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Transposition of the Great Arteries (TGA)

Transposition of the great arteries (TGA) is a serious but rare congenital (from birth) heart defect, in which the two main arteries leaving the heart are reversed (transposed).

TGA changes the way blood circulates through the body, leaving a shortage of oxygen in blood flowing from the heart to the rest of the body. Without enough oxygen, your child's body can't function.

What happens once you have transposition of the great arteries (TGA)?

TGA is often detected as soon as your baby is born or during the first week of life. If signs and symptoms don't appear in the hospital, seek emergency medical help if you notice that your baby's skin starts to look blue.

TGA symptoms include:

  • Shortness of breath.

  • Poor feeding and weight gain.

  • Skin that looks blue (cyanosis).

TGA may cause any of these conditions:

  • Hypoxia: With this condition, the body is deprived of oxygen at the tissue level. Hypoxia may be classified as either generalized, affecting the whole body, or local, affecting and area of the body.

  • Heart failure: This is a condition in which the heart can't pump enough blood. It may develop over time because the right ventricle is pumping under higher pressure than usual. This added work may make the right ventricle stiff or weak.

  • Lung damage: Too much oxygen-rich blood can cause damage to the lungs, making breathing difficult.

What causes transposition of the great arteries (TGA)?

TGA occurs when your baby's heart is developing in the womb. Why this defect happens is unknown in most cases. Some factors, such as genetics, rubella or other viral illnesses during pregnancy, maternal age over 40 or maternal diabetes, may increase the likelihood of getting this condition.

What types of tests are used to diagnose transposition of the great arteries (TGA)?

Your baby's doctor may suspect a heart defect if they hear a heart murmur—an abnormal whooshing sound caused by turbulent blood flow. One of these tests is usually necessary for a final diagnosis:

  • Echocardiogram: This ultrasound can show problems with the structure of the heart.

  • Cardiac catheterization: This test involves looking at the inside of the heart with a catheter (thin tube) and measuring the blood pressure and oxygen.

  • Electrocardiogram (EKG): This test measures the electrical activity of the heart.

  • Chest X-ray: This shows your baby's heart size and the aorta and pulmonary artery position.

What types of treatments and procedures are used to treat transposition of the great arteries (TGA)?

Surgery is usually required to treat TGA. However, your baby's doctor may recommend other options until the surgery is done. These include:

  • Medication: Medication may help keep the connection between the aorta and pulmonary artery open to increase blood flow and improve the mixing of oxygen-poor and oxygen-rich blood.

  • Atrial septostomy: This procedure, done using cardiac catheterization, enlarges a natural connection between the heart's upper chambers (atria). It results in a higher oxygen level in your baby's body.

Surgical options include:

  • Arterial switch operation: This is the most common surgery used to correct TGA. The pulmonary artery and the aorta are moved to their normal positions. 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.

  • Atrial switch operation: 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. The right ventricle is forced to pump blood to the body instead of just to the lungs as it would do in a normal heart.

What can I do to support my health when I have transposition of the great arteries (TGA)?

You or your child will need to be monitored and treated regularly for life. TGA can contribute to other health problems. Adults who have congenital heart defects may need other treatments for their condition.

Why choose Presbyterian for transposition of the great arteries (TGA)?

Presbyterian’s Pediatric and Congenital Cardiology team has many different options to help you manage your or your child’s heart condition. The team performs various diagnostic tests and procedures to help form an accurate diagnosis and create individualized treatment plans. Depending on the type of heart condition your child has and its underlying cause, the team can recommend a wide variety of treatment options. Our pediatric cardiologists, pediatric interventional cardiologists and pediatric cardiovascular surgeons work closely together for cardiac repair or surgery cases is the best treatment option.