It's hard to put into words the fear and sadness you feel when you hear that your newborn baby has a heart condition, isn't it? But don't worry. Sometimes babies can have two of the main blood vessels in their hearts switched when they are born. Today we're talking about one such condition, called `(Transposition of the Great Arteries)`. This may seem a bit complicated, but let's keep it simple.
What is Transposition of the Great Arteries?
Simply put, this is a ``congenital`` condition that occurs when a baby is born. That is, this problem occurs while the baby is still in the mother's womb. We have two main blood vessels that carry blood from our heart to the rest of our body. One is
the pulmonary artery, which carries blood to the lungs , and the other is
the aorta, which carries blood to the rest of our body . What happens in this condition is that these two large blood vessels are connected to the heart in the wrong places, not in the right places. It's like the pipes going to two water tanks are switched.
How does blood normally travel? What happens in this situation?
Normally, this is what happens: the body's oxygen-poor blood (blue blood) goes to the heart, from there to the lungs to pick up oxygen. Then the new, oxygen-rich blood (red blood) goes back to the heart, from there to the whole body through the great arteries. But in this ``Transposition of the Great Arteries'' condition, because the two blood vessels are switched, the oxygen-poor blood goes back to the body instead of going to the lungs. Similarly, the oxygen-rich blood coming from the lungs goes back to the lungs instead of going to the body. Imagine how much less oxygen this will get to the baby's organs.
Are there types of this?
Yes, there are two main types of this: 1.
Levo-transposition (Levo-transposition or l-TGA): In this case, the baby's aorta is on the left side of the pulmonary artery. In this case, not only the two blood vessels, but also the lower chambers of the heart are switched. However, in this type, deoxygenated blood goes to the lungs and oxygenated blood goes to the body, so it does not cause much harm. This is a little less common. 2.
Dextro-transposition (Dextro-transposition or d-TGA): In this case, the baby's aorta is on the right side of the pulmonary artery. This is the most common type, and
it is also the type that needs more attention. We will talk more about this `(d-TGA)` in this article.
Why is this condition called d-TGA dangerous for babies?
As I said before, in the case of `(d-TGA)`, the baby's body is full of oxygen-poor blood. This means that all the vital organs of the baby, such as the brain, kidneys, and liver, do not receive the required amount of oxygen. This is very dangerous for the baby's life. Sometimes, when these babies are born, there may be a hole between the upper chambers of the heart `(Atrial Septal Defect or ASD)` or a hole between the lower chambers of the heart `(Ventricular Septal Defect or VSD)`. Although these holes are really unusual conditions, in such cases, these holes can be of little help. That is, these holes allow some oxygen-rich blood to mix with the blood that does not have oxygen. However, the amount of oxygen that is received is not enough at all. Therefore, the baby definitely needs treatment.
Don't worry, there are surgeries for this condition. Doctors have been performing these surgeries successfully for years.
What are the signs and symptoms if your baby has this condition? (Symptoms)
Newborns with `(d-TGA)` may develop a condition called `(cyanosis),` which is a blue/gray color of the skin due to lack of oxygen. They may also have a weak heart. The main symptoms are:
- Difficulty breathing .
- The pulse is very weak.
- Shows reluctance and difficulty drinking milk.
- My heart feels like it's beating too loudly, like it's beating too fast.
- The skin and whites of the eyes may appear blue (in babies with fair skin) or gray (in babies with dark skin).
When do these symptoms start?
A baby with `(d-TGA)` will start to show these symptoms at birth. However, sometimes, due to things like `(ASD)`, the small holes in the baby's heart can cause some oxygen-rich blood to get to the body, so the symptoms can be less noticeable. Also, the `(patent ductus arteriosus)`, a blood vessel that the baby uses while in the womb, can remain open for a few days after birth, causing blood to mix. However, once these temporary holes and tubes close, the symptoms can suddenly increase. In that case, the baby needs immediate medical attention.
Why is this happening? (Reasons)
Doctors still don't know exactly what causes Transposition of the Great Arteries. Like other congenital heart diseases, it is thought to be caused by a genetic mutation or exposure to toxins during pregnancy. Some of the factors that can contribute to the condition include:
Don't be alarmed by these things. Not everyone who has had one of these things will experience this.
How do doctors diagnose this? (Diagnosis)
Sometimes, doctors can detect this condition while you are still pregnant. This is done through prenatal tests. If
your doctor suspects something is wrong during an ultrasound scan of your baby, he or she may ask you to have a fetal echocardiogram. This is similar to an ultrasound, but it looks at the baby's heart in great detail. This can confirm whether you have d-TGA. If it is not detected during pregnancy, it is usually detected within the first week after birth.
What tests are done for this?
The tests that doctors use to confirm this condition are:
- Echocardiogram (Echo): This is also an ultrasound scan of the heart.
- Electrocardiogram (EKG): A test that looks at the electrical activity of the heart.
- Newborn pulse oximetry screening: This is often done on all newborns.
- Chest X-ray test.
- Cardiac catheterization: This is a more complicated test. A thin tube ( catheter ) is inserted through the leg or arm into the heart. This is done if other tests are not clear.
- A CT scan is a test.
How to treat this? Your baby needs help fast!
A baby born with `(d-TGA)`
must have surgery to survive. Most of the time, this surgery is done
within the first week of birth. This surgery is called
an arterial switch procedure . Simply put, this involves reconnecting the two switched blood vessels (the aorta and the pulmonary artery) back into their correct positions. This allows blood to flow properly. If your baby has a hole in their heart, such as a `(VSD)`, that will also be repaired during this surgery.
Temporary things to do before surgery
Doctors use several temporary treatments to stabilize the baby's condition until major surgery can be performed. These include:
- Prostaglandin: This medicine is used to open the ductus arteriosus, a blood vessel that the baby used to have in the womb but closes after birth. Once this is open, some oxygenated blood starts to flow into the body.
- The procedure called Balloon atrial septostomy:In this, a thin tube (catheter) is used to enlarge the natural opening between the two upper chambers of the heart. This allows oxygenated and deoxygenated blood to mix, providing the body with some oxygen.
Can this situation be prevented?
There is no known way to prevent Transposition of the Great Arteries. However, it is important to follow good health practices during your pregnancy. Get all your shots on time, take your multivitamin, and keep your doctor appointments. If anyone in your family has a history of congenital heart disease, talk to your doctor about it. He or she may recommend genetic counseling.
What happens after surgery? How to live with TGA
Although surgery does not completely "cure" the condition, many people with `(d-TGA)` live full, healthy lives. However, those with this `(congenital)` condition
require lifelong medical supervision. A cardiologist will regularly monitor your child's condition and provide any necessary advice. The survival rate after `(arterial switch)` surgery is more than 95%. It is said that this rate remains the same even after 25 years.
Can your child live well with TGA?
Yes, absolutely. After treatment for the condition `(Transposition of the Great Arteries)`, your child can live a normal life. However, the heart needs to be taken care of throughout life. That means:
- You should maintain regular contact with a cardiologist who specializes in these types of conditions.
- You need to take the prescribed medication exactly.
- Tests that check the functioning of the heart, such as `(EKG), `(Holter monitor), `(exercise stress tests), and `(echocardiogram),' will need to be done regularly.
Many cardiologists do not recommend playing competitive sports after a `(d-TGA)` surgery. Therefore, you and your child, your pediatrician, and your cardiologist should work together to make the best decision for your child's health. Many women who have had `(d-TGA)` surgery have successfully given birth to children. However, you should definitely talk to your doctor and cardiologist before getting pregnant.
Will more heart surgeries be needed in the future?
Yes, more surgeries may be needed later. Most often, they are to correct a heart rhythm problem or to repair heart valves.
Is there a risk of endocarditis?
Endocarditis is a condition that occurs when a bacterial infection enters the heart. People with heart conditions like TGA are more likely to develop this. Therefore, people who have had transposition surgery may need to take antibiotics before dental treatment.
Could it affect brain development?
Some children who have had an arterial switch may have ADHD (attention deficit hyperactivity disorder). Or they may need special help with schoolwork. Be aware of this as well.
When should I see a doctor?
If your baby has these symptoms...
- If you feel like you're having trouble breathing.
- If the pulse is very weak.
- If the skin around the mouth has turned blue/white.
If you see something like this, see a doctor immediately.
If you had this surgery as a child...
You will need
regular medical checkups and monitoring throughout your life. See a cardiologist who is experienced in adult (congenital) heart disease.
What questions should you ask the doctor?
If your baby has Transposition of the Great Arteries, you can ask the doctor these questions:
- Does my baby need surgery soon?
- What is the best treatment?
- What kind of follow-up care does my baby need?
- Will he have to have another surgery?
- Are there any restrictions on his activities?
- How should I take care of my baby after the surgery?
If you had surgery for this condition as a child, you can ask your doctor:
- Will I need another surgery?
- What kind of medical supervision do I need?
- Are there any restrictions on my activities?
- Can I have a child?
Finally, the most important thing (Take-Home Message)
Finding out that your newborn has a congenital heart condition is not something any parent expects. It can be heartbreaking. But,
you are not alone. Your baby's doctors can help you through this journey and guide you through the decisions you make.
Remember, doctors have been treating babies with TGA for years, and the results are very successful. Be strong for your child. Don't be afraid to ask your doctor questions about anything you don't understand or are unsure about. Your awareness is your child's greatest strength for a healthy future.
Cardiac shunting, congenital heart disease, arterial switch surgery, cyanosis, infantile heart disease, d-TGA, cardiac surgery
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