TGA Flashcards
Anatomical defect
1- aorta arising from rv
2- pa arising from lv
3- communication is a must ( pda , vsd , asd )
Hemodynamics
- 2 closed cycle
• rv ~> aorta ( cyanosis) ~> body ~> rv
• lv ~> pa~> lung ~> lv - mixing defect is essential
History
1- central cyanosis :
-Onset : fist few hours , increases in days ( محاولة ال PDA انه يقفل بس مش هيقفل )
- not relived by 100% o2 ( hyperoxia test to differentiate between resp , cardiac causes of central cyanosis)
2- dynsea
3- hf
4- recurrent chest inf ( PDA ~> lung plethora)
Why hf
1- ischamia
2- pressure overload ( rv deals with aorta)
3- volume overload ( PDA , ASD)
( lt at~> rt at ( volume) ~> rt v ( volume ) ~> aorta ~> lung ( pda ) causing lung plethora ~> lt at ( volume ) ~> lt v not affected ( blood will be divided then )
Exam
General
1- ftt
2- hf
3- recurrent chest inf
4- central cynosis
5- clubbing ( 1-2 y)
Cardiac
Insp and palp
1-Rt at, v and lt at hypertrophy
2- thrills of mixing defect ( vsd , pda )
Ausc
1- single A2 ( ant displacement of aorta , post displacement of pa )
2- murmur of mixing defect ( vsd , pda)
Comp
1- polycyathmia ~> thrombosis
2- brain abscess, brain inf~> hemplegia ( loss of lung filter)
3- iron deficiency
4- infective endocarditis
5- hf
6- recurrent chest infection
Inv
1- cbc : + hb , + hematocrit , microcytosis
2- xray : * egg on side
~> rt at ,v and lt at hypertrophy
* narrow pedicle ( upper mediastinam )
~> aorta is just infront of pa
* lung plethora
3- ecg : hypertrophy
4- echo
Ttt
- pg :patency of pda ( immediately after birth )
( cant account on as se is bleeding tendency) - rashkind procedure ( ballon atrial septostomy ) ( urgent shunt )
- sugical correction : arterial repair within 2-3 weeks of life
Ages 🛑🛑🛑
(6)
1- vsd ~> 6:12 m
2- pda ~> over 6 kg
3- asd. ~> 3-5 y
4-avcd ~> 3:6 m before p htn
5- tetralogy ~> 6:9 m
6- tga ~> 2:3 weeks ( the youngest )
