The transposition of the great vessels occurs when the aorta emerges directly from the right ventricle and the pulmonary artery from the left ventricle, which causes an independent, parallel pulmonary and systemic circulation. Oxygenated blood can not enter the body except through the openings that connect the right to the left side (z. B. patent foramen ovale, ventricular septal defect [VSD]). The symptoms are severe primarily Neugeborenenzyanose and occasionally heart failure associated VSD. Heart sounds and heart sounds vary with the presence of other congenital malformations. The diagnosis is made by echocardiography. The final treatment is surgical.

The transposition of the great arteries (TGA transposition of the great vessels) are attributed to 5-7% of congenital heart defects. Approximately 30-40% of patients have a VSD; 5% have a subvalvular pulmonary stenosis.

The transposition of the great vessels occurs when the aorta emerges directly from the right ventricle and the pulmonary artery from the left ventricle, which causes an independent, parallel pulmonary and systemic circulation. Oxygenated blood can not enter the body except through the openings that connect the right to the left side (z. B. patent foramen ovale, ventricular septal defect [VSD]). The symptoms are severe primarily Neugeborenenzyanose and occasionally heart failure associated VSD. Heart sounds and heart sounds vary with the presence of other congenital malformations. The diagnosis is made by echocardiography. The final treatment is surgical. The transposition of the great arteries (TGA transposition of the great vessels) are attributed to 5-7% of congenital heart defects. Approximately 30-40% of patients have a VSD; 5% have a subvalvular pulmonary stenosis. Transposition of the great vessels Nichtoxygeniertes blood returns to the right heart, flows into the AO, leading to a severe cyanosis. Oxygenated blood flows back to LA, enters the pulmonary circulation again. The RV is hypertrophied and there is a mixing foramen ovale, but he may be insufficient. The arteries pressures are medium pressures. AO = aorta; IVC = inferior vena cava; LA = left atrium; LV = Left ventricle; PA = pulmonary artery; PV = pulmonary veins, RA = right atrium; RV = right ventricle; SVC = superior vena cava. Pathophysiology The systemic and pulmonary blood flow is completely separate. Oxygenated blood flows from the left heart rather reserved in the lungs than in the rest of the body. Not Saturated systemic blood after it has returned to the right ventricle is pumped into the lungs into the systemic circulation without oxygenation. This malformation incompatible with life, but not saturated and oxygenated blood through openings at several levels in the heart (atrial, ventricular, large arteries) can mix. Symptoms and complaints within hours after birth, there is a severe cyanosis, which is followed due to poor peripheral blood flow quickly from a metabolic acidosis. Patients with a large VSD, a patent ductus arteriosus, or both are less cyanotic, but the above symptoms and heart failure (z. B. tachypnea, dyspnea, tachycardia, diaphoresis, no weight gain) can develop during the first weeks of life. The clinical examination is fairly unremarkable except for a generalized cyanosis. Heart murmurs are not present, unless there is another malformations before. The second heart sound (S2) is individually and noisy. Diagnostic chest X-ray and ECG echocardiogram Diagnosis is suspected clinically, supported by a chest x-ray absorption and an EKG and by two-dimensional Farbechokardiographie and Doppler sonography confirmed. On the X-ray image can be a cardiac silhouette that looks like an egg on a thread, with a narrow mediastinum, see The ECG shows a right ventricular hypertrophy, but may be normal for a newborn. A cardiac catheterization is not for diagnosis necessary but can be useful for improved atrial connection. Treatment infusion of prostaglandin E1 (PGE1) Sometimes atrial Ballonseptostomie (Rashkind procedure) Surgical correction If the arterial O2 saturation only slightly reduced and the atrial compound is sufficient to provide a PGE1 infusion can (0.01-0.1 ug / kg / min iv help) thereby to open the patency of the ductus arteriosus and maintain; this infusion increased pulmonary blood flow, which can promote the right atrium left-right shunt, which leads to improved systemic oxygenation. If the patent foramen ovale, however, has a small opening, PGE1 may have the opposite effect, because the increased blood return the flap of the foramen ovale to the left atrium may close, resulting in a reduced mixture. The opening of the duct can also reduce the systemic blood flow. Why must PGE1 be used with caution and patients should be carefully monitored. The metabolic acidosis is treated with NaHCO3. The pulmonary edema and respiratory failure may make mechanical ventilation support required. Tips and risks A PGE1 infusion usually helps with TGA, but can be harmful if the patent foramen ovale is small. Some strong hypoxic newborns who do not respond to PGE1 or have a very reduced foramen ovale, a heart catheter and an atrial Ballonseptostomie (Rashkind method) may improve arterial systemic O2 saturation immediately. A balloon catheter through the open foramen ovale out into the left atrium. The balloon is inflated with contrast medium and jerky back into the right atrium to create a large opening in the atrial septum. Alternatively, for the transport of the infant in the cardiac catheterization laboratory, the septostomy process can be performed at the bedside under echocardiographic monitoring. Procedimiento de Rashkind var model = {thumbnailUrl: ‘/-/media/manual/professional/images/rashkind_procedure_high_blausen_de.jpg?la=de&thn=0&mw=350’ imageUrl: ‘/ – / media / manual / professional / images / rashkind_procedure_high_blausen_de. ? jpg lang = en & thn = 0 ‘, title:’ Procedimiento de Rashkind ‘description:’ u003Ca id = “v37897560 ” class = “”anchor “” u003e u003c / a u003e u003cdiv class = “” para “” u003e u003cp u003eEn el procedimiento de Rashkind

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