Transposition of the Great Arteries: A complicated & critical procedure aimed at curing a congenital problem

In a complicated and critical procedure to cure a congenital problem in a 6-day old child, Dr Manoj Daga at the BM Birla Heart Research Centre (BMB) and his team gave a baby a new chance at life. The procedure known as Transposition of the Great Arteries (TGA) or more commonly Arterial Switch, was recently performed successfully at the Paediatric Cardiology
Department of BMB.

In this congenital complication, the two main arteries leaving the heart are reversed or transposed. Transposition of the great arteries changes the way blood circulates through the body, leaving a shortage of oxygen in blood flowing from the heart to the rest of the body. Without an adequate supply of oxygen-rich blood, the body can’t function properly and the child faces serious complications or death without treatment.

In a normal human heart, there are four chambers, two on top and two at the bottom. Impure blood from the body usually comes into the right chambers. Two tubes usually come out of the heart and one of these, the pulmonary artery, takes impure blood to the lung for purification and the purified blood comes back to the left side to be pumped back into the body via the aorta. In the case of TGA, these two critical tubes, the pulmonary artery and the aorta, changes position. Oxygen-poor blood circulates through the right side of the heart and back to the body without passing through the lungs. Oxygen-rich blood circulates through the left side of the heart and directly back into the lungs without being circulated to the rest of the body. Therefore, the baby receives critically low levels of oxygen and may die within days of birth if not treated on time. The patient treated at BMB was only 6 days old and was showing classic signs of TGA when brought to BMB.

The child was showing blue colouration and was severely out of breath. The Paediatric Cardiologist at BMB immediately admitted the baby and operated on the heart. The case was extremely complicated due to the age of the baby and the size of the heart and arteries.
Moreover, timely intervention is paramount in these cases as every minute lost brings the baby closer to heart failure. The precision and expertise required for such a surgery is exceptional and such procedures are undertaken successfully by very few doctors in the city.

In conclusion:
While there are no known causes of TGA, increased incidence has been seen in mothers who have poorly controlled diabetes or those that have poor nutrition during pregnancy.
Therefore, it is best to monitor closely if mothers are diabetic. After birth if the new-born shows any signs of bluishness on the skin they should be rushed to a paediatric cardiologist
without wasting any time.

Dr. Manoj Kumar Daga
Dr. Manoj Kumar Daga

Consultant & Director of Paediatric & Adult Cardiac Surgery
Department of Cardiac Surgery