Transposition of the Great Arteries

Published on 07/06/2015 by admin

Filed under Neonatal - Perinatal Medicine

Last modified 07/06/2015

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18 Transposition of the Great Arteries

I. CASE

A 23-year-old white woman, gravida 4, para 0+3, was referred at 23 weeks’ gestation by the obstetrician for an abnormal scan and a previous baby with ventricular septal defect (VSD).

F. Neonatal management

1. Medical.

a. Prostaglandin E1 (PGE1) infusion to keep the ductus open to increase pulmonary blood flow and raise arterial oxygen saturation.

b. Administration of oxygen can increase oxygen saturation by decreasing the pulmonary vascular resistance and increasing blood flow.

c. Therapeutic balloon atrial septostomy may be performed if the infant is very cyanotic, particularly with metabolic acidosis (a PaO2 level of 25 mm Hg and a pH of less than 7.15).

d. At times, volume and inotropic support may be indicated to improve ventricular function and atrial-level mixing.

2. Surgical.

a. Palliative.

b. Corrective.

c. Timing of surgery varies by institution.

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