transposition of the great arteries

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Paediatrics (Cardio) Mindmap am transposition of the great arteries, erstellt von v.djabatey am 28/01/2014.
v.djabatey
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Zusammenfassung der Ressource

transposition of the great arteries
  1. right to left shunt
    1. =discordant ventriculo-arterial connection
      1. aorta connected to right ventricle
        1. pulmonary artery connected to left ventricle
        2. blue blood is returned to body
          1. & pink blood returns to lungs
            1. i.e. 2 parallel circulations
              1. incompatible with life
                1. unless there is mixing of the blood btw them
                  1. e.g. by VSD, ASD, PDA
        3. Clinical features
          1. Sx
            1. cyanosis
              1. main sx
                1. profond and life-threatening
                  1. usually presents on day 2 of life
                    1. ductal closure-> marked reduction in mixing of sat and desat blood
                    2. less severe and presentation delayed if there is more mixing of blood
                      1. from assoc anomalies e.g. ASD
                  2. physical signs
                    1. cyanosis
                      1. always present
                      2. loud & single S2
                        1. usually no murmur
                          1. but maybe systolic murmur
                            1. from increased flow or stenosis within left ventricular (pulmonary) outflow tract
                      3. Ix
                        1. CXR
                          1. classic findings
                            1. narrow upper mediastinum
                              1. due to ant-post relationship of great vessels & narrow vascular pedicle
                              2. cardiac shadow: egg on side appearance
                                1. due to hypertrophied right ventricle
                              3. increased pulmonary vasc markings
                                1. due to increased pulmonary blood flow
                              4. ECG
                                1. usually normal
                                2. Echo
                                  1. to show abnormal arterial connections & assoc abnormalities
                                    1. essential
                                  2. Mx
                                    1. in sick cyanosed neonate, key is to improve mixing
                                      1. must maintain patency of ductus arteriosus
                                        1. w/ prostaglandin infusion
                                        2. balloon atrial septostomy
                                          1. life-saving
                                            1. done in 20% of cases
                                              1. catheter with inflatable balloon at tip
                                                1. passed through umbilical/femoral v through into right atrium and formaen ovale
                                                  1. balloon inflated in left atrium & pulled back through atrial septum
                                                    1. atrial septum torn, so foramen ovale valve left incompetent
                                                      1. so sys and pulmonary venous blood can mix
                                              2. surgery
                                                1. all pts w/ TGA need this
                                                  1. usually arterial switch procedure
                                                    1. done in neonatal period (esp 1st few days of life)
                                                      1. pul artery & aorta are transected above arterial valves & switched over
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