CHDFNigeria
Transposition of the great arteries, TGA, is type of CHD where the major blood vessels leaving the heart, the Aorta (which carries oxygen rich blood to the body) and Pulmonary Artery (carrying oxygen and nutrient poor blood to the lungs for oxygenation) are transposed (misaligned or switched) originating from the wrong side of the heart. It is one of the most severe and critical types of congenital heart defects, as the blood that is pumped from the aorta to the general body is deoxygenated blood, hence it requires immediate lifesaving procedures performed in the first week of life.
It usually co-exists with VSD to help mixture of blood. A TGA with intact septum is more critical. According to Centre for Disease Control, CDC, the incidence of TGA is about 1 in 3,957 babies in the United States are born with a d-TGA, with an estimated 928 babies born with d-TGA annually. In Nigeria, there is need for research and surveillance to arrive at incidence.
Signs and Symptoms:
Symptoms of TGA are usually pronounced, and features of distress are noticed in the first 48 hours of life. They include:
- Low level oxygen saturation less than 80%
- Cyanosis
- Tachypnoea
- Difficulty in feeding
- Fatigue
- Poor weight gain
- Tachycardia
Diagnosis and Investigations
Can be made before or after birth as with any other CHDs. Similar diagnostic investigations are ordered e.g.
Chest X-ray
ECG
Echocardiograph
CT scan of TGA is similar with other types of CHD earlier discussed
Management
Stabilization: TGA requires both urgent medical and procedural treatments in the first few hours of life. Immediate treatment includes the administration of a prostaglandin infusion. Prostaglandin is an essential medication that is administered intravenously (IV) and keeps the ductus arteriosus open. Goals of treatment are aimed at stabilizing and supporting the infant until surgical intervention. Essential medication like prostaglandin are necessary to keep PDA duct opened, however, these meds are not readily available and accessible in Nigeria. ………………please add link to essential drug/medication by WHO
Other times, arterial septostomy is performed to allow mixture in cases of intact TGA.
Arterial switch operation is the definitive treatment of TGA. See link for videos on the operation https://www.youtube.com/watch?v=QNUnZqoeBTo
