Treatments for Transposition of the Great Arteries (TGA) in Children

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Contact the Complex Biventricular Repair Program

Having identified your child's heart condition, we're able to begin the process of treating him, so that we may ultimately return him to good health.

Treatment options

Upon birth, your newborn will be admitted to Boston Children's Hospital's cardiac intensive care unit (CICU). Initially, he or she may be placed on oxygen or a ventilator to help with breathing, and IV (intravenous) medications may be given to help the heart and lungs function more efficiently.

Once stabilized, your baby's treatments will probably include:

  • medication: Doctors may administer an IV (intravenous) medication (prostaglandin E1) to keep open the infant's ductus arteriosus (the prenatal connection between the aorta and the pulmonary artery, which usually closes shortly after birth, but which is now important as a temporary alternative opening for blood flow).
  • cardiac catheterization: Before TGA surgery, doctors may perform a cardiac catheterization procedure called balloon atrial septostomy to improve the mixing of oxygen-rich (red) blood and oxygen-poor (blue) blood. A special catheter with a balloon in the tip is used to create or enlarge an opening in the atrial septum (wall between the left and right atria).
  • surgery: Within a baby's first two weeks, transposition of the great arteries is surgically repaired through a procedure called an “arterial switch,” which roughly describes the surgical process. A heart-lung machine does the work of the heart, while the aorta and pulmonary arteries are disconnected, then “switched” and finally reconnected to their proper ventricles.

    As part of the procedure:
  • The coronary arteries are repositioned to the newly positioned aorta so that “red” blood can supply the muscle of the heart.
  • The associated holes between the chambers of the heart are closed.
  • The heart is reactivated as the heart-lung machine is withdrawn.

Will my child be OK in the long term?

Surgical techniques for treating congenital heart defects are continually being refined, and Boston Children's surgical success rates are very high. Nevertheless, your child will need periodic monitoring, since he or she could be at some risk for:

  • abnormal heart rhythms (arrhythmias)
  • leaky heart valves
  • narrowing of one or both switched arteries at the site(s) of the switch
  • narrowing of the coronary arteries at the site of their switch

At home: caring for your child after surgery

After surgery, your child's cardiologist will offer recommendations for follow-up care, including:

  • wound care
  • a nutritional program to encourage weight gain
  • an oral hygiene program to prevent infection
  • an appropriate exercise regimen to build body mass and achieve fitness

As your baby recovers and grows, be sure to follow a regular program of well-baby/well-child checkups.

Your child's long-term outlook

Your child's cardiologist will help you create a long-term care program as your baby matures into childhood, the teen years and even adulthood. Most of our patients who have had congenital heart disease retain an ongoing relationship with their Boston Children's cardiologist. We will prevent and treat complications, as well as advise on daily-life issues, such as exercise and activity levels, nutrition and precautions related to pregnancy.

Surgical techniques for TGA and its associated defects are continually being refined, and the long-term outlook is improving. Most children who've had TGA surgery recover and grow normally. Even so, your child will need periodic monitoring, since he or she may be at increased risk for arrhythmias, leaky valves, narrowing of the arteries, and other heart issues.

Coping and support

We understand that you'll have a lot of questions. Will surgery help my child? What's the long-term outlook? Boston Children's Hospital has a variety of resources at that may be helpful to your family, including:

  • patient education: Our nurses will be on hand to walk you through your child's treatment and help answer any questions you may have.
  • parent-to-parent: Want to talk with someone whose child has been treated for TGA? We can often put you in touch with other families who've been down a similar road and can share their experiences. To request family-to-family support, talk with your child's health care team or contact The Center for Families.
  • faith-based support: If you and your family are in need of spiritual support, we can connect you with the Boston  Children's chaplaincy. Our program includes nearly a dozen clergy representing Protestant, Jewish, Muslim, Roman Catholic and other faith traditions who will listen to you, pray with you and help you observe your own faith practices during your treatment experience.
  • social work and mental health professionals: Boston Children's social workers and mental health clinicians have helped many other families in your situation. We can offer counseling and assistance with a wide variety of issues, such as coping with your child's diagnosis, stresses relating to coping with illness and dealing with financial difficulties.
     
  • As your child reaches adulthood, you'll want him to know about our Boston Adult Congenital Heart and Pulmonary Hypertension Service (BACH). Children's is a founding institution of BACH, an international center for excellence providing long-term inpatient and outpatient care and advanced therapeutic options as needed for congenital heart disease patients as they reach and progress through adulthood.
We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”
- Sandra L. Fenwick, President and CEO

Boston Children's Hospital 300 Longwood Avenue, Boston, MA 02115 617-355-6000 | 800-355-7944

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