Transposition of the Great Arteries (TGA) in children

Transposition of the Great Arteries (TGA) is a serious congenital heart defect in which the two main arteries leaving the heart are reversed (transposed). This condition changes the way blood circulates through the body, leading to a shortage of oxygen in blood flowing from the heart to the rest of the body.

Types of TGA

Dextro-Transposition of the Great Arteries (d-TGA):
- The more common type, where the aorta arises from the right ventricle, and the pulmonary artery from the left ventricle.
Levo-Transposition of the Great Arteries (l-TGA):
- Less common, both the aorta and the pulmonary artery are connected to the right ventricle.

Symptoms

Cyanosis: A bluish tint to the skin, lips, and nails, indicating low oxygen levels.
Difficulty Feeding: Babies may become breathless and fatigued during feeding.
Shortness of Breath.
Poor Weight Gain.
Heart Murmurs.

Diagnosis

Echocardiogram: Primary tool for diagnosing TGA, providing detailed images of the heart’s structure.
Chest X-ray: Shows the size and shape of the heart.
Electrocardiogram (ECG): Records the electrical activity of the heart.
Cardiac Catheterization: Sometimes used for a more detailed examination.

Treatment

Prostaglandin E1 Infusion: Administered shortly after birth to keep the ductus arteriosus open, allowing some mixing of oxygen-rich and oxygen-poor blood.
Balloon Atrial Septostomy (BAS): A catheter-based procedure performed to create or enlarge an opening between the heart’s upper chambers to improve oxygenation.
Surgery: The definitive treatment for TGA.
- Arterial Switch Operation: The most common surgical method where the positions of the pulmonary artery and the aorta are switched back to their normal locations.

Prognosis

With timely surgical intervention, most infants with TGA can have successful outcomes and live relatively normal lives.
Long-term follow-up with a cardiologist is essential to monitor for any complications.

Complications

Heart Rhythm Problems (Arrhythmias).
Heart Function Issues: Like ventricular dysfunction or valve problems.
Neurodevelopmental Issues: Can occur, especially if there were complications during the newborn period.

Preventive Measures

The cause of TGA is largely unknown, and there are no specific preventive measures.
Good prenatal care and avoiding harmful substances during pregnancy may reduce the risk of congenital heart defects.

Children with TGA require close follow-up care throughout their lives, even if their initial surgeries are successful, to monitor and manage any long-term effects of the condition or its treatment.