Transposition of the Great Arteries (TGA) | Treatments

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What are the treatment options for transposition of the greater arteries?

Upon birth, a newborn with transposition of the greater arteries 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, the baby's treatments may 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 The heart is reactivated as the heart-lung machine is withdrawn.

Caring for transposition of the greater arteries

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.

Long-term outlook for children with TGA

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.

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- Sandra L. Fenwick, President and CEO

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