Supporting the New Zealand Adult Congenital Heart Community
Homepage
Consumers
Professionals
The arterial switch operation was first performed successfully by Dr Adib Jatene in 1975. Prior to this time, surgeons had thought that the arterial switch would not be possible, because of the need to switch over not only the main arteries, but also the coronary arteries. The coronary arteries are the small blood vessels that supply blood to the heart muscle and in newborn babies they are only 1-2mm in diameter. Once the technique to do this was developed, the arterial switch gradually became the standard surgery for babies with transposition.
There are lots of people in New Zealand and around the world who have had the arterial switch and are now adults, but the oldest people are still relatively young, with the oldest in NZ being in their early 30’s, and most in their 20’s still. We think that the long-term outlook for adults who have had the arterial switch is likely to be good in most cases, but there are a few problems that can occur and therefore we do need to continue follow-up for the long term, probably for your whole life. The most common problems are narrowing of the pulmonary arteries, leaky aortic valve and enlargement of the first part of the aorta. Read on to get some more information about these problems.
The boxes below describe three of the most important problems that we see in adults with TGA after the Arterial Switch operation
For further information about TGA and the arterial switch click on the links at the bottom of the page
Pulmonary Artery Stenosis
It means narrowing of one or both of the arteries that take blood from the heart to the lungs.
When the surgeons do the arterial switch, the pulmonary arteries have to be moved forward into their new position. This often leads to some stretch on the pulmonary arteries, which can result in narrowing developing.
Major narrowing of the pulmonary arteries can reduce the amount of blood flowing to one of the lungs. It can also require the heart to generate extra pressure to push blood through the narrowed arteries to the lungs, making extra work for the heart.
If the narrowing is tight enough, then we can do a procedure to open it up – either a heart catheter procedure or an operation.
No. It’s something that develops following on from the original surgery. It will usually have been picked up in childhood and in most cases it will be sorted out before you reach adulthood.
Aortic Regurgitation
It’s a leak back through the aortic valve, which is the valve that controls blood being pumped out around your body. This means that some of the blood will leak back into the main pumping chamber of the heart.
The valve can sometimes be abnormal in people with transposition, but also the first part of the aorta often becomes gradually enlarged with time, and this can result in the valve becoming enlarged and leaky.
When the aortic valve is leaky, some blood will leak back into the main pumping chamber of the heart (the left ventricle). This makes extra work for the heart and if the leak is severe it can eventually cause enlargement and weakness of the left ventricle.
If the leak gets severe and causes progressive enlargement of the left ventricle, we may recommend an operation to replace or repair the aortic valve. Sometimes we try medications to delay the need for surgery.
Not usually, although keeping normal blood pressure is important. If you notice a deterioration in your exercise tolerance or you are getting more breathless, then get in touch with your heart team so that we can check you out.
Coronary Artery Stenosis
Narrowing of the coronary arteries, which are the blood vessels that supply the heart muscle.
The surgeon has to re-implant the coronary arteries as part of the arterial switch operation. Sometimes they can become kinked or stretched as the heart grows, leading to them becoming narrowed.
The coronary arteries supply blood to the heart muscle, so they are very important. If they become narrowed they may not supply enough blood to the heart muscle. If the narrowing is major, it can cause heart muscle damage in the same way as a heart attack in an older person.
Major narrowing of the coronary arteries may require surgery to open up or bypass the narrowed section.
The original tendency to narrowed coronary arteries results from the arterial switch operation, but there are things that you can do to minimise the risk of extra damage to the coronary arteries. These include things like not smoking, keeping active, keeping your blood pressure normal and your cholesterol under control.