Moderate
Left anterior thoracotomy
Isolated pulmonary artery banding (PAB)
Left lateral thoracotomy
PAB (when coarctation or aortic arch repair also required)
Right lateral thoracotomy
Blalock-Hanlon atrial septectomy
Each of these procedures is performed through an incision between the ribs and visualized by echocardiogram; these are far less common than heart cath procedures. Pulmonary artery banding is used in a small number of cases of d-TGA, usually when the corrective surgery needs to be delayed, to create an artificial stenosis in order to control pulmonary blood pressure; PAB involves placing a band around the pulmonary trunk, this band can then be quickly and easily adjusted when necessary. An atrial septectomy is the surgical removal of the atrial septum; this is performed when a patent foramen ovale (PFO), or atrial septal defect (ASD) are not present and additional shunting is required to raise the oxygen saturation of the blood flowing eventually into the aorta. Major
Median sternotomy
PAB (when intracardiac procedures also required)
Concomitant atrial septectomy
In recent years, it is quite rare for palliative procedures to be done via median sternotomy. However, if a sternotomy is required for a different procedure, in most cases all procedures that are immediately required will be performed at the same time. Monitoring and maintenance
Nasogastric tube (NG tube or simply NG)
Intubation, oxygen mask, or nasal cannula
Intravenous drip (IV)
Arterial line
Central venous catheter
Fingerprick
Sphygmomanometer
Pulse oximeter
EKG
An NG tube is used to deliver nourishment, and occasionally medication, to the patient. Since the tube extends right into the stomach, it can also be used to monitor how well the patient is digesting their "food".
When no other heart defects are present it is called simple d-TGA; when other defects are present it is called complex d-TGA.Although it may seem counterintuitive, complex d-TGA presents better chance of survival and less developmental risks than simple d-TGA, as well as usually requiring fewer invasive palliative procedures. This is because the left-to-right and bidirectional shunting caused by the defects common to complex d-TGA allow a higher amount of oxygen-rich blood to enter the systemic circulation. However, complex d-TGA may cause a very slight increase to length and risk of the corrective surgery, as most or all other heart defects will normally be repaired at the same time, and the heart becomes "irritated" the more it is manipulated. Treatment
Life-saving heart surgery is always required. If the diagnosis is made in a standard hospital or other clinical facility, the baby will be transferred to a childrens hospital, if such facilities are available, for specialized paediatric treatment and equipment. The patient will require constant monitoring and care in an intensive care unit (ICU). Palliative
Palliative treatment is normally administered prior to corrective surgery in order to reduce the symptoms of d-TGA (and any other complications), giving the newborn or infant a better chance of surviving the surgery.