This leaflet aims to give you an overview of a complex congenital heart condition called Transposition of the Great Arteries.
Transposition of the great arteries – Arterial Switch
Transposition of the great arteries (TGA) is a serious heart condition in which the two main arteries coming out of the heart are the wrong way round. Babies born with transposition of the great arteries will become blue (low in oxygen) shortly after birth and without heart surgery, the condition is usually fatal in the first weeks of life.
Treatment as a child
You have had an operation called an ‘Arterial Switch’, to switch the arteries back to the correct place in the heart. The coronary arteries, which feed blood rich in oxygen to the heart muscle, have to be re-connected. Although this operation is often referred to as “corrective” surgery, it never makes the heart completely normal. The switch is usually done within the first three weeks after birth.
Transposition of the Great Arteries – Transcript
This video explains the condition transposition of the great arteries or
TGA for short and its treatment you may find it helpful to look at our
video of the normal heart before watching this video in the normal circulation blood that is low in oxygen returns from the body in veins to the right side of the heart where it is pumped from the right ventricle to the lungs through the pulmonary artery plant picks up oxygen in the lungs and returns to the heart where it is pumped from the left ventricle to the body through the aorta the aorta and pulmonary artery are
together referred to as the great arteries shortly after the aorta leaves the heart it gives off two branches the coronary arteries that supply the heart itself with blood in transposition of the great arteries the aorta and pulmonary artery are connected to the heart the wrong way round
this means that blood returning from the body that is low in oxygen is pumped out of the right ventricle to the aorta and so back around the body at the same time blood returning from the lungs that has lots of oxygen is pumped from the left ventricle to the pulmonary artery and back to the lungs the consequence of transposition of the great arteries is that oxygen cannot be delivered to the body and unless treated quickly the baby is unlikely to survive the immediate priority is to ensure that at least some oxygenated blood can get to the body when a baby is born there is a natural hole called a patent for a monovale between the two collecting chambers of the heart the right atrium and the left atrium
often this hole is not wide enough so a procedure called a balloon atrial septostomy is performed a tube is inserted through a vein in the
groin into the right atrium and across into the left atrium once in the left atrium a balloon is inflated and pulled back into the right atrium this enlarges the hole between the right and left atria and so allows for more oxygenated blood to be pumped around the body by improving the delivery of blood to the body this procedure buys some time until a corrective operation can be performed although not illustrated here oxygenated blood can also pass between the aorta and pulmonary artery through a small connection between the two arteries called the ductus arteriosus the ductus arteriosus is open when a baby is in the womb but usually closes shortly after birth a baby with transposition of the arteries might be given a drug to keep the ductus arteriosus open until a
balloon atrial septostomy or a correction operation are performed surgical correction of transposition of the great arteries is achieved by performing an arterial switch operation usually in the first few weeks of life after opening the chest through the middle of the breastbone the coronary arteries are detached from the aorta and both the aorta and pulmonary artery are cut just above where they leave the heart each artery is moved and reconnected to the correct side of the heart the aorta to the left ventricle and the pulmonary artery to the right ventricle the
coronary arteries are then reconnected to the aorta in its new position
the arterial switch operation therefore results in a normal circulation with
oxygenated blood being pumped from the left ventricle to the body via the aorta and blood that is low in oxygen being pumped from the right ventricle to the lungs via the pulmonary artery lifelong follow-up is required after the arterial switch operation in most patients it is likely that no further operations or procedures will be required but in some patients complications occur that require further treatment either in childhood or in adulthood.
Transposition of the great arteries Arterial Switch – YouTube
Issues relating to adult patients
The arterial switch operation has been performed since the early 1990’s so we don’t have long-term data about this operation but we are hopeful that life should be relatively normal. We do know there are a few potential problems that may occur, so you do need to have life-long follow up to monitor for these.
These include;
- Narrowings near the pulmonary valve.
- Leaking of the aortic valve or stretching of the aorta.
- Impaired function of the left pumping chamber, if there was some damage during the operation.
- Problems relating to the coronary arteries ( the blood vessels that supply the heart muscle with blood).
General advice for the future
- Most patients lead a normal active life after after an arterial switch operation, including sports. We would recommend against very heavy weight lifting to avoid placing extra strain on the aorta. Please ask if you would like further information about this.
- All patients who have had a switch operation are at risk of infection in the heart (called endocarditis). Endocarditis may be caused by infections of the teeth or gums, therefore it is important to visit the dentist regularly. Some people require antibiotics before invasive dental treatment. Please ask your doctor or specialist nurse if this applies to you. Body piercing and tattoos are best avoided as they also carry a small risk of infection which may spread to the heart.
- Because there may be a risk of early disease in the coronary arteries, because they have been re-implanted, we strongly advise against smoking. It is important to try to maintain a healthy lifestyle overall to reduce your risk of developing cardiovascular disease in the future.
- The chances of having a baby born with congenital heart disease are slightly increased from the general population if you have congenital heart disease yourself. The risk is generally quoted as being about 4-5%, compared to 1% for the general population. Your cardiologist can discuss this with you in clinic prior to planning a family. We can offer a specialised scan of your unborn baby’s heart at around 18-20 weeks into pregnancy, which can detect any major abnormality of the heart.
- Talk to us before you get pregnant. This is to enable the cardiologist to assess your heart in more detail prior to pregnancy and to arrange further tests if necessary.
Contact us
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For clinical queries
ACHD Specialist Nurses
Please contact the ACHD Specialist Nurses.
Further Support and Advice
The Somerville Heart Foundation
For young people and adults with congenital heart disease.
Join as a ‘friend’ to access their benefits including advice around benefits, employment, pensions, will writing and insurance. They also have a counselling service and support groups.