MedicoNotebook

0 Transposition of the Great Arteries (TGA)

Transposition of the Great Arteries (TGA)

Types :

Complete
With Communication
Corrected

1. Complete : has 2 circuits

Oxygenated - Pulmonary circuit
Un-Oxygenated - Systemic circuit

Therefore O2 therapy will not help as there is no path for O2 to reach systemic circuit.

Hence the child dies without t/t in 1st wk of life due to Hypoxia

T/t -

PGE1 infusion to keep Ductus open (i.e to keep PDA)

Emergency Surgery ( Create artificial ASD with balloon - Balloon atrial septostomy )

Definitive Surgery at later stage : Arterial Switch Surgery ( Jatene Procedure )

2. With Communication :

With ASD - Small patent foramen ovale , Not helpful - hence cyanosis in 1st wk of life

With VSD and PDA - good mixing of blood , therefore only mild cyanosis at 6-12 months of life.

3. Corrected : Physiologically behaves Normal.

Ventriculo-Arterial disconcordance with Atrioventricular disconcordance (See the image below)

Ventriculo-Arterial disconcordance means - Aorta arise from RV ; PA arise from LV
AtrioVentricular dysconcordance means - Rt Arium opens into LV ; Lt Atrium opens into RV

Image Courtesy - DrAyushGoel

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

0 Duct dependant heart defects

Duct dependant heart defects

i.e - good with Patent ductus arteriosus but deteriorates with its closure

Left Sided Lesions : (depend on ductus for systemic blood flow)

Congenital AS
Coarctation of Aorta
Interrupted Aortic Arch
Hypoplastic Left heart syndrome

if ductus closes - Presents as Shock

Therefore give Prostaglandins infusion (PG E1)

Severe Right Sided Lesion (Depend on ductus for pulmonary blood flow)

i.e After birth - blood flow to lungs only if Ductus is open - if closes then Cyanosis.

Critical PS
Tricuspid Atresia
Tetrology of fallot

TGA i.e Aorta from right and pulmonary trunk from left

Thus systemic circuit will have only unoxygenated blood

and Pulmonary circuit will have only oxygenated blood

thus it depends on Ductus for Oxygen.

Note : Truncus Arteriosus (i.e Pulm Art and Aorta are 1) is ductal independant.

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

1 Chest X-Ray PA view - Cardiac Borders

MCQ 117

Q. Which of the following, per se, does not form Left cardiac border on CXR PA view ?

a. Left atrium
b. Left Ventricle
c. Aortic arch/knob
d. Pulmonary trunk

ANSWER:

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

0 Medical One Liners 131 - 140

131. Cat eye syndrome :

Partial trisomy of chromosome 22
Vertical oval pupil due to inferior iris coloboma

132. Single S2 in Tetrology of fallot.

133. All newborns have right ventricular hypertrophy and right axis deviation.

134. AA which have a pKa of 4 - aspartic acid and glutamic acid

135. Topoisomerase I (relaxase)