Transposition of great vessels

 Definition: The aorta arises from the right ventricle and the pulmonary

artery arises from the left ventricle.
 Associated with VSD or PDA
 Oxygen and pressure less than 85%
 Cyanosis
 Increase pulmonary blood flow
 The whole body will suffer
 No murmurs l loud second heart sound
 Temporary Tx:
1. Prostaglandin to keep PDA open
2. Balloon septostomy: to made large ASD
 Definitive Tx: arterial switching procedure
 Complication: heart failure
 Investigation:
1. X ray: egg heart shape
2. ECG: right ventricle hypertrophy

Intracardiac shunt in the transposition of the great vessels

In transposition of the great vessels, deoxygenated blood enters the systemic circulation.
Survival after birth is only possible via an intracardiac shunt (e.g., across a patent ductus
arteriosus and/or a patent foramen ovale). The shunt diverts oxygenated blood from the
pulmonary circulation into the systemic circulation (white arrows).
TGV is fatal unless a shunt between the two circulations is present (i.e., a patent ductus
arteriosus or a patent foramen ovale) or a surgical intervention is performed in the
neonatal period
Balloon atrial septostomy

The heart with transposition of the great vessels (TGV)

Slight oxygen saturation of the blood occurs via the ductus arteriosus as well as a small
atrial septal defect. This left-to-right shunt is enlarged using balloon atrial septostomy:
(1) A balloon catheter is advanced into the right atrium through the inferior vena cava,
then through the patent foramen ovale into the left atrium.
(2) The correct positioning of the balloon is controlled via ultrasound. The balloon is
expanded with a saline solution.
(3) The balloon is pulled back through the foramen ovale into the right atrium, resulting
in the fossa ovalis of the atrial septum tearing and creating an enlarged left-to-right
shunt.
(4) This results in an increase of oxygenated blood in the systemic circulation and a
corresponding rise in saturation, usually directly following the procedure.

However, balloon atrial septostomy is only a temporary measure. Patients with TGV will
undergo an arterial switch surgery, which will result in a normal circulation of blood in the
body.

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Pulmonary stenosis:

 Obstruction of blood outflow from the right ventricle into the pulmonary
arteries during systole.
 Valvular or infundibular
 Asymptomatic –
 Acyanotic
 Increase the pressure in right ventricle more than 25%
 No shunt or mixing
 Murmur:
1. Harsh ejection systolic murmur
2. Pulmonary area with single sound associated with systolic thrill
3. Manifestation of right ventricular hypertrophy
 Investigation:
1. X ray: decrease pulmonary vascularity , post stenotic dilatation in valvular
type
2. ECG: right ventricular hypertrophy
 Treatment: balloon or surgery
 Complication: RHF

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Aortic stenosis:

 Valvular-sub valvular
 More in male
 No shunt no mix
 More than 120 the pressure
 Asymptomatic / anginal pian with effort
 Systolic thrill on aortic area propagated to carotid arteries and suprasternal notch
 Harsh ejection systolic murmur on aortic area
 Pulse presuer low
  Investigation :
1. X ray: normal or left ventricle enlargement
2. ECG : left ventricle hypertrophy
 Tx : surgery or balloon

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Cortication of aorta

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