Ventriculoarterial connection

Question 1

d-TGA definition

Answer 1

where the AO arises from the morphological RV and the PA from the LV
-creating a parrell circut

Question 2

d-TGA is more common in ____
and in infants with ___ mothers?

Male vs Female

Answer 2

Males
infants with diabetic mothers

Question 3

d-TGA is highly associated with what type of septal defect?

Answer 3

VSD but not always present

Question 4

In d-TGA where does most mixing of blood occur?

Answer 4

at the atrial level

often requires balloon septostomy within first few days of life to increase mixing of blood

Question 5

Because of the parrell circut what is necessary for survival?

Answer 5

mixing of oxygenated and deoxygenated blood, most commonly done at the atrial level.

Question 6

d-TGA present on a chest x-ray as

Answer 6

Oval cardiac silhouette

Question 7

clinical signs of d-TGA are

Answer 7

tachypnea
cyanosis
RVH/LVH

Question 8

Diagnosis can be made in PLAX and PSAX because of what 2D findings?

Answer 8

PLAX:Double barrel from two outflow vessels running parrell to each other
PSAX: both vessels are on the same plane as one another, AO is anterior and to the right of the PA

AO is usuall anterior and rightward in PSAX

Question 9

Does d-TGA affect the coronary arteries?

Answer 9

Yes, 50-70% of the time they are in their normal location, however, two common varients are
-left circumflex off the right coronary
-single right coronary artery

Question 10

d-TGA surgical repair consist of

Answer 10

Jatene procedure/arterial switch procedure
or
atrial switch/Mustard/Senning procedure (mostly seen in adults rarely performed anymore)

Question 11

Congenital defects associated with d-TGA

Answer 11

• anomalous coronary arteries (1/3 of patients)
• pulmonary stenosis
• right AO arch
• CoA

Question 12

d-TGA two different surgical procedures are

Answer 12

Jatene “arterial switch” procedure
or
mustard and sennings procedure

Question 13

With d-TGA the arch can be mistaken for

Answer 13

PDA due to its size, look for the brances on the arch

Question 14

L-TGA the pulmonary and systemic circuits are “corrected” as a result of

Answer 14

ventricular inversion

Question 15

L-TGA is a result of multiple malformations, what are those?

Answer 15

Aorta and pulmonary arteries are transposed like in (d-TGA)
and the right and left ventricles are inverted

As a result the the RA is attaced to the LV from which the PA arises ; and the LA is attaced to the RV where the AO arises making them physiologically corrected.

atrioventricular discordance and ventriculoarterial discordance

Question 16

in L-TGA the AO is postioned ____ in relation to the PA?

Answer 16

anterior and leftward

Question 17

If the patient has isolated L-TGA the symptoms are

Answer 17

patient may be asymptomatic well into adulthood if no other congenital defects are associated.

Question 18

What abnormalities are commonly found with L-TGA?

Answer 18

• VSD
• pulmonary stenosis
• TV abnormal, underdeveloped, Ebsteins, TR
• RVE
• RV function deminished (not made to work as the systemic chamber)
• dextrocardia

The combination of severe PS and VSD can lead to cyanosis

Question 19

What is the main thing that differentiates L-TGA vs D-TGA?

Answer 19

Look at the ventricles and determine which ventricle is trabeculated and has a moderator band which are characteristics of the RV

both will have the parrell vessels in PLAX, PSAX will be slightly different where the AO will be slightly rightward in D-TGA than in L-TGA

Question 20

In L-TGA the atriums position are normal or switched

Answer 20

they are in normal position with the LA being on the left and the RA being on the right.

Question 21

Other associated congenital complex associated with L-TGA are?

Answer 21

• CoA
• IAA
• DORV

Question 22

In L-TGA the AV valves always stay with the corresponding?

atria or ventricle

Answer 22

the AV valves will stay with the ventricles

mitral with the LV and tricuspid with RV

look at the relation of placement to the crux, Tricupid septal leaflet further down the ventricle

Question 23

The Jatene procedure is used with what congenital defect and what is performed in this opertaion?

Answer 23

Surgical repair for transposition of the great arteries D-type
-involves switching the AO and PA back to their original position by detaching them from above their roots/coronary arteries and attaching them to their new roots. coronaries will be attached to the “neo-aorta”
-PDA ligated
-ASD and VSD reapir

Question 24

What maneuver involves the main pulmonary and pulmonary branches being pulled anterior to the AO, and straddle the ascending AO

Answer 24

Lecompte maneuver

used in the Jatene procedure

Question 25

Mustard and senning procedures (atrial switch) consist of and was used to correct what complex?

Answer 25

intra-atrial surgical repairs used to treat D-TGA prior to the Jatene procedure

Question 26

What does Mustard and Senning surgery involve?

Answer 26

atria are “switched”; IAS excised and a patch is used to create a tunnel/baffle

Oxygenated pulmonary venous return is directed by the baffle to the TV and is drained into the morphological RV and out the AO

deoxygenated cavae flow is directed to the MV and drains into the morphological LV and out the PA

Unfortuantly the RV is not meant to do the systemic work of the LV, later on the RV may fail.
Baffle obstructions are common

Question 27

Double Switch procedure

Answer 27

involves the mustard/senning procedure with a Jatene procedure

isolated L-TGA

If pulmonary stenosis is a factor then Jatene procedure can not be performed. The mustard/senning can be done with a rastelli conduit to connect the RV to the PA.