TGA (Transposition of the Great Arteries)
TGA stands for transposition of the great arteries and is a common condition in which the two main vessels that arise from the heart are backwards. These two main vessels, the aorta and the pulmonary artery, are backwards such that they arise from the opposite ventricles from those of normal patients.
All children with TGA have other defects inside and around their hearts (see VSD, ASD and PDA), and some even have other more complicated associated conditions such as coarctation and hypoplastic or interrupted aortic arch). Before the advent of modern successful heart surrey, all children with this condition would die as infants or toddlers, and many would not even survive the newborn period.
Thankfully, surgery can now be performed in almost every newborn with TGA and almost every other associated lesion repaired at the same time in one stage. For the most complex combinations, occasionally a child may require two procedures, but this “staged approach” is unusual in the current era. After repair, whether a single procedure or two is staged, the vast majority of children go on to live active and healthy lives and do not need further surgery. The modern repair that is preferred is called the arterial switch operation (ASO for short). The ASO remains a major, complex cardiac operation that is performed in the first few weeks of life and requires surgeons specifically trained in such newborn repairs.
There are many nuances and subtypes of TGA, and it is important for your newborn to be evaluated and treated at a center with experience in managing all forms of this disease to obtain the best possible results. For patch material during the repair, we prefer to use something called pericardium (the tough lining around the heart) or Gore-Tex (the same durable material that rain jackets are made from). Both are time-tested materials which produce no problems for the child as they grow, even years later. The ASO always requires an incision and cardiopulmonary bypass.
In our program, we have been managing patients with all forms of TGA for more than 30 years and now exclusively perform the ASO for babies with this condition. Our surgeons have written about many of the techniques and results for such switch operations. (See these published articles: “Current expectations for newborns undergoing the arterial switch operation” and “Current risk factors and outcomes for the arterial switch operation.“)
The arterial switch places the main arteries back where they belong, and along with this, we close associated ventricular septal defects, atrial septal defects and patent ductus arteriosus and repair any associated coarctation or arch problems.
Our surgeons have been trained in the centers where the modern ASO techniques were initially developed, including Boston Children’s and University of Michigan. From 2009-2013 alone, we have performed more than 70 arterial switch operations with a 100 percent survival, even for the more complex patients with several associated defects.