Ventriculoarterial connection Flashcards
D-TGA, L-TGA
d-TGA definition
where the AO arises from the morphological RV and the PA from the LV
-creating a Parrell circuit
d-TGA is an
atrioventricular ____
Ventricular arterial ____
options concordance or discordance
atrioventricular concordance
Ventricular arterial discordance
d-TGA is more common in ____
and in infants with ___ mothers?
Male vs Female
Males
infants with diabetic mothers
d-TGA is highly associated with what type of septal defect?
VSD but not always present
In d-TGA where does most mixing of blood occur?
at the atrial level
often requires balloon septostomy within first few days of life to increase mixing of blood
Because of the parrell circuit what is necessary for survival?
ASD
mixing of oxygenated and deoxygenated blood, most commonly done at the atrial level.
d-TGA present on a chest x-ray as
Oval cardiac silhouette
clinical signs of d-TGA are
tachypnea
cyanosis
RVH/LVH
D-TGA
Diagnosis can be made in PLAX and PSAX because of what 2D findings?
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
Does d-TGA affect the coronary arteries?
Yes, 50-70% of the time they are in their normal location, however, two common variants are
-left circumflex off the right coronary
-single right coronary artery
d-TGA surgical repair consist of
Jatene procedure/arterial switch procedure
or
atrial switch/Mustard/Senning procedure (mostly seen in adults rarely performed anymore)
Congenital defects associated with d-TGA
- anomalous coronary arteries (1/3 of patients)
- pulmonary stenosis
- right AO arch
- CoA
d-TGA two different surgical procedures are
Jatene “arterial switch” procedure
or
mustard and sennings procedure
Rastelli procedure is used for d-TGA with a
VSD
Explain the Rastelli procedure
creating a tunnel by using a patch, connecting the left ventricle to the aorta and effectively closing the VSD. Conduit is then placed between RV and the pulmonary outflow.
With d-TGA the arch can be mistaken for
PDA due to its size, look for the branches on the arch
L-TGA the pulmonary and systemic circuits are “corrected” as a result of
ventricular inversion
L-TGA is a result of multiple malformations, what are those?
Aorta and pulmonary arteries are transposed like in (d-TGA)
and the right and left ventricles are inverted
As a result, the RA is attached to the LV from which the PA arises; and the LA is attached to the RV where the AO arises making them physiologically corrected.
atrioventricular discordance and ventriculoarterial discordance
in L-TGA the AO is positioned ____ in relation to the PA?
anterior and leftward
If the patient has isolated L-TGA the symptoms are
patient may be asymptomatic well into adulthood if no other congenital defects are associated.
What 2D echo findings are commonly found with L-TGA?
- VSD
- pulmonary stenosis
- TV abnormal, underdeveloped, Ebsteins, TR
- RVE
- RV function diminished (not made to work as the systemic chamber)
- dextrocardia
The combination of severe PS and VSD can lead to cyanosis
By 2D echo what findings can help differentiate between L-TGA and D-TGA?
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
In L-TGA the atriums position are normal or switched
they are in normal position with the LA being on the left and the RA being on the right.
Other associated congenital complex associated with L-TGA are?
- CoA
- IAA
- DORV
In L-TGA the AV valves always stay with the corresponding?
atria or ventricle
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
The Jatene procedure is used with what congenital defect and what is performed in this operation?
Surgical repair for transposition of the great arteries D-type
-involves switching the AO and PA back to a semi normal arrangement 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 repair
What maneuver involves the main pulmonary and pulmonary branches being pulled anterior to the AO, and straddle the ascending AO
Lecompte maneuver
used in the Jatene procedure
Mustard and Senning procedures (atrial switch) consist of and was used to correct what complex?
intra-atrial surgical repairs used to treat D-TGA prior to the Jatene procedure
What does Mustard and Senning surgery involve?
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
Unfortunately the RV is not meant to do the systemic work of the LV, later on the RV may fail.
Baffle obstructions are common
Double Switch procedure
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.
What is the most common type of obstruction after a mustard or senning procedure
SVC obstruction
