Dextro-transposition of the great arteries pathophysiology
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Dextro-transposition of the great arteries/complete transposition of the great arteries Microchapters |
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Differentiating dextro-transposition of the great arteries from other Diseases |
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Diagnosis |
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Transposition of the great vessels Microchapters |
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Classification |
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Differentiating Transposition of the great vessels from other Diseases |
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Diagnosis |
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Surgery |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editors-In-Chief: Keri Shafer, M.D. [2]; Atif Mohammad, M.D., Priyamvada Singh, MBBS
Pathophysiology
In a normal heart, oxygen-depleted ("blue") blood is pumped from the right side of the heart, through the pulmonary artery, to the lungs where it is oxygenated. The oxygen-rich ("red") blood then returns to the left heart, via the pulmonary veins, and is pumped through the aorta to the rest of the body, including the heart muscle itself.
With d-TGA, blue blood from the right heart is pumped immediately through the aorta and circulated to the body and the heart itself, bypassing the lungs altogether, while the left heart pumps red blood continuously back into the lungs through the pulmonary artery. In effect, two separate "circular" (parallel) circulatory systems are created, rather than the "figure 8" (in series) circulation of a normal cardio-pulmonary system.
In d-TGA, the pulmonary and the systemic circuits are in parallel circulation, rather than in series, which is incompatible with life if there is no mixing of the two systems. Therefore, in most cases, a complex d-TGA is the one that allows survival due to the presence of other heart defects like patent foramen ovale (PFO) for mixing blood between the two systems. Other possible mixing sites include a PDA or a VSD.
The course of TGA is determined by the degree of hypoxia, and the ability of each ventricle to sustain an increased work load in the presence of reduced coronary arterial oxygenation. It is also important the nature of associate heart defects, and the status of the pulmonary vascular circulation.
The pulmonic flow is increased in those cases with transposition and large VSD or large PDA without obstruction to left ventricular outflow. In these cases, pulmonary vascular obstruction develops by 1 to 2 years of age.
References
Acknowledgements and Initial Contributors to Page
Leida Perez, M.D.
External links
- Diagram at kumc.edu
- Diagram and description at umich.edu
- Overview at pediheart.org
- Royal Children's Hospital, Melbourne
- Mayo Clinic, Arizona - Florida - Minnesota, USA
