How Is d-TGA Treated?
Definitive treatment for TGA always involves open-heart surgery, though some treatment measures may be undertaken soon after birth. To improve the body's oxygen supply, the ductus arteriosus may be kept open with a medicine called prostaglandin. Also, a special procedure called balloon atrial septostomy may be used to allow more oxygen-rich blood from the left atrium to mix with the oxygen-poor blood in the right atrium. This procedure is performed either in the catheterization laboratory or at the bedside and involves placing a catheter from the right atrium to the left atrium and blowing up a balloon in the left atrium. The balloon is then pulled across the wall between the two atria to tear a hole in the wall. Treatment with prostaglandin and the balloon atrial septostomy help improve the oxygenation and stabilization of the infant until surgery can be performed. Depending on other associated heart defects, these treatment measures are not always required.
In general, the goal of surgery is to end up with the appropriate ventricle hooked up to the appropriate artery the way a normal heart is supposed to be. In the past, surgical operations known as the Senning and Mustard procedure were performed, but are no longer part of current surgical management in uncomplicated TGA. (However, adults may have had these surgeries in infancy or early childhood when these procedures were still being performed.) The standard surgical operation for TGA at most hospitals is the Jatene procedure or arterial switch operation. This procedure hooks up the aorta to the left ventricle and the pulmonary artery to the right ventricle the way they are supposed to be. There is also a surgical operation known as the Rastelli procedure for patients with TGA, and additional defects consisting of a VSD and pulmonary stenosis.
The risks of open-heart surgery always include bleeding, infection and the need for cardiopulmonary bypass. Special risks of the Jatene procedure include injury to the coronary arteries, the possibility of narrowing of the pulmonary arteries.