Arterial switch is a surgical procedure for correcting the Transposition of the Great Arteries (TGA). The great arteries refer to the aorta and the pulmonary artery, which are the two major arteries that carry blood away from the heart.
In TGA the arteries are transposed from their normal position. This means that the aorta arises from the right ventricle while the pulmonary artery arises from the left ventricle. This causes the blood containing oxygen from the lungs to be pumped back into the lungs, while blood that lacks oxygen is pumped throughout the body.
Babies with TGA become very sick soon after birth due to a severe lack of oxygen. Hence a surgical correction or arterial switch procedure is required without which the new born will not survive for long.
Arterial switch procedure is also called Jatene procedure and is usually done within the first week after birth.
Diagnosis of TGA
TGA can be usually diagnosed by a foetal ultrasound. Sometimes specialists may have to perform the foetal echocardiogram to make the diagnosis.
TGA is diagnosed within first few hours or days after birth due to the low oxygen levels or cyanosis. A baby with cyanosis is placed on supplemental oxygen, but in cardiac problems like TGA there will be very little effect on the oxygen levels. Emergency balloon atrial septostomy is needed to help increase the oxygen level in the blood and ensures optimisation of baby for corrective surgery.
How is the procedure done?
During the arterial switch procedure, the aorta and the pulmonary artery are switched back to their normal positions. The coronary arteries are attached to the aorta in the correct positions. The new aorta carries oxygenated blood from the left ventricle throughout the body.
If the baby has a significant ventricular septal defect, the surgeon will close the hole between the ventricles during the procedure.
The entire procedure will take around three to six hours.
After the successful arterial switch procedure, the child is transferred to the cardiac critical care unit (CCCU). After a few days in CCCU the child is transferred to the cardiac inpatient unit to recover completely. When the child is breathing comfortably and can feed well by mouth, the child is discharged from the hospital.
The long-term cardiac function is usually excellent in patients after the arterial switch procedure. Though it is a major surgical procedure, results are excellent and more than 99 percent of the children recover and grow normally. They can enjoy a good quality of life in adulthood and take up physical activity without any difficulty.