Transposition of the Great Arteries (TGA), Newborn — Post Delivery/Pre-operative Management — Clinical Pathway: ICU and Inpatient

Transposition of the Great Arteries (TGA) Clinical Pathway — CICU

Post-delivery/Pre-operative Management

Goal: Optimize pre-operative systemic arterial oxygen content

Vascular Access
  • UV, UA catheters
  • Insert arterial lines "high" (T7-9) or "low" (below L2)
  • Confirm placement with radiograph
Diagnostic Studies
  • Subsequent Studies for Intubated Patients
  • ABGs as needed to achieve optimal ventilator settings, then q8 hrs
  • Daily CBC, BMP, CXR
Prostaglandins
  • Initiate PGE: 0.01 mcg/kg/min
    • Continue until arterial switch unless clinical concern
Respiratory Support
  • Maintain normocarbia
  • Wean supplemental O2 to maintain preductal saturation > 80%
Echocardiogram Obtain as soon as possible at the discretion of Attending Cardiologist
Indications for Balloon Septostomy Balloon Septostomy Required
  1. ASD by width of color Doppler jet < 3 mm with intact ventricular septum regardless of oxygen saturation
  2. ASD between 3 and 5 mm plus one of the following:
    • Arterial co-oximetry (measured arterial oxygen saturation) < 75% on any support > 2 L 100% nasal cannula
      or
    • Pulse oximetry measurement in the right arm < 70 on any support > 2 L 100% nasal cannula
  3. VSD > 2 mm plus one of the following:
    • Arterial co-oximetry (measured arterial oxygen saturation) < 75% on any support
      > 2 L 100% nasal cannula
      or
    • Pulse oximetry measurement in the right arm < 70 on any support > 2 L 100% nasal cannula

Balloon Septostomy not Required
ASD > 5 mm, and no evidence of restricted flow by echocardiogram

Address acidosis and other causes of hypoxemia after ASD is addressed
Nutrition Refer to: Nutrition for Neonates Undergoing Surgery for Congenital Heart Disease.