Transposition of the main blood vessels in newborn children: complete, corrected

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Congenital abnormal vessels emanating from the ventricles of the heart are life threatening. Transposition of the main vessels is the most common congenital heart disease among other vices. Observation of a pregnant woman can reveal a problem before the birth of a child, which will help plan her treatment.

Features of the disease

The correct structure provides that the pulmonary trunk leaves the ventricle on the right, which is responsible for the venous blood. Through this main vessel blood is directed to the lungs, where it is enriched with oxygen. An artery emerges from the left ventricle. The left half is responsible for the arterial blood, which is sent to a large circle to feed the tissues.

Transposition is a pathology when the main vessels are swapped. From the right ventricle, depleted blood enters the artery and a large circle. And from the left ventricle, the blood, designed to saturate the cells with oxygen, goes again in a closed circle into the lungs.

Two parallel circles are obtained, where the enriched blood can not fall into a large circle, and when it gets into the lungs, it does not saturate with oxygen, because it did not give it to the tissues and it did not become impoverished. Venous blood in a large circle immediately creates oxygen starvation of tissues.

How abnormal vessel arrangements are perceived for different periods of life:

• A child in the womb. A child in the womb does not experience discomfort with such a pathology, because his blood does not go through a large circle and he is not at this time vital.
• For a born child it is important that there is at least some part of the venous blood getting oxygen. The situation is helped by the presence of other congenital anomalies. Defect of the interventricular septum, when there is an opening in it and the blood of different ventricles can communicate with each other. Part of the venous blood moves to the left ventricle and is therefore involved in a small circle. It has the ability to get oxygen by getting into the lungs. Arterial blood, partially falling into the right half of the heart, along the artery goes to a large circle and does not allow tissues to get into a critical condition due to hypoxia. Also, a partial exchange of blood between the venous and arterial blood circulation can be achieved due to:
  • not yet closed arterial duct,
  • if the atrial septum is defective,
  • to the oval window.

• Adult person, if in an early childhood the congenital defects caused by this type of defect were not corrected, it can not be viable. This is due to the fact that the results of progression of pathology accumulating in the body leading to irreversible processes accumulate in the body. Variants can be if the anomaly is not of a very severe form, but it is impossible to have a normal life span without correction at all.

The peculiarities of the disease and the main method of fighting the transposition of the main vessels are described in more detail by the medical specialists in the following video:

Forms and classification of

Specialists distinguish four variants of violations.

1. Incomplete transposition. When the main vessels depart from one ventricle, for example: the right.
   If the vessels have been reversed by mistake of nature, but one of them has the vent of both ventricles.
2. Full transposition of the main vessels. This is the name of vice, when the main arteries and the pulmonary trunk are exchanged. The result is two parallel circles of blood circulation. In this case, the blood of the venous circulation and the arterial circle is not communicated with each other.
   A complicated case. The arterial duct helps to stay until correction, which makes it possible to communicate blood of a small and large circle. It persists from the perinatal period, and doctors try to delay its closure before the corrective procedure.
3. Transposition of highways, which has additional defects of physiology. Suitable cases are when the septum of the heart has a hole, which is a defect. However, this circumstance facilitates the newborn's condition and gives an opportunity to live up to a corrective procedure.
4. Corrected form of transposition of the main vessels
   With this pathology, nature seems to have made a double mistake. As in the first case, the main trunk vessels are mutually displaced in places. And the second anomaly - the left and right ventricles too are in place of each other. That is, the right ventricle is located on the left and vice versa.
   This form makes the situation easier, because the blood circulation does not have a strong effect. But over time, the consequences of pathology still accumulate, because the right and left ventricles are naturally created to carry a different load and it is difficult for them to replace each other.

Incorrect arrangement of the main vessels( diagram)

Causes of the

Incorrect arrangement of the main vessels is formed during the perinatal life of the fetus during the period when the heart and the vessel system are being created. This falls on the first eight weeks. Why there is an abnormal failure is not exactly known.

The factors that contribute to the in utero development of organs include:

• susceptibility of the future mother to influences:
  • exposure to harmful chemicals,
  • taking medications without consulting the doctor,
  • exposure to ionizing radiation,
  • living in ecologically unsafe areas,
  • if the pregnant woman has recovered:
    • chicken pox,
    • ARVI,
    • measles,
    • herpes,
    • mumps,
    • syphilis,
    • rubella;
• predisposition at genetic level,
• malnutrition or non-compliance with diet,
• alcohol consumption,
• diabetes mellitus in a prospective mother without proper supervision during childbearing,
• if pregnancy occurs over the age of forty,
• tobacco smoking,
• disease occurs in children withother chromosomal abnormalities, for example, Down Syndrome.

Symptoms of

Since patients do not survive without correction in early childhood, it is possible to talk about the symptoms of transposition of major vessels in newborns:

• skin has a bluish tint,
• enlarged liver,
• dyspnea,
• rapid heartbeat;
• in the future, if the child could survive without repairing the defects:
  • is delayed in physical development,
  • poorly accumulates the weight required in accordance with age,
  • is enlarged chest,
  • heart is larger than normal,
  • is swollen.

Diagnosis

It is possible to determine the transposition of the main vessels in the fetus during its intrauterine development. This will help plan the care for the child and prepare for it. If the problem has not been identified, then at birth, cyanosis specialists suggest heart disease.

To clarify the type of violation can be such procedures.

• Echocardiography
  Very informative and safe method. You can determine the wrong location of the vessels and other defects.
• X-ray pictures
  Give the opportunity to see the shape and size of the heart, some features of the vessels.
• Catheterization of
  A catheter is inserted into the area of ​​the heart. With its help, it is possible to examine in detail the internal structure of the heart chambers.
• Angiography
  One of the methods of examination of vessels with the use of contrast medium.

The following video will tell you what the transposition of the main vessels looks like:

Treatment of

The main and only method of treatment for transposition of the main vessels is operation. There are several methods how to support the newborn in the period before the adjustment.

Therapeutic and medical methods

The therapeutic method is needed during the observation of the condition after the operation. Apply a medical method, as an auxiliary. During the preparation of a newborn to an adjustment, he may be assigned to take prostaglandin E1.Purpose: to prevent the arterial duct from becoming infected.

It exists in the child before birth, then overgrows. Maintaining the duct open will help the child survive the operation. There will be an opportunity to communicate with the venous and arterial blood circulation.

And now let's talk about the operation when transposing the main vessels.

Operation

• The first surgical intervention, which in most cases makes the newborn as soon as possible, is the Raskind procedure. It consists in the introduction of a catheter with a balloon into the heart area under the supervision of the apparatus.
  The balloon in the oval window swells, thereby expanding it. Operation of the closed type( palliative).
• The operation for the correction of defects is a radical intervention with the use of artificial maintenance of blood circulation( Operation Zhatene).The purpose of the procedure is a complete correction of natural defects. The best time for it is the first month of life.
• If you are late with referrals to specialists for help, sometimes the operation to move the vessels can not be done. This is due to the fact that the ventricles are adjusted and adapted to the existing load and the change may not be sustained. Usually this applies to children over the age of up to two years. But experts have the option of how you can help them. An operative intervention is performed to redirect the blood flow, so that as a result, a large circle circulates arterial blood, and in a small circle - the venous blood.

More details on how the operation is performed, if a transposition of the main vessels is detected in the child, the following video will tell:

Prevention of the disease

. We need to seriously prepare for the conception of the child, to examine the health, to follow the recommendations of specialists. During pregnancy, situations that are harmful should be avoided:

• should be located in areas with an unfavorable environment,
• should not be exposed to chemicals,
• should not be exposed to vibration, ionizing radiation;
• tablets, if necessary, take it, then consult a specialist;
• observe precautions to avoid infectious diseases.

But if there was a pathology, the best option is to find it before the birth of the child. Therefore, it should be observed during the bearing of the child.

Complications of

The longer a child lives without adjustment, the more the organism adapts to the situation. The left ventricle gets used to the lowered load, and the right to increased. In a healthy person, the load is distributed on the contrary.

The reduced load allows the ventricle to reduce the thickness of the walls. If you make an adjustment late, the left ventricle after the procedure can not cope with the new load.

In order to avoid this in many clinics apply:

• special method of sewing elements, taking into account the further growth of the highway;
• uses natural materials for prosthetics.

Forecast

After performing the corrective operation, positive results occur in 90% of cases. Such patients after the procedure need long-term follow-up by specialists. They are advised not to expose themselves to significant physical exertion.

Without skilled care, newborns with naturally displaced vessels die in the first month of life to 50%.The remaining patients mostly live no longer than a year due to hypoxia, which is progressing.