Definitive treatment of choice for Transposition of great vessels (TGA) is
Correct Answer: Aerial switch
Description: The aerial switch operation is now established as the treatment of choice for TGA and most centers endeavour to offer this procedure for all infants with TGA. In this operation, the pulmonary aery and aoa are transected. The distal aoa is anastomosed to the proximal pulmonary stump (neo-aoic root) and the pulmonary aery to the proximal aoic stump (neopulmonary aery). The coronary aeries are moved along to the neo-aoic root along with a cuff of aoic tissue to allow suturing without compromise of coronary blood flow. There is a limited window of time for performing the aerial switch for TGA. Infants with TGA and intact septum should ideally undergo this procedure within the first 2-4 weeks of life. As pulmonary vascular resistance falls after bih the left ventricle regresses rapidly. In 1-2 months the left ventricle has the ability to adjust to the elevated systemic vascular resistance after the aerial switch through hyperplasia of the available muscle. After this, it is difficult for the left ventricle to adapt to an aerial switch. Later in infancy, the atrial switch operation (Senning operation) is the only option for TGA with intact ventricular septum. This is not an ideal long-term option because the right ventricle remains as the systemic ventricle for life. Over time, right ventricle dysfunction and severe tricuspid regurgitation sets in. Additionally, extensive restructuring of atria predisposes to atrial rhythm disturbances. Reference: Essential Paediatrics; O.P. Ghai; Page no: 426
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Pediatrics
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