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» Personal Loan No Credit Check, Online Economics » Kardiologie » Topics begins with T » Transposition of the large Arterien


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The Transposition of the large Arterien (TGA) arises with approx. 4.8% of the innate heart errors both and exclusive false formation and in connection with a ventricle septum defect (VSD), an additional Pulmonalstenose (narrowing of the lung artery flap) and other complex false formations.

The disease picture

With the TGA are the main artery (Aorta) and the lung artery exchanges. They over-cross not as with a healthy heart, but ascend parallel. The Aorta is fed by the right Herzkammer, which lung artery of the left. Body and lung cycle are switched not one behind the other, but form two separate cycles. With the in the nut/mother body this becomes still balanced by natural cross connections: The Ductus arteriosus (PDA) connects Aorta and Lungenarterie, the Foramen oval (PFO) the two forecourts and by these two connections can arterial (oxygen-rich) blood into the body arrive and the venous (oxygen-poor) blood into the lung cycle. If the fetalen (vorgeburtlichen) cross connections lock after the birth, the child comes into a life-threatening condition because body and lung cycle is now actually separate and thus the oxygen supply of the body is prevented. The cross connections close after the birth slowly and the child become increasingly cyanotic.

Diagnostics

  • The Echokardiografie nearly always supplies a clear diagnosis.
  • A heart catheter only in some cases necessarily if further false formations will be present.

First measures

As soon as PDA and PFO lock, one tries to keep the PDA open with the active substance Prostaglandin as life-saving measures. A further possibility consists of it extending the Foramen oval with the Rashkind maneuver (tear the forecourt septum with a balloon catheter). An artificial atrium septum defect (ASD) develops.

Operations

  • The today usual operation of a TGA is the "arterial SWITCH operation". It is accomplished in the first life days or - weeks. Aorta and lung artery are separated briefly above the Herzklappen and sewn on exchanged again. The heart wreath/ring containers must be transplanted likewise. An existing ventricle septum defect (VSD) is locked. The cycle corresponds now to the anatomically correct process. The children develop usually completely complicationless and normally.
  • Earlier operation procedures were the nearly identical operation procedures forecourt reversal after Senning or Mustard. The forecourt septum was removed and created on forecourt level an artificial bypass of the venous blood, so that the oxygen-rich blood arrives into the body cycle. Aorta and lung artery stopped to "operated" place. That means that now, against the natural cycle, the right heart pumps the body cycle and the left lung cycle. Many according to these methods operated patients are today well. Must on heartbeat disturbances possibly be counted however in the long term, the Trikuspidalklappe can become leaky and the right system ventricle can due to the high pressures, which he must apply, fail. Therefore these operations are only accomplished after in the meantime sufficient and positive experiences with the arterial SWITCH operation in very rare cases.
  • The principle of the Rastelli operation with a TGA with VSD and Pulmonalstenose is based on the fact that the left Herzkammer must by a narrowing in the lower part of the lung artery a high pressure apply and therefore the oxygen-rich blood coming from the lungs over the VSD into the Aorta flow can. The cycles are thus separated on the level of the ventricles (Herzkammern) by using a fold-basic Conduits and the functional catch of the VSD. The Conduit must be exchanged depending upon age and time of the operation later. Because after this operation the left Herzkammer pumps the body cycle and the right Herzkammer the lung cycle, it concerns an anatomical correction likewise. This operation procedure is used also today still with appropriate indications.

All operations are accomplished with the help of the heart lung machine. Lifelong control investigations are to be kept and also on the Endokarditisprophylaxe are to be respected.

Taussig Bing complex

The Taussig Bing complex is a very rare special form of the TGA (a partial TGA):

  • The Aorta rises from the right Herzkammer
  • The Pulmonalarterie "rides" over a ventricle septum defect and takes up the blood from both Herzkammern

Consequences:

  • The venous blood from the body cycle continues to flow over right forecourt into the right Herzkammer, into the Aorta and into the body cycle.
  • The arterial blood from the lung flows over the left pre-chamber into the left Herzkammer and then to the larger part by the "riding" Pulmonalarterie (with it the connection both to the right and the left Herzkammer has) again into the lung and to the smaller part by the ventricle septum defect into the right Herzkammer and then over the Aorta into the body cycle.
  • An overload develops both the lungs and the right heart, which can lead to the insufficiency of both organs.

This disease picture is after the Erstbeschreibern Helen B. Taussig and Kardiologin, 1898 - 1986, Baltimore and Boston) and Richard B. sing (more amer. Surgeon, geb. 1909) designated.

Corrected Transposition of the large Arterien

As is the case for the simple TGA described in the first place is there also the corrected Transposition of the large Arterien. The Arterien runs, as described above, parallel, in addition, the right and left Herzkammer is exchanged. The left forecourt gives its blood, which it received over the exchanged lung artery, directly to the right Herzkammer off. From there it over the exchanged Aorta and the body cycle flow in right forecourt, which delivers it into the left Herzkammer. Heart and lung cycle are thus separate, but the left Herzkammer maintains the lung cycle and the right Herzkammer the body cycle. The children appear heart healthy. Additional heart false formations can make this disease picture however complicated.

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