Atrial Switch

Transposition of the Great Arteries (TGA) is a congenital heart defect (present at birth) in which the two main arteries carrying blood out of the heart: The main pulmonary artery and the aorta, are switched in position, or “transposed.” There are two types of TGA: dextro TGA (d-TGA) and levo TGA (l-TGA). Without surgery, the only way to temporarily survive this condition is to have leakages that would allow for some oxygen-rich blood to cross into the oxygen-poor blood for delivery to the body.

There are two types of surgeries: Arterial switch and atrial switch. Both are open-heart surgeries (involves dividing the breast bone / general anesthesia) and need to be performed within the first week of life. Based on your baby’s specific medical condition, your doctor will identify which of the two options is best for your baby.

What to Expect Before the Procedure

Before the procedure, your doctor may perform a variety of diagnostic tests, including:

• Echocardiogram (ECHO)
• Cardiac catheterization
• Computed tomography (CT scan)
• Magnetic resonance imaging (MRI)
• X-Rays
• Electrocardiogram (EKG/ECG)
• Stress test

What to Expect During the Procedure

This procedure usually takes 3 to 6 hours, but preparation and recovery may add several hours. The procedure is usually performed in the cardiothoracic operating room (OR). In general, during this procedure:

• Your baby will be sedated, then the doctor will insert a breathing tube through your baby’s throat into their lungs and connect it to a ventilator. This will breathe for your baby during surgery.
• Your doctor will administer general anesthesia (will make your baby feel sleepy).
• The procedure begins when your doctor exposes your baby’s heart by dividing the breastbone (sternum) in half. Your doctor then spreads both halves to gain access to your baby’s heart (open-heart surgery).
• For this type of surgery, the heart must be still. Prior to doing so, your doctor will place tubes into your baby’s heart so that blood can be pumped through your baby’s body by use of a heart-lung machine. This machine takes over for the heart by replacing the heart’s pumping action and the lungs by adding oxygen to the blood.
• Once the blood has been diverted into the bypass machine for pumping, your doctor will then stop the heart by injecting it with a cold solution.
• When the heart has been stopped, your doctor will start with the repair. The repair involves the construction of an atrial baffle which redirects the blood coming into the atria to restore the connection between systemic and pulmonary circulation.
• After the switch has been completed, the doctor will closely check to make sure everything is working properly. Once checked, the doctor will let the blood circulating through the bypass machine back into your baby’s heart.
• Once the procedure is complete, the machine will be turned off. The tubes will be removed and the sternum will be sewn together with the use of sutures or surgical staples.

What to Expect After the Procedure

After the procedure, your baby will be taken to the cardiothoracic intensive recovery unit (CTICU) for a few days. Your baby will also spend several days in the recovery unit. During this time the cardiac team will:

General Guidelines

• Make sure your baby’s vital signs, such as heart rate and breathing, are watched.
• Make sure your baby feels no pain by giving pain medication.
• Make sure to look after your newborn’s medications.
• Manage the tubes (drains) that were placed in your baby’s chest during surgery.
• Take care of the chest wound (sternal incision) and any other incision sites.
• Make sure that your newborn is able to feed well by mouth.
• Will give you instructions to follow during your baby’s recovery.