Transposition of the great vessels

What is transposition of the great vessels?

Transposition of the great vessels is a congenital heart defect in which the pulmonary artery leaves the left ventricle and the aorta leaves the right ventricle, thus altering the normal circulation of blood in a very important way:

  • Oxygen-poor blood arriving in the right ventricle circulates throughout the body.
  • The freshly oxygenated blood in the lungs that reaches the left ventricle returns back to the lungs, forming two separate circuits.

This pathology often involves other associated cardiac defects, such as patent ductus arteriosus, communications or openings in the septum between the atria or the septum between the ventricles. Paradoxically, these associated defects are what allow a child with transposition of the great vessels to survive, since they cause blood from one circuit to mix with the other, thus allowing it to achieve oxygenation.

Prognosis of the disease

Transposition of great vessels has a poor prognosis if corrective surgery is not performed.

Once the child undergoes surgery, symptoms will improve and development will be normal. Likewise, a pediatric cardiologist will always follow up to evaluate and monitor any possible cardiac problems. Once the patient is an adult, the follow-up will be done by a cardiologist.

Transposition of the great vessels is one of the most common congenital heart defects.

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Symptoms of transposition of the great vessels

The severity depends on the associated heart defects, which are those that allow oxygenation of the newborn’s blood. Low oxygen levels cause the baby to become cyanotic (blue) and respiratory distress.

Symptoms appear at birth or very soon after birth.

Medical tests for transposition of the great vessels

The diagnosis of transposition of the great vessels can be made before the baby is born through routine ultrasounds performed on all pregnant women. When the baby is born, it can be diagnosed by auscultation of a murmur and the presence of a bluish color in the newborn’s skin and mucous membranes. The test that confirms the diagnosis is cardiac ultrasound.

What are the causes of transposition of the great vessels?

Transposition of the great vessels is one of the most common congenital heart defects, and is the second most common cause of problems in early infancy. The origin of transposition of the great vessels is unknown, as is the case with most congenital heart defects, although there are some maternal factors associated with a higher frequency of occurrence of these alterations:

  • Rubella during pregnancy
  • Poor nutrition
  • Alcoholism
  • Advanced age
  • Diabetes

Can it be prevented?

This heart defect is congenital and of unknown cause, so there is no known way to prevent it. What can be prevented are some complications and symptoms that arise later in the patient’s life, if detected early. Treatments for transposition of the great vessels Within the first two weeks of the baby’s age, the transposition of the great vessels will be surgically repaired through a procedure called arterial switch, also known as the “Jatene” operation.

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In the last 20 years, the arterial switch has been the surgical technique of choice to repair transposition of great vessels. However, previously the atrial switch or “Senning” or “Mustard” operation was performed, which consisted of directing the venous drainage of the body to the left atrium and the venous drainage of the lungs to the right atrium.

Which specialist treats it?

The pediatric cardiologist treats heart disease in the pediatric age. It begins in fetal life, with the diagnosis of intrauterine heart disease, and continues until the end of adolescence. It is a medical-surgical specialty, since many heart diseases will require surgical intervention and the pediatric cardiologist must be trained for this, as in the case of transposition of the great vessels.

Throughout the life of the patient who has suffered a transposition of the great vessels, he/she must be followed up by a specialist in Cardiology.