Transposition of the Great Arteries

Transposition of the great arteries (TGA) is a congenital defect of the heart in which the anatomic relationship of the great arteries is reversed. This chapter discusses patients with transposed great vessels who have undergone D-looping with two ventricles. Patients with TGA are subdivided into those with intact ventricular septum, ventricular septal defect (VSD), and VSD with pulmonary stenosis. Antenatal diagnosis of TGA correlates with increased perioperative stability and improved surgical outcomes. Infants with TGA may be at a higher risk for cerebral ischemic compromise resulting from chronically decreased oxygen delivery to the brain in fetal life. Medical management of neonates with TGA centers around the stabilization and correction of physiologic aberrations caused by cyanosis and poor perfusion. The surgical management of TGA is determined by the associated lesions. Pulmonary artery banding was first introduced for palliation in patients with VSD.