tga-dr.elamaran
DESCRIPTION
Transposition of great arteriesTRANSCRIPT
![Page 1: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/1.jpg)
Dr.Elamaran.E
Senior Resident Dept. of CTVS,JIPMER
![Page 2: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/2.jpg)
o Congenital cardiac anomaly
o Atrioventricular concordance and Ventriculo arterial discordance.
o Aorta arises from the morphologic right ventricle and the pulmonary artery arises from the morphologic left ventricle.
![Page 3: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/3.jpg)
![Page 4: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/4.jpg)
Morphologic description of TGA –Baillie(1797)
Transposition of the aorta and pulmonary artery was coined - Farre (1814)
Surgery for TGA Atrial septectomy - Blalock and
Hanlon(1950) Balloon atrial septostomy - Rashkind
and Miller - (1966)
![Page 5: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/5.jpg)
Partial physiological correction – Lillehei (1953)
Physiologic correction at the atrial level –Senning(1959) and Mustard(1963)
Arterial switch procedure –Jatene (1975)
![Page 6: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/6.jpg)
Etiology for transposition of the great arteries is unknown and is presumed to be multifactorial.
Common association in infants of diabetic mothers.
![Page 7: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/7.jpg)
Persistence of sub Aortic conus and absorption of sub pulmonary conus
Failure of the Truncus Arteriosus to septate normally
![Page 8: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/8.jpg)
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.
Male-to-female ratio is 2:1. Male predominance increases to 3.3 : 1 (ventricular septum is intact)
![Page 9: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/9.jpg)
Right ventricle –Hypertrophied, Sub aortic conusLeft ventricle- Normal to thinned out, Pulmonary-Mitral continuityAorta- Anterior and right of PAAtria – Normal (RA>LA)Atrio-Ventricular valves – Same levelConduction tissue – Normal position and abnormal shape
![Page 10: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/10.jpg)
Normal -2/3 and Abnormal -1/3
![Page 11: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/11.jpg)
![Page 12: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/12.jpg)
The pulmonary and systemic circulations function in parallel, rather than in series.
![Page 13: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/13.jpg)
When patients with all varieties of TGA are considered
55% - 1 month 15% - 6 months 10% - 1 year
![Page 14: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/14.jpg)
Transposition of the great arteries with intact ventricular septum – Hypoxia
Transposition of the great arteries with ventricular septal defect –cardiac failure
Transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction- Hypoxia
![Page 15: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/15.jpg)
Aggressive medical and surgical management in the neonate has around 90% early and midterm survival
![Page 16: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/16.jpg)
1. TGA with intact ventricular septum
2. TGA with VSD
3. TGA with VSD and LVOTO
4. TGA with VSD and pulmonary vascular obstructive disease.
![Page 17: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/17.jpg)
Patent foramen ovale or Atrial septal defect- 75%
Ventricular septal defect- 25% -40% Patent ductus Arteriosus-functionally
closes by 1 month Left ventricular outflow obstruction-5% Mitral valve-cleft leaflet/accessory
chordal tissue Tricuspid valve – regurgitation/dysplasia
![Page 18: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/18.jpg)
Symptoms and clinical presentation
Depend on degree of mixing between the two parallel circulatory circuits.
![Page 19: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/19.jpg)
TGA with intact ventricular septum – Cyanosis within 24 hours
TGA with VSD– congestive heart failure (2 to 4 months)
TGA with VSD and LVOTO- similar to TOF
TGA with VSD and PVOD – develop Hypoxia after 6 months
![Page 20: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/20.jpg)
An oval-or egg-shaped cardiac silhouette with a narrow superior mediastinum
Mild cardiac enlargement
Moderate pulmonary plethora
![Page 21: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/21.jpg)
![Page 22: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/22.jpg)
Simple TGA – Neonates- Arterial switch within 1 month
Simple TGA – after 30 days Pulmonary artery banding- Arterial
switch after 2 weeks Atrial switch
TGA with VSD- Arterial switch within few weeks
TGA with VSD and LVOTO – repair - 6 months
![Page 23: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/23.jpg)
Establishing Ventriculo-arterial concordance
Anatomical correction
![Page 24: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/24.jpg)
![Page 25: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/25.jpg)
![Page 26: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/26.jpg)
![Page 27: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/27.jpg)
![Page 28: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/28.jpg)
![Page 29: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/29.jpg)
![Page 30: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/30.jpg)
Coronary artery lesions
Neo Aortic valve regurgitation
RVOTO and LVOTO obstruction
![Page 31: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/31.jpg)
Cardiac failure- Secondary to severe LV dysfunction(imperfect coronary artery transfer to Neoaorta)
RV dysfunction – Progressive pulmonary vascular disease (1%)
Coronary events
![Page 32: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/32.jpg)
Physiological correction
![Page 33: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/33.jpg)
![Page 34: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/34.jpg)
![Page 35: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/35.jpg)
![Page 36: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/36.jpg)
![Page 37: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/37.jpg)
![Page 38: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/38.jpg)
Baffle obstruction and leak
Rhythm disturbances
Severe Tricuspid regurgitation
Right ventricle failure
![Page 39: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/39.jpg)
Low output – early post op period
Systemic RV failure
![Page 40: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/40.jpg)
![Page 41: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/41.jpg)
![Page 42: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/42.jpg)
Aortic translocation(TGA with VSD & LVOTO) – Nikaidoh
Damus-Kaye-Stansel(TGA with large VSD and RVOTO)
TGA with posterior Aorta- Arterial switch procedure without Lecompte maneuver
![Page 43: TGA-Dr.Elamaran](https://reader038.vdocuments.net/reader038/viewer/2022110309/55858f6ad8b42ad06d8b4755/html5/thumbnails/43.jpg)
Thank You