Difference between revisions of "Transposition of the great vessels history and symptoms"

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{{Transposition of the great vessels}}
 
{{Transposition of the great vessels}}
  
{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com]; {{CZ}}; [[User:KeriShafer|Keri Shafer, M.D.]] [mailto:kshafer@bidmc.harvard.edu]; '''Assistant Editor(s)-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@elon.edu]
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{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com]; {{CZ}}; [[User:KeriShafer|Keri Shafer, M.D.]] [mailto:kshafer@bidmc.harvard.edu]; [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@elon.edu]
  
 
==Overview==
 
==Overview==
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The clinical features of D-TGA are solely dependent on the degree of mixing between the parallel circuits. Most patients present with signs and symptoms during the [[neonatal]] period. Symptoms of D-TGA present with [[cyanosis]], [[tachypnea]] and [[murmurs]]. Patients with L-TGA present with symptoms of [[heart failure]] until later in life when the [[right ventricle]] can no longer compensate increased [[after load]].
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==History  ==
 
==History  ==
  
 
* '''Cyanosis''' can seen soon after the birth, due to the low oxygen saturation of the blood.   
 
* '''Cyanosis''' can seen soon after the birth, due to the low oxygen saturation of the blood.   
* Peripheral areas such as around the mouth and lips, fingertips, and toes are affected first because they are furthest from the heart, and since the circulated blood is not fully oxygenated to begin with, very little oxygen reaches the peripheral arteries.
 
 
*Screening ultrasounds do not routinely reveal TGA in-utero.
 
*Screening ultrasounds do not routinely reveal TGA in-utero.
 +
*Peripheral areas such as around the mouth and lips, fingertips, and toes are affected first because they are furthest from the heart, and since the circulated blood is not fully oxygenated to begin with, very little oxygen reaches the peripheral arteries.
  
 
== Symptoms ==
 
== Symptoms ==
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**A [[gallop rhythm]]  
 
**A [[gallop rhythm]]  
 
**[[Hepatomegaly]]  
 
**[[Hepatomegaly]]  
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<br />
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{| class="wikitable"
 +
|+
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! colspan="2" |TGA manifestations depending upon intercirculatory mixing and the associated anatomic lesions
 +
|-
 +
|Transposition of the great arteries with intact ventricular septum
 +
|
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* Prominent and progressive cyanosis within the first 24 hours of life is the usual finding in infants if no significant mixing at the atrial level is evident.
 +
|-
 +
|Transposition of the great arteries with large ventricular septal defect
 +
|
 +
* Infants may not initially manifest symptoms of heart disease.
 +
* Mild cyanosis is often noted during agitation or crying.
 +
* Signs of congestive heart failure ([[tachypnea]], [[tachycardia]], [[diaphoresis]], and failure to gain weight) may become evident over the first 3-6 weeks as pulmonary blood flow increases.
 +
|-
 +
|Transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction
 +
|
 +
* Infants often present with extreme cyanosis at birth, proportional to the degree of left ventricular (pulmonary) outflow tract obstruction.
 +
* The clinical history may be similar to that of an infant with [[Tetralogy of Fallot|tetralogy of Fallot.]]
 +
|-
 +
|Transposition of the great arteries with ventricular septal defect and pulmonary vascular obstructive disease
 +
|
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* The pulmonary vascular obstructive disease can prevent this rare subgroup of patients from developing symptoms of congestive heart failure, despite a large ventricular septal defect.
 +
* Most often, patients present with progressive [[cyanosis]], despite an early successful palliative procedure.
 +
|}
  
 
==References==
 
==References==

Latest revision as of 17:35, 19 February 2020

Transposition of the great vessels Microchapters

Home

Patient Information

Overview

Historical perspective

Classification

Dextro-transposition of the great arteries
L-transposition of the great arteries

Pathophysiology

Causes

Differentiating Transposition of the great vessels from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

MRI

CT

Echocardiography

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Palliative care
Corrective surgery
Post-operative care
Follow up

Prevention

Reproduction

Case Studies

Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3]; Keri Shafer, M.D. [4]; Kristin Feeney, B.S. [5]

Overview

The clinical features of D-TGA are solely dependent on the degree of mixing between the parallel circuits. Most patients present with signs and symptoms during the neonatal period. Symptoms of D-TGA present with cyanosis, tachypnea and murmurs. Patients with L-TGA present with symptoms of heart failure until later in life when the right ventricle can no longer compensate increased after load.

History

  • Cyanosis can seen soon after the birth, due to the low oxygen saturation of the blood.
  • Screening ultrasounds do not routinely reveal TGA in-utero.
  • Peripheral areas such as around the mouth and lips, fingertips, and toes are affected first because they are furthest from the heart, and since the circulated blood is not fully oxygenated to begin with, very little oxygen reaches the peripheral arteries.

Symptoms

  • The clinical features of D-TGA are solely dependent on the degree of mixing between the parallel circuits.[1]
  • Most patients present with signs and symptoms during the neonatal period (first 30 days of life).

The following are the typical clinical manifestations of TGA:

  • Cyanosis
    • The degree of cyanosis is dependent on the amount of mixing between the two parallel circuits.[2]
    • Factors affecting intracardiac mixing include the size and presence of an ASD or VSD.
    • Cyanosis is not affected by exertion or supplemental oxygen.
  • Tachypnea
    • Patients usually have a respiratory rate higher than 60 breaths per minute but without retractions, grunting, or flaring and appear comfortable.
  • Murmurs
  • Patients with L-TGA are typically unaffected until later in life when the right ventricle can no longer compensate for the increased afterload of the systemic circulation. These patients present with signs and symptoms of heart failure.
  • Other non-specific symptoms include:


TGA manifestations depending upon intercirculatory mixing and the associated anatomic lesions
Transposition of the great arteries with intact ventricular septum
  • Prominent and progressive cyanosis within the first 24 hours of life is the usual finding in infants if no significant mixing at the atrial level is evident.
Transposition of the great arteries with large ventricular septal defect
  • Infants may not initially manifest symptoms of heart disease.
  • Mild cyanosis is often noted during agitation or crying.
  • Signs of congestive heart failure (tachypnea, tachycardia, diaphoresis, and failure to gain weight) may become evident over the first 3-6 weeks as pulmonary blood flow increases.
Transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction
  • Infants often present with extreme cyanosis at birth, proportional to the degree of left ventricular (pulmonary) outflow tract obstruction.
  • The clinical history may be similar to that of an infant with tetralogy of Fallot.
Transposition of the great arteries with ventricular septal defect and pulmonary vascular obstructive disease
  • The pulmonary vascular obstructive disease can prevent this rare subgroup of patients from developing symptoms of congestive heart failure, despite a large ventricular septal defect.
  • Most often, patients present with progressive cyanosis, despite an early successful palliative procedure.

References

  1. Warnes CA (December 2006). "Transposition of the great arteries". Circulation. 114 (24): 2699–709. doi:10.1161/CIRCULATIONAHA.105.592352. PMID 17159076.
  2. Oster ME, Aucott SW, Glidewell J, Hackell J, Kochilas L, Martin GR, Phillippi J, Pinto NM, Saarinen A, Sontag M, Kemper AR (May 2016). "Lessons Learned From Newborn Screening for Critical Congenital Heart Defects". Pediatrics. 137 (5). doi:10.1542/peds.2015-4573. PMC 5227333. PMID 27244826.
  3. Van Praagh R, Geva T, Kreutzer J (November 1989). "Ventricular septal defects: how shall we describe, name and classify them?". J. Am. Coll. Cardiol. 14 (5): 1298–9. doi:10.1016/0735-1097(89)90431-2. PMID 2808986.




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