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Treatments and drugs
By Mayo Clinic staffAll infants with transposition of the great arteries require surgery to correct the defect.
Before surgery
Your baby's doctor may recommend several options to help manage the condition before corrective surgery. They include:
- Medication. The medication prostaglandin E-1 helps keep open the ductus arteriosus — a connection between the aorta and pulmonary artery — to increase blood flow and improve mixing of oxygen-poor and oxygen-rich blood.
- Atrial septostomy. This procedure — usually done using cardiac catheterization rather than surgery — enlarges a natural connection between the heart's upper chambers (atria). It allows for the oxygen-rich and oxygen-poor blood to mix and results in improved oxygen delivery to your baby's body.
Surgery
Surgical options include:
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Arterial switch operation. This is the surgery that doctors most often use to correct transposition of the great arteries. Doctors usually perform this surgery within the first month of life.
During an arterial switch operation, the pulmonary artery and the aorta are moved to their normal positions: The pulmonary artery is connected to the right ventricle, and the aorta is connected to the left ventricle. The coronary arteries also are reattached to the aorta.
If your baby has a ventricular septal defect or an atrial septal defect, those holes usually are closed during surgery. In some cases, however, the doctor may leave small ventricular septal defects to close on their own.
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Atrial switch operation. In this surgery, the surgeon makes a tunnel (baffle) between the heart's two upper chambers (atria). This diverts the oxygen-poor blood to the left ventricle and the pulmonary artery and the oxygen-rich blood to the right ventricle and the aorta. With this procedure, the right ventricle must pump blood to the entire body, instead of just to the lungs as it would do in a normal heart.
The atrial switch was used frequently beginning in the 1960s. Since the 1980s, however, it has been largely replaced by the arterial switch operation because the latter is not associated with many of the long-term complications of the atrial switch, such as arrhythmias, baffle obstructions or leaks, and problems with right ventricle function.
After surgery
After corrective surgery, your baby will need lifelong follow-up care with a heart doctor (cardiologist) who specializes in congenital heart disease to monitor his or her heart health. The cardiologist may recommend that your child limit physical activity. Your child may need to take antibiotics before dental procedures and other surgical procedures to prevent infections.
Many people who undergo the arterial switch operation don't need additional surgery. However, some complications, such as arrhythmias, heart valve leaks or problems with the heart's pumping, may require treatment.
