Transposition of the Great Arteries

Transposition of the great arteries, also called dextro-transposition or d-TGA, is a congenital heart defect. The heart’s arteries are reversed, affecting blood oxygen levels. d-TGA can be life-threatening without surgery to repair it. With lifelong care from a cardiologist, people with d-TGA can live long, healthy lives.


What is transposition of the great arteries?

Transposition of the great arteries is a congenital heart defect. A baby is born with it.

In dextro-transposition or d-TGA, the two arteries that carry blood away from your baby’s heart are reversed (transposed). The two arteries are:

  • The main pulmonary artery, which carries blood into the lungs.
  • The aorta, the artery that carries blood from the heart to the rest of the body.

People sometimes call transposition of the great arteries:

  • Transposition of the great vessels.
  • Dextro-transposition of the great arteries.
  • D-transposition.
  • d-TGA.

How does d-transposition affect people?

Your arteries are part of your circulatory system, which helps blood flow through your body. Arteries bring oxygen-rich blood from the heart to the rest of your body. The one exception to this is your pulmonary arteries, which bring oxygen-poor blood to your lungs.

With d-TGA, your baby’s pulmonary artery and aorta connect to the wrong parts of their heart. This problem affects how blood travels. It can make it difficult for enough oxygen to reach their organs. Blood may circulate:

  • In a body-heart-body pattern, without getting oxygenated in their lungs.
  • In a lungs-heart-lungs pattern, without traveling throughout their body to deliver oxygen.

What other heart conditions might a baby with d-transposition have?

Babies born with transposition of the great arteries may have other heart defects, including:

What is levo-transposition of the great arteries?

An even rarer type of transposition is levo-transposition of the great arteries, or l-transposition. With this condition, the lower section of your heart is also reversed, so that the de-oxygenated blood is pumped to your baby’s lungs and to their body by the wrong pumping chamber.

How common is transposition of the great arteries?

Around 1,100 babies are born with d-transposition in the United States every year. That’s about 1 in every 3,400 babies born.


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Symptoms and Causes

What causes transposition of the great arteries?

Researchers don’t know what causes d-transposition. Like other congenital heart defects, it might result from a genetic mutation (change) or exposure to toxins during pregnancy.

A baby may be more likely to be born with d-TGA if, during pregnancy, you:

  • Had gestational diabetes.
  • Had rubella (German measles).
  • Were exposed to certain pesticides or herbicides.
  • Took certain antiepileptic medications.

What are the symptoms of transposition of the great arteries?

Newborns with d-TGA have symptoms of cyanosis (low oxygen) and may also have heart failure. Symptoms include:

  • Trouble breathing.
  • Weak pulse.
  • Difficulty feeding.
  • Heart pounding.
  • Skin or whites of their eyes appear bluish (in light-skinned babies) or grayish (in dark-skinned babies).

When do symptoms of transposition of the great arteries appear?

Signs appear soon after birth. Their severity depends on whether oxygen-rich blood can reach the rest of your baby’s body by “mixing” in the upper chamber of their heart.

Babies with d-TGA who have a large enough atrial septal defect may have less severe symptoms. That’s because ASD makes a hole for some oxygenated blood to get pumped into their body.

People with d-TGA also sometimes have a hole between the lower pumping chambers, called a ventricular septal defect or VSD.

Some newborns don’t show symptoms right away because small openings around their heart haven’t closed yet. Once the holes close, symptoms appear, and your baby requires immediate medical attention.


Diagnosis and Tests

Can transposition of the great arteries be diagnosed during pregnancy?

Yes, your healthcare provider may diagnose d-TGA during pregnancy. Prenatal tests check for heart defects and other conditions.

If your provider notices a concern during a prenatal ultrasound, they may recommend a fetal echocardiogram. This noninvasive test is similar to an ultrasound but more detailed. It can confirm a d-TGA diagnosis.

How is transposition of the great arteries diagnosed?

If the condition wasn’t diagnosed before birth, providers typically diagnose it within your baby’s first week of life. To diagnose d-transposition, providers can use:


Management and Treatment

How is d-TGA treated?

Babies born with transposition of the great arteries need surgery to survive.

Your child’s care team may use other treatments to delay major surgery for a short time until your baby can handle the procedure better. These include:

  • Prostaglandin: This medication can keep the ductus arteriosus open, allowing oxygen-rich blood to flow through the body.
  • Catheterization: A balloon atrial septostomy uses a catheter (thin tube) to widen the natural opening between the atria (right and left upper chambers in the heart). This minimally invasive procedure allows blood to mix so it can collect oxygen and deliver it to the body.

Will my baby have surgery for d-TGA right away?

Many babies with d-TGA have surgery immediately.

What are the surgical options for transposition of the great arteries?

D-TGA is corrected by an arterial switch procedure that should be (ideally) performed within the first week of life. This surgery involves switching the positions of your baby’s aorta and pulmonary artery to restore a typical pathway for blood to flow through their heart and out to their body. If there is a VSD present, this will also be repaired at the same time using a synthetic patch.

Your surgeon:

  1. Removes the coronary arteries from your baby’s native aorta, which comes off of their right ventricle in d-TGA.
  2. Moves your baby’s aorta and pulmonary artery to their correct positions.
  3. Connects their aorta to their left ventricle.
  4. Connects the pulmonary artery to the right ventricle.
  5. Reattaches their coronary arteries to their new aorta.

What follow-up do babies need after transposition repair surgery?

After surgery, your baby may need medications to:

  • Help their heart pump more efficiently.
  • Help manage their blood pressure.
  • Get rid of excess fluid.
  • Correct an abnormal heartbeat.

If your baby has a slow heartbeat, your provider may recommend a pacemaker. This is usually associated with the closure of the VSD.


How can I prevent transposition of the great arteries?

There is no known way to prevent transposition of the great arteries. Good prenatal care matters. Be sure your immunizations are up to date, take a multivitamin as prescribed by your provider and attend prenatal appointments.

If you have a history of heart defects in your family or a child with a congenital heart defect, talk to your provider. They may recommend genetic testing and counseling before you get pregnant.

Outlook / Prognosis

What’s the outlook for people with transposition of the great arteries?

While surgery doesn’t cure d-transposition, most people with the condition can lead full, healthy lives. People with this heart defect need lifelong care. A cardiologist (heart specialist) monitors your progress to help you manage complications.

Living With

What types of heart complications might my child have?

After transposition surgery, people have a higher risk for other heart problems. Potential heart complications include:

  • Loss of heart muscle or heart valve function.
  • Valve leakage or coronary artery problems.
  • Heart rhythm problems like arrhythmia, a heart rate that’s too fast or too slow.
  • Enlargement of their new aorta.
  • Problems with their re-implanted coronary arteries.

Will my child need more heart surgeries?

Some babies with transposition of the great arteries or other congenital heart disease treatments may need another procedure to correct later problems. The most common procedures are to restore their heart’s rhythm in circumstances where a VSD was repaired or to repair heart valves.

Can my child play sports if they have d-transposition?

Many cardiologists don’t recommend competitive sports after transposition surgery. You and your child should talk to your pediatrician and cardiologist. Together, you can make a decision that’s best for your child’s health.

How can my child best live with d-TGA?

Your child can live a long, enjoyable life after treatment for transposition of the great arteries. Their heart needs lifelong follow-up care, including:

  • Regular appointments with a cardiologist with expertise in this condition.
  • Medications.
  • Regular, noninvasive heart function tests, which may include EKGs, Holter monitors, exercise stress tests and echocardiograms.

Is there a risk for endocarditis?

Endocarditis is an infection that happens when bacteria enter your heart. It’s more common in people with heart conditions, such as d-TGA. People who had transposition surgery may need to take antibiotics before dental procedures.

If I had d-TGA surgery as a child, can I get pregnant?

Many people who had d-TGA surgery have had successful pregnancies. Talk to your healthcare provider and a cardiologist before getting pregnant. You may need to find a center that offers both high-risk obstetrical services and expertise in adult congenital heart disease.

When should I see a healthcare provider for transposition of the great arteries?

See a healthcare provider if your baby has:

  • Trouble breathing.
  • Weak pulse.
  • Bluish or whitish skin around their mouth.

If you had transposition surgery as a child, you should see a cardiologist with experience caring for adults with congenital heart disease. You need routine care and evaluation throughout your life.

What should I ask my healthcare provider?

If your child has transposition of the great arteries, ask your healthcare provider:

  • Will my child need surgery right away?
  • What procedure is best?
  • What kind of follow-up care will my child need?
  • Will they need a second surgery?
  • Are there any restrictions on their activities?
  • How can I best care for my child after surgery?

If you had surgery for transposition as a child, ask your provider:

  • Will I need another surgery?
  • What type of monitoring do I need?
  • Are there any restrictions on my activities?
  • Can I get pregnant?

A note from Cleveland Clinic

Transposition of the great arteries (sometimes called transposition of the great vessels) is a congenital heart defect. Healthcare providers diagnose it during pregnancy or soon after a baby is born. While the condition is life-threatening, surgery can repair it. With lifelong care from a cardiologist, people who had surgery for d-TGA can lead long, healthy lives.

Medically Reviewed

Last reviewed on 06/26/2022.

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