No other congenital heart defect better demonstrates the close co-operation between cardiologist, interventionalist and surgeon in bringing about excellent outcome as does TGA.

What are the treatment options ?

This is a rather complicated topic, so I will split it into sections - initial stabilization, palliative treatment and definitive treatment.

Initial stabilization of the sick patient with TGA

As I mentioned earlier, the first treatment measure is to improve mixing of venous and arterial blood. And the best method is to start a "prostaglandin drip". This must only be done in a well equipped hospital, under the guidance of qualified physicians. Prostaglandin can suppress breathing, and sometimes the child may need to be connected to an artificial respirator. Oxygen may need to be administered by an "oxygen tent" or mask.

Palliative treatment

Most complex heart defects may need to be treated in stages. The first procedure aims at improving the condition of the child, so that he or she is better prepared to tolerate the more rigorous definitive operation. In TGA, palliation is usually achieved by trans-catheter methods.
A catheter is a special thin tube passed into the blood vessels through a small needle-stick in the groin or forearm, and guided into the heart. Through this catheter, a special device that resembles a balloon is passed into the heart. The wall between the right and left atrium is punctured and the catheter device pushed through the small hole thus created. The balloon is then inflated, and the catheter is pulled back through the small hole, tearing it and making it larger. This procedure is called a Balloon Atrial Septostomy and was first devised by Dr.Rashkind. The aim is to create a large enough opening between the two atria, so that blood can freely mix across it, and improve oxygen supply.
Sometimes, a balloon atrial septostomy does not provide adequate mixing, or cannot be carried out at all. In this situation, surgical creation of a "hole" in the wall between the atria is necessary. The operation was first described by Drs.Blalock and Hanlon, and is called an atrial septectomy. It is a "closed-heart" operation, in which a part of the atrial septum is surgically removed after applying special clamps on the heart to prevent bleeding. The results of atrial septectomy are usually good.

And finally "definitive treatment"

Basically, there are two ways to deal with the abnormality of TGA. First, the venous blood returning to the right atrium can be diverted to the LEFT ventricle, from where it will go to the lungs through the pulmonary artery. At the same time, the pure blood returning from the lungs will be diverted to the RIGHT ventricle which will pump it into the aorta. This operation is performed from within the atrium, and is called an ATRIAL SWITCH OPERATION.
The second approach is easier to understand. The aorta and pulmonary artery are divided, their positions "switched" and stitched back to their CORRECT ventricles - the aorta to the LEFT ventricle and the pulmonary artery to the RIGHT. This is called the ARTERIAL SWITCH OPERATION. Of course, nothing in congenital heart surgery is really simple, and there are any number of special circumstances that make modifications of the treatment approach necessary.

What is the Arterial Switch Operation ?

 

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