Transposition of the great vessels medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
Surgery is the mainstay of treatment for TGA. However, infusion of PGE1 to a newborn diagnosed with TGA is recommended as it prevents the ductus arteriosus from closing, therefore providing an additional shunt through which to provide the systemic circulation with a higher level of oxygen. | Surgery is the mainstay of treatment for TGA. However, infusion of [[Prostaglandin|PGE1]] to a newborn diagnosed with TGA is recommended as it prevents the [[ductus arteriosus]] from closing, therefore providing an additional shunt through which to provide the systemic circulation with a higher level of [[oxygen]].<ref name="pmid24400257">{{cite journal |vauthors=Unolt M, Putotto C, Silvestri LM, Marino D, Scarabotti A, Valerio Massaccesi, Caiaro A, Versacci P, Marino B |title=Transposition of great arteries: new insights into the pathogenesis |journal=Front Pediatr |volume=1 |issue= |pages=11 |date=June 2013 |pmid=24400257 |pmc=3860888 |doi=10.3389/fped.2013.00011 |url=}}</ref> | ||
*[[Prostaglandin]]s (PGE) | *[[Prostaglandin]]s (PGE) | ||
**Prevents the ductus arteriosus from closing, therefore providing an additional shunt through which to provide the systemic circulation with a higher level of oxygen. | **Prevents the [[ductus arteriosus]] from closing, therefore providing an additional shunt through which to provide the systemic circulation with a higher level of oxygen. | ||
*[[Antibiotics]] | *[[Antibiotics]] | ||
**Antibiotics may be administered preventively. However, due to the physical strain caused by uncorrected d-TGA, as well as the potential for introduction of bacteria via arterial and central lines, infection is not uncommon in pre-operative patients. | **Antibiotics may be administered preventively. However, due to the physical strain caused by uncorrected d-TGA, as well as the potential for introduction of bacteria via arterial and central lines, infection is not uncommon in pre-operative patients. | ||
*[[Diuretics]] | *[[Diuretics]] | ||
**Diuretics aid in flushing excess fluid from the body, thereby easing strain on the heart. | **[[Diuretics]] aid in flushing excess fluid from the body, thereby easing strain on the [[heart]]. | ||
*[[Analgesics]] | *[[Analgesics]] | ||
**Analgesics normally are not used pre-operatively, but they may be used in certain cases. They are occasionally used partially for their sedative effects. | **Analgesics normally are not used pre-operatively, but they may be used in certain cases. They are occasionally used partially for their sedative effects. | ||
*[[Cardiac glycosides]] | *[[Cardiac glycosides]] | ||
**Cardiac glycosides are used to maintain proper heart rhythm while increasing the strength of each contraction. | **Cardiac [[glycosides]] are used to maintain proper heart rhythm while increasing the strength of each contraction. | ||
*[[Sedatives]] | *[[Sedatives]] | ||
**Sedatives may be used palliatively to prevent a young child from thrashing about or pulling out any of their lines. | **[[Sedatives]] may be used palliatively to prevent a young child from thrashing about or pulling out any of their lines. | ||
== Life Style Modifications == | |||
Patients with transposition of the great arteries and a large [[ventricular septal defect]] who have not undergone repair may require certain life style modifications to control symptoms which include: | |||
* Increased caloric density during infancy (particularly if they have significant [[congestive heart failure]] and [[poor weight gain]]). | |||
** Following definitive repair, most patients do not need a special diet. | |||
* Specific activity restrictions are dependent on the patient's residual hemodynamic abnormalities. | |||
* Following the arterial switch procedure, exercise stress testing is necessary in older patients who are interested in participating in competitive sports. | |||
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Revision as of 17:19, 26 February 2020
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Transposition of the great vessels Microchapters |
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Classification |
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Differentiating Transposition of the great vessels from other Diseases |
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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
Surgery is the mainstay of treatment for TGA. However, infusion of PGE1 to a newborn diagnosed with TGA is recommended as it prevents the ductus arteriosus from closing, therefore providing an additional shunt through which to provide the systemic circulation with a higher level of oxygen.
Medical Therapy
Surgery is the mainstay of treatment for TGA. However, infusion of PGE1 to a newborn diagnosed with TGA is recommended as it prevents the ductus arteriosus from closing, therefore providing an additional shunt through which to provide the systemic circulation with a higher level of oxygen.[1]
- Prostaglandins (PGE)
- Prevents the ductus arteriosus from closing, therefore providing an additional shunt through which to provide the systemic circulation with a higher level of oxygen.
- Antibiotics
- Antibiotics may be administered preventively. However, due to the physical strain caused by uncorrected d-TGA, as well as the potential for introduction of bacteria via arterial and central lines, infection is not uncommon in pre-operative patients.
- Diuretics
- Analgesics
- Analgesics normally are not used pre-operatively, but they may be used in certain cases. They are occasionally used partially for their sedative effects.
- Cardiac glycosides
- Cardiac glycosides are used to maintain proper heart rhythm while increasing the strength of each contraction.
- Sedatives
- Sedatives may be used palliatively to prevent a young child from thrashing about or pulling out any of their lines.
Life Style Modifications
Patients with transposition of the great arteries and a large ventricular septal defect who have not undergone repair may require certain life style modifications to control symptoms which include:
- Increased caloric density during infancy (particularly if they have significant congestive heart failure and poor weight gain).
- Following definitive repair, most patients do not need a special diet.
- Specific activity restrictions are dependent on the patient's residual hemodynamic abnormalities.
- Following the arterial switch procedure, exercise stress testing is necessary in older patients who are interested in participating in competitive sports.
References
- ↑ Unolt M, Putotto C, Silvestri LM, Marino D, Scarabotti A, Valerio M, Caiaro A, Versacci P, Marino B (June 2013). "Transposition of great arteries: new insights into the pathogenesis". Front Pediatr. 1: 11. doi:10.3389/fped.2013.00011. PMC 3860888. PMID 24400257. Vancouver style error: initials (help)