Transposition of the great arteries
Treatment & Care
Having identified your child’s heart condition, we’re able to begin the process of treating him, so that we may ultimately return him to good health.
Upon birth, your newborn will be admitted to Children’s Hospital Boston’s cardiac intensive care unit (CICU). Initially, he may be placed on oxygen or a ventilator to help him breathe, and IV (intravenous) medications may be given to help his heart and lungs function more efficiently.
Once he’s stabilized, your baby’s treatments will probably include:
- medication: Doctors may administer an IV (intravenous) medication (prostaglandin E1) to keep open the infant’s ductus arteriosus (the prenatal connection between the aorta and the pulmonary artery, which usually closes shortly after birth, but which is now important as a temporary alternative opening for blood flow).
- cardiac catheterization: Before TGA surgery, doctors may perform a cardiac catheterization procedure called balloon atrial septostomy to improve the mixing of oxygen-rich (red) blood and oxygen-poor (blue) blood. A special catheter with a balloon in the tip is used to create or enlarge an opening in the atrial septum (wall between the left and right atria).
surgery: Within a baby’s first one to two weeks, transposition of the great arteries is surgically repaired through a procedure called an “arterial switch,” which roughly describes the surgical process. A heart-lung machine does the work of the heart, while the aorta and pulmonary arteries are disconnected, “switched” and reconnected to their proper ventricles.
As part of the procedure:
- The coronary arteries are repositioned to the newly positioned aorta so that “red” blood can supply the muscle of the heart.
- The associated holes between the chambers of the heart are closed.
- The heart is reactivated as the heart-lung machine is withdrawn.
At home: caring for your child after surgery
After surgery, your child’s cardiologist will offer recommendations for follow-up care, including:
- wound care while the baby is healing
- a nutritional program to encourage weight gain
- an oral hygiene program to prevent infection
- an appropriate exercise regimen to build body mass and achieve fitness
As your baby recovers and grows, be sure to follow a regular program of well-baby/well-child checkups.
As he grows: your child's long-term outlook
Surgical techniques for TGA and its associated defects are continually being refined, and the long-term outlook is continually improving. Most children who’ve had TGA surgery recover and grow normally. Even so, your child will need periodic monitoring, since he may be at some risk for arrhythmias, leaky valves, narrowing of the arteries at the sites of the switch, and other heart issues.
Your child’s cardiologist will help you create a long-term care program as your baby matures into childhood, the teen years and even adulthood. Most people who have had congenital heart disease repair will have an ongoing relationship with their cardiologist. We’ll prevent and treat any complications (often detected through cardiac MRI) and will advise on daily-life issues, such as activity levels, nutrition and precautions related to pregnancy.
Coping and support
We understand that if your child is has TGA, you’ll have a lot of questions. Will surgery help my child? What’s the long-term outlook? Children’s Hospital Boston has a variety of resources at that may be helpful to your family:
- patient education: Our nurses will be on hand to walk you through your child’s treatment and help answer any questions you may have.
- parent-to-parent: Want to talk with someone whose child has been treated for TGA? We can often put you in touch with other families who’ve been down a similar road and can share their experiences. To request family-to-family support, talk with your child’s health care team or contact The Center for Families.
- faith-based support: If you and your family are in need of spiritual support, we can connect you with the Children’s chaplaincy. Our program includes nearly a dozen clergy representing Protestant, Jewish, Muslim, Roman Catholic and other faith traditions who will listen to you, pray with you and help you observe your own faith practices during your treatment experience.
social work and mental health professionals: Children’s social workers and mental health clinicians have helped many other families in your situation. We can offer counseling and assistance with a wide variety of issues, such as coping with your child’s diagnosis, stresses relating to coping with illness and dealing with financial difficulties.
- As your child reaches adulthood, you’ll want him to know about our Boston Adult Congenital Heart and Pulmonary Hypertension Service (BACH). Children’s is a founding institution of BACH, an international center for excellence providing long-term inpatient and outpatient care and advanced therapeutic options as needed for congenital heart disease patients as they reach and progress through adulthood.
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|Children’s Heart Care Center|
The Heart Care Center at Children’s is one of the largest pediatric heart programs in the United States. Our staff of more than 80 pediatric cardiac specialists cares for thousands of children and adults with congenital and acquired heart defects each year, from simple to complex cases. We have experience treating rare heart problems—with results that are among the best in the world.
|Children’s Development of Interventional Catheterization|
You’ll be comforted to know that Children’s pioneered the use of interventional catheterization for many congenital heart defects and is a leader in the use of this procedure.