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.
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:
People sometimes call transposition of the great arteries:
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:
Babies born with transposition of the great arteries may have other heart defects, including:
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.
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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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:
Newborns with d-TGA have symptoms of cyanosis (low oxygen) and may also have heart failure. Symptoms include:
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.
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.
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:
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:
Many babies with d-TGA have surgery immediately.
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.
After surgery, your baby may need medications to:
If your baby has a slow heartbeat, your provider may recommend a pacemaker. This is usually associated with the closure of the VSD.
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.
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.
After transposition surgery, people have a higher risk for other heart problems. Potential heart complications include:
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.
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.
Your child can live a long, enjoyable life after treatment for transposition of the great arteries. Their heart needs lifelong follow-up care, including:
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.
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.
See a healthcare provider if your baby has:
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.
If your child has transposition of the great arteries, ask your healthcare provider:
If you had surgery for transposition as a child, ask your provider:
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.
Last reviewed by a Cleveland Clinic medical professional on 06/26/2022.
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