CHD: transposition of great arteries

Question 1

TGA is common in

Answer 1

infants of diabetic mothers

Question 2

prominent in

Answer 2

males

Question 3

blood flow in TGA

Answer 3

aorta arises from RV
pulmonary arises from LV
-RA sends deoxygenated blood to RV-> aorta-> RA through vena cava
-pulmonary veins-> LA-> oxygenated blood to LV-> back to lungs

Question 4

what is necessary for survival?

Answer 4

PDA

patent foramen ovale

Question 5

what increases risk for CHF?

Answer 5

if VSD, ASD, and PDA present

-less cyanotic tho

Question 6

presentation of TGA

Answer 6

cyanotic
loud single S2
tachypnea and VSD murmur if 2 weeks and concomitant VSD present

Question 7

CXR

Answer 7

-egg-shaped with narrow mediastinum, cardiomegaly and increased pulmonary vascular markings if VSD present

Question 8

ECG

Answer 8

R axis deviation

RVH (normal for neonates)

Question 9

echo

Answer 9

confirms switched position of great arteries, demonstrates ductal flow or atrial mixing

Question 10

TGA treatment:

Answer 10

PGE1 infusion
O2
arterial switching: Jatene procedure 1st
-after 2 weeks two stage switch can be done
-infants with a VSD can have it close after 2 weeks of switch-> control CHF to prevent pul VD

Question 11

TGA treatment: atrial switching (Mustard/Sennig)

Answer 11

• mortality from RV failure, or TR

- morbidity: arrhythmias, baffle obstruction flow

Question 12

TGA treatment: arterial switch Jatene

Answer 12

morbidity: supravalvular stenosis at re-anastomosis sites, dilation of aortic root with valvular insufficiency, coronary perfusion issues