PRESENTED BY:

A.PRIYADHARSHINI M.Sc(N),

DEPT. OF PAEDIATRIC NURSING,

JAI INSTITUTE OF NURSING AND RESEARCH,

GWALIOR.

The transposition of the great arteries is ventriculo arterial discordance, in which the aorta arises from the morphologic right ventricle and the pulmonary artery arises from the morphologic left ventricle.

Transposition of the great arteries (TGA) is the most common cyanotic congenital heart lesion that presents in neonates.

 This lesion presents in 5-7% of all patients with congenital heart disease.

The overall annual incidence is 20-30 per 100,000 live births.

Etiology for transposition of the great arteries is unknown and is presumed to be multifactorial.

This congenital heart defect is more common in infants of diabetic mothers.

(The pulmonary and systemic circulations function in parallel, rather than in series)

Causes

Transposition of great arteries

Oxygenated pulmonary venous blood returns to the left atrium and left ventricle

Recirculated to the pulmonary vascular bed via the abnormal pulmonary arterial connection to the left ventricle.

Deoxygenated systemic venous blood returns to the right atrium and right

ventricle

pumped to the systemic circulation, effectively bypassing the lungs

deficient oxygen supply to the tissues

and an excessive right and left ventricular workload

It is incompatible with prolonged survival unless mixing of oxygenated and deoxygenated blood occurs at some anatomic level like

ASD VSD PDA

Prominent and progressive cyanosis within the first 24 hours of life is the usual finding in infants.

Tachypnea Tachycardia Diaphoresis Failure to gain weight

A single or narrowly split, diminished second heart sound

Systolic ejection murmur may be present. 

History collection Physical examination ABG analysis Echocardiography Cardiac catheterization

Chest radiography

demonstrate the classic "egg on a string" appearance in approximately one third of patients.

Initial treatment consists of maintaining ductal patency with continuous intravenous (IV) prostaglandin E1 infusion to promote pulmonary blood flow.

Antibiotic Prophylactic Regimens for Endocarditis.

 Fluid replacement Bicarbonate administration- Acidosis Mechanical ventilation

Rastelli-type procedure-ligate the main pulmonary artery and place an aortopulmonary shunt during the newborn period to restrict pulmonary blood flow.

Arterial switch procedure

Congestive heart failure Arrhythmia Eisenmenger syndrome (irreversible and

progressive pulmonary vascular obstructive disease)

The overall survival rate following arterial switch operation is 90%.

The overall mortality rate following an atrial level switch is low; however, long-term morbidity associated with systemic (right) ventricular dilatation and failure, systemic atrioventricular (tricuspid) valve regurgitation, and atrial bradyarrhythmias and tachyarrhythmias is significant.

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