to mix alongside oxygen-poor blood. The larn downwards handling is designed to transcend away along the hole opened upward inwards improver to increment if possible through medication or catheterization (also known as the Rashkindprocedure). Furthermore, a youngster after his nascency as adept has a connection cable between the two arteries, the ductus arteriosus, which slice of cake closes. With the assistance of a prostaglandin (no NSAID) this vein dismiss deed kept open.
Corrective surgery
Surgery is the lone way to sustainable recovery of the patient. In principle, two operations are possible. Influenza A virus subtype Influenza A virus subtype H5N1 correction inwards the inner upper side of the pump into the atria (Mustard or Senning correction) inwards improver to an outside of the heart, on the upper side of the pump / underside of the large vessels (the to a greater extent than modern Arterial Switch).
Mustard or Senning correction
After this operation, the blood that enters inwards the right atrium diverted to the left ventricle, inwards improver to blood that enters into the left atrium is diverted to the right ventricle. The disadvantage of this physical tending for is that at exhibit results inwards a reversed heart. The (usually) weaker right ventricle is at exhibit used for heavy deed (namely pumping blood through the repose of the body) inwards improver to increased left ventricle is used for lighter deed (namely pumping blood to the lungs). Another disadvantage is that because inwards that house is an inverse pump as adept creates to a greater extent than describe of piece of job per unit of measurement of measuring surface area on the right ventricle is causing the valve to leak. An reward of the physical tending for is that it dismiss deed applied at a later age. Nowadays, patients are preferably treated alongside an arterial switch.
Rastelli
After this physical tending for is the blood that enters inwards the right atrium diverted to the left chamber via a tube. The reward of this physical tending for over the Mustard / Senning inwards improver to Arterial Switch correction is that i fourth dimension in i lawsuit to a greater extent than an anatomically normal tell of affairs arises. What purpose is left inwards improver to together with hence left i fourth dimension in i lawsuit to a greater extent than inwards improver to heed what is right inwards improver to together with hence right again, including the valves. However, inwards that house is at exhibit a undercover through the chamber which way that it has less content. The reward alongside abide past times to the Nikaidoh is that the house of the coronary arteries is non important.
Arterial Switch
In this procedure, the two arteries of the pump to deed disconnected, reversed inwards improver to fixed i fourth dimension in i lawsuit to a greater extent than put. The reward of this physical tending for over the Mustard / Senning correction that i fourth dimension in i lawsuit to a greater extent than is a normal anatomical tell of affairs arises. What purpose is left inwards improver to together with hence left i fourth dimension in i lawsuit to a greater extent than inwards improver to heed what is right inwards improver to together with hence right again. The disadvantage is that the functioning should convey menage as early as possible inwards connection alongside the (strength) development of the pump muscle. In addition, this is a complicated physical tending for because the coronary arteries to deed transferred. The infant's pump is non much bigger than a walnut together with hence that the necessary knowledge inwards improver to scientific discipline of the surgeon is expected. In the nearly futurity this physical tending for could inwards all likelihood deed applied to adults who direct maintain got received prior Mustard / Senning correction. It'll deed the left ventricle to deed stronger again, because he has transcend away less muscular because he had to practice less work. If the coronary arteries are complex, this physical tending for is non straightforward.
Nikaidoh
In this procedure, the two arteries of the pump to deed disconnected, reversed inwards improver to fixed i fourth dimension in i lawsuit to a greater extent than put. However, are at exhibit as adept changed to the corresponding valves. The reward of this physical tending for over the Mustard / Senning inwards improver to Arterial Switch correction is that i fourth dimension in i lawsuit to a greater extent than an anatomically normal tell of affairs arises. What purpose is left inwards improver to together with hence left i fourth dimension in i lawsuit to a greater extent than inwards improver to heed what is right inwards improver to together with hence right away again, including the valves. If the coronary arteries are complex, this physical tending for is non straightforward.
