This document discusses the history, diagnosis, and treatment of transposition of the great arteries (TGA). It notes that TGA is a congenital heart defect where the aorta arises from the right ventricle and the pulmonary artery from the left ventricle. The document outlines the key developments in the surgical treatment of TGA, from early septostomies and shunts to the arterial switch procedure. It also describes the clinical presentation and management of different variations of TGA.

1. Dr.Elamaran.E
Senior Resident Dept. of CTVS,JIPMER

2. o Congenital cardiac anomaly
o Atrioventricular concordance and Ventriculo
arterial discordance.
o Aorta arises from the morphologic right
ventricle and the pulmonary artery arises
from the morphologic left ventricle.

4.  Morphologic description of TGA –Baillie(1797)
 Transposition of the aorta and pulmonary
artery was coined - Farre (1814)
 Surgery for TGA
 Atrial septectomy - Blalock and Hanlon(1950)
 Balloon atrial septostomy - Rashkind and
Miller - (1966)

5.  Partial physiological correction – Lillehei
(1953)
 Physiologic correction at the atrial level –
Senning(1959) and Mustard(1963)
 Arterial switch procedure –Jatene (1975)

6.  Etiology for transposition of the great
arteries is unknown and is presumed to be
multifactorial.
 Common association in infants of diabetic
mothers.

7.  Persistence of sub Aortic conus and
absorption of sub pulmonary conus
 Failure of the Truncus Arteriosus to septate
normally

8.  Transposition of the great arteries (TGA) is
the most common cyanotic congenital heart
lesion that presents in neonates.
 This lesion presents in 5-7% of all patients
with congenital heart disease.
 Male-to-female ratio is 2:1.
Male predominance increases to 3.3 : 1
(ventricular septum is intact)

9. Right ventricle –Hypertrophied, Sub aortic conus
Left ventricle- Normal to thinned out, Pulmonary-Mitral continuity
Aorta- Anterior and right of PA
Atria – Normal (RA>LA)
Atrio-Ventricular valves – Same level
Conduction tissue – Normal position and abnormal shape

10. Normal -2/3 and Abnormal -1/3

12.  The pulmonary and systemic circulations
function in parallel, rather than in series.

13.  When patients with all varieties of TGA are
considered
 55% - 1 month
 15% - 6 months
 10% - 1 year

14.  Transposition of the great arteries with intact
ventricular septum – Hypoxia
 Transposition of the great arteries with
ventricular septal defect –cardiac failure
 Transposition of the great arteries with
ventricular septal defect and left ventricular
outflow tract obstruction- Hypoxia

15.  Aggressive medical and surgical management
in the neonate has around 90% early and
midterm survival

16. 1. TGA with intact ventricular septum
2. TGA with VSD
3. TGA with VSD and LVOTO
4. TGA with VSD and pulmonary vascular
obstructive disease.

17.  Patent foramen ovale or Atrial septal defect-
75%
 Ventricular septal defect- 25% -40%
 Patent ductus Arteriosus-functionally closes
by 1 month
 Left ventricular outflow obstruction-5%
 Mitral valve-cleft leaflet/accessory chordal
tissue
 Tricuspid valve – regurgitation/dysplasia

18.  Symptoms and clinical presentation
 Depend on degree of mixing between the
two parallel circulatory circuits.

19.  TGA with intact ventricular septum –
Cyanosis within 24 hours
 TGA with VSD– congestive heart failure (2 to
4 months)
 TGA with VSD and LVOTO- similar to TOF
 TGA with VSD and PVOD – develop Hypoxia
after 6 months

20.  An oval-or egg-
shaped cardiac
silhouette with a
narrow superior
mediastinum
 Mild cardiac
enlargement
 Moderate
pulmonary plethora

22.  Simple TGA – Neonates- Arterial switch within
1 month
 Simple TGA – after 30 days
 Pulmonary artery banding- Arterial switch
after 2 weeks
 Atrial switch
 TGA with VSD- Arterial switch within few
weeks
 TGA with VSD and LVOTO – repair - 6 months

23.  Establishing Ventriculo-arterial concordance
 Anatomical correction

30.  Coronary artery lesions
 Neo Aortic valve regurgitation
 RVOTO and LVOTO obstruction

31.  Cardiac failure- Secondary to severe LV
dysfunction(imperfect coronary artery
transfer to Neoaorta)
 RV dysfunction – Progressive pulmonary
vascular disease (1%)
 Coronary events

32. Physiological correction

38.  Baffle obstruction and leak
 Rhythm disturbances
 Severe Tricuspid regurgitation
 Right ventricle failure

39.  Low output – early post op period
 Systemic RV failure

42.  Aortic translocation(TGA with VSD & LVOTO) –
Nikaidoh
 Damus-Kaye-Stansel(TGA with large VSD and
RVOTO)
 TGA with posterior Aorta- Arterial switch
procedure without Lecompte maneuver

43. Thank You