What is the arterial switch procedure for transposition of the great arteries (also known as transposition of the great vessels)?
The arterial switch procedure is the surgery offered at the Inova Heart Center to correct the congenital heart defect called transposition of the great arteries (TGA or TGV). This heart problem occurs when the aorta (the blood vessel that supplies blood to the body) originates out of the right (instead of the left) ventricle, while the pulmonary artery (the blood vessel that transports blood to the lungs) originates out of the left ventricle. The surgery is usually done in the first two weeks of life.
Preparing for the procedure
Prior to surgery, the baby will have had tests to diagnose the heart defect including an EKG, a chest x-ray and an echocardiogram. Either during the echocardiagram or through a cardiac catheterization, the coronary arteries will be identified. If the baby needs a bigger hole in the atrium to let the blood mix together, a balloon atrial septostomy may be performed. In addition, blood tests to determine blood type and compatibility will be done to prepare for the use of blood during surgery. Other blood tests to be sure the baby is stable may also be done.
During the procedure
During the procedure, the baby will be placed under general anesthesia and special monitoring IVs will be used. The chest is opened through the sternum (breastbone). The heart/lung machine is connected. Once the heart is stopped and emptied, the aorta and the pulmonary artery are divided. The coronary arteries are then removed from their attachment to the aorta and moved to their new location. The aorta and pulmonary arteries are then switched back to connect to the appropriate ventricles. The heart is then allowed to fill and take over its normal function. Temporary pacemaker wires and drainage tubes are then placed and the chest is closed. The baby is then allowed to awaken from anesthesia slowly over the next few hours and will stay on the respirator overnight until his or her breathing is adequate and heart function has stabilized.
After the procedure
After surgery, the baby will need a number of days to recover from the surgery and anesthesia, and from the use of the heart-lung bypass machine. The baby will be on a ventilator (breathing machine) and may need support from IV medicines and a temporary pacemaker. Once the breathing tube (endotracheal tube) is out, one of main goals will be to encourage the baby to eat normally and gain weight.
Click here for recovery guidelines after discharge for congenital heart defect repair at the Inova Heart Center.