Essential Lessions for Perioperative Care of Transposition of Great Arteries

ABSTRACT

Of those neonates admitted with TGA, 4.1% died before surgery. 3.7% died due to consequences of inadequate interatrial mixing despite PGE1 infusion. Earlier diagnosis and balloon atrial septostomy are critically important in determining survival. Prenatal diagnosis with delivery in a high-risk obstetrical unit with facilities for immediate BAS and supportive therapy for pulmonary hypertension. A management using inhaled nitric oxide and extracorporeal membrane oxygenation was successfully used in neonates with transposition of the great arteries, intact ventricular septum, and persistent pulmonary hypertension. Early arterial switch operation may improve survival in patients with low birth weight or prematurity. Optimal management of dextrotransposition of the great arteries with intact ventricular septum is currently an arterial switch procedure performed in the first 2 weeks of life. However, a subgroup of patients presents for surgery beyond this time for reasons of necrotizing enterocolitis, low birth weight, or late referral. In this case, arterial switch following LV retraining in TGA IVS is a satisfactory option. In conclusion, meticulous care and harmonious team work between pediatric cardiologist and cardiac surgeon are essential for successful perioperative care of TGA.