Transposition of the Great Arteries

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Anatomically Corrected L-Transposition

Baffe Procedure

Baffe procedures were performed as palliation of d-TGA during the fifties and consisted of redirection of the inferior vena caval return to the left atrium by a homograft or synthetic conduit, and also rearrangement of the right pulmonary venous return to the right atrium. This gave a relatively effective shunt at the atrial level, and probably most of the survivors later got a mustard type of correction by placement of a baffle for complete switch of return to the atrial level.

Information provided by: Kjell Borthne M.D. Ped. Cardiol.
Children's Dept.
University Hospital of Trondheim

Auscultation in Transposition

Loud second heart sound at the upper left sternal border.

The aortic component of the second heart sound is loud when the aortic valve is close to the chest wall. This is the case in l-transpositions where the aorta is anterior and to the left of the pulmonary artery.

A loud second heart sound heard at the left upper sternal border should not be mistakenly assumed to represent a loud pulmonic second sound of pulmonary hypertension.

The loudness, presence and timing of P2 are influenced by presence and degree of pulmonic stenosis. The loudness of P2 decreases with worsening pulmonic stenosis and with a posteriorly located pulmonic valve.

Systolic murmur.

A loud harsh systolic murmur may be due to pulmonic stenosis or ventricular septal defect. A palpable precordial thrill can be felt with either condition. The murmur of pulmonic stenosis may have more ejection quality than the murmur of ventricular septal defect.

The location of the murmur high up over the base of the heart suggests pulmonic stenosis. A location lower down the left sternal border suggests ventricular septal defect.

Systolic ejection clicks may be heard when a ventricular septal defect is present. An ejection click that decreases on inspiration is characteristic of pulmonic stenosis.

Apical diastolic filling murmurs may be heard with increased pulmonary flow due to a ventricular septal defect, and consequent increased diastolic flow into the systemic ventricle. The decreased pulmonary artery flow in pulmonic stenosis does not cause this murmur.

Continuous murmur.

The infant with pulmonary atresia will have a continuous murmur due to a patent ductus arteriosus.

Differential cyanosis.

Differential cyanosis with legs more pink than arms may be present in transposition with ventricular septal defect, patent ductus arteriosus and preductal coarctation of the aorta. Oxygenated blood from the pulmonary veins to left atrium to the ventricle to the pulmonary artery enters the descending aorta. More cyanotic blood supplies the ascending aorta.

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