Arterial Switch

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An arterial switch operation is used to correct dextro-transposition of the great arteries (d-TGA). In this congenital (present at birth) heart condition, the pulmonary artery and aorta are reversed from the positions they would have in a healthy heart. This causes two parallel circulations — one going to the body and back to the left side of the heart, and the other going to the lungs and back to the right side of the heart.

Unless the baby’s heart has communication between chambers — atrial septal defect (ASD), ventricular septal defect or patent ductus arteriosus (PDA) — this heart defect will be incompatible with life. Therefore, doctors use prostaglandin medications to keep the PDA open so the oxygen-rich blood on the right side can mix with the oxygen-poor blood on the left side that delivers blood out to the body.

To further create mixing and oxygenated blood flow to the body, babies with d-TGA may need an emergency procedure called a balloon septostomy shortly after birth to create an ASD, a hole between the atria. This procedure may be done in the catheterization lab or at the bedside by a specialist called an interventional pediatric cardiologist.

The cardiothoracic surgeons at Norton Children’s Heart Institute, affiliated with the UofL School of Medicine, have been performing the arterial switch procedure for decades. Children who receive this surgery — usually in the first week of life — routinely go on to lead active, healthy lives.

Norton Children’s Heart Institute is the leading provider of pediatric heart care in Louisville and Southern Indiana.

Norton Children’s Heart Institute has a network of remote diagnostic and treatment services in Kentucky and Southern Indiana.

Transposition of the Great Arteries Symptoms

Patients with d-TGA most likely will show symptoms in infancy. These may include:

  • Cyanosis, a blue discoloration of the skin and lips
  • Not moving around
  • Fast breathing
  • Not eating
  • Sweating with feeds

Diagnosing d-TGA

In infants, cyanosis, poor feeding/nursing and difficulty breathing may signal a problem with the heart, such as d-TGA.

The following tests may provide more details to find the diagnosis:

  • Chest X-ray: This shows pictures of the heart and lungs, and can show heart issues, extra blood flow or fluid in the lungs.
  • Echocardiogram (echo): This test uses sound waves (ultrasound) to produce images of the heart and blood vessels’ structures on a screen. It can show the structure and function of the heart. Norton Children’s Heart Institute has 28 tele-echo locations in Kentucky and Southern Indiana so many patients don’t have to travel far from home for an echocardiogram.
  • Electrocardiogram (ECG or EKG): This is a test that checks the heart’s electrical activity to show damage or irregular rhythms, suggesting an issue with the heart.
  • Heart catheterization: This invasive procedure studies the structure, function, and provides direct pressure measurements of the heart chambers. Catheterization can provide the visual angiogram images to also diagnose d-TGA.

What Happens in an Arterial Switch Operation?

The cardiothoracic surgeon will switch the pulmonary artery and the aorta back to their normal positions.

During the procedure, a heart-lung machine will support your child. Your child will be sedated (asleep). A specially trained pediatric cardiac anesthesiologist will care for your child.

During an arterial switch operation, the surgeon will:

  • Detach the aorta from the right atrium and connect it to the left atrium
  • Detach the pulmonary artery from the left atrium and connect it to the right atrium
  • Remove the coronary arteries from the pulmonary artery and attach them to the aorta
  • Close off the hole between the atria, which may have been enlarged by a balloon atrial septostomy
  • Close the patent ductus arteriosus

Arterial Switch Operation After Care

An arterial switch operation has an excellent success rate, but it is a major heart surgery. Your child will be in the intensive care unit for a number of days recovering from the surgery.

  • Babies will be mechanically ventilated initially after surgery
  • A Foley catheter will be used to collect urine from the bladder
  • Chest tubes are required to help drain fluid within the chest

Some children may:

  • Require cardiac medications to help the heart function better
  • Experience abnormal heart rhythms
  • Have postoperative bleeding
  • Have feeding and swallowing issues
  • Experience vocal cord injuries
  • Have bruises from the intravenous line, a small tube placed in a child’s arm or leg vein that it is used to give fluids or medicines

Your baby will be ready to go home when he or she is breathing well and can feed easily by mouth. Your heart team will teach you the following before going home:

  • How to bathe your baby, change diapers and safely hold your baby
  • How to care for the chest incision and wound (sternal incision)
  • How to give any medicines your baby needs

Why Choose Norton Children’s Heart Institute

  • Norton Children’s Hospital has been a pioneer in pediatric cardiothoracic surgery, performing Kentucky’s first pediatric heart transplant in 1986 and becoming the second site in the United States to perform an infant heart transplant.
  • The American Board of Thoracic Surgery has certified our cardiothoracic surgeons in congenital heart surgery.
  • The Adult Congenital Heart Association has accredited Norton Children’s Heart Adult Congenital Heart Disease Program as the only comprehensive care center in Kentucky and Indiana treating adults born with a heart defect.
  • More than 17,000 children a year visit Norton Children’s Heart Institute for advanced heart care.
  • Norton Children’s Heart Institute has offices across Kentucky and Southern Indiana to bring quality pediatric heart care closer to home.
  • The Jennifer Lawrence Cardiac Intensive Care Unit (CICU) at Norton Children’s Hospital is the largest dedicated CICU in Kentucky, equipped with 17 private rooms and the newest technology available for heart care.

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