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Transposition of the Great Arteries (TGA) is a severe congenital condition in which the body’s largest arteries are incorrectly attached to the chambers of the heart. In this 23-minute video, you'll learn how experts from the Fetal Heart Program and Cardiac Center identify TGA during pregnancy, support the baby's delivery, and provide surgery and comprehensive care after birth.
Donna Lamborne, Mother: As we started visiting CHOP each month, Dr. Rychik wanted to continue monitoring the size of the hole in Grace's heart in order to continue to keep her stable.
Thomas Spray, MD: Most of the time after delivery a baby with transposition of the great arteries will be extremely blue from inadequate mixing of the circulation.
Sarah Tabbutt, MD: One of the areas where blood can mix is at the ductus, which is a connection between the blood flow to the lungs and the body. You can keep that blood vessel open with a medication called prostaglandins. And so, therefore, by giving a baby prostaglandins you are actually replicating the same physiology that it had in the uterus when it was very stable to when it's outside the uterus. But the more important place where the mixing can happen is between the two top chambers of the heart called the atrium. There is a hole normally there and blood can mix back and forth there. In some babies with transposition that hole is not big enough. It's not adequate for there to be enough mixing back and forth, and those babies can actually have fairly low oxygen levels.
Thomas Spray, MD: Very commonly they require a Rashkind procedure or a balloon to be pulled across the upper chamber of the heart to allow an opening to be created that allows better mixing.
Jonathan Rome, MD: You can advance that balloon up through the vein into the heart under X-ray guidance, which is what catheterization is, and then you position the balloon across one side of this wall between the upper two chambers, you inflate the balloon and you pull it back very quickly, and you literally rip a hole and that allows the blue and the red blood to mix and then the kids get much pinker.
Peter Gruber, MD: That technique was invented by one of the prior chiefs of the division of cardiology here at Children's Hospital, Dr. Bill Rashkind.
J. William Gaynor, MD: And was the first interventional cath procedure for children, which has led to the whole field of interventional cardiac catheterization today.
Jonathan Rome, MD: The children become much pinker. They have oxygen in their bloodstream.
Thomas Spray, MD: This often stabilizes the baby and allows them to be-- to have better oxygen levels and to be more stable before the actual surgical repair of this heart defect.
Peter Gruber, MD: And this is very important because if you're born without a connection between the two sides, oftentimes the child is very sick. And you need time for the child to recover from that initial stress before going forward to surgery in a controlled fashion. And kids do better if they go under surgery in a non-emergent fashion.
Contact the Fetal Heart Program for more information