Interviewer: There is a condition called Transposition or Great Vessels, what is that mean?
Interviewee: Well transposition of the great vessel is congenital heart problem in which the two large arteries that come out of the heart are connected to the opposite pumping chambers from the pumping chambers that Mother Nature can intend to be connected too. So what thus means is that the right lower pumping chamber pumps the bloods to the main circulation and left lower pumping chamber pumps the blood to the lungs.
Interviewer: How do we get these things communicate because it goes to one side and the other we can’t live, can you?
Interviewee: Oh baby with the transposition of the great vessels are generally quite ill at the time of birth. There in the first few hours of life they maybe okay but the reason why they are okay is because they have persistence of areas inside and outside the heart with the pink blood can mix with the blue blood and this is what allows them to be okay. But these are temporary connections which will not sustain the baby in the long run so all babies with transposition of the great vessels require some intervention generally it’s surgery and it usually needs to be done right around the time of birth.
Interviewer: What would be that can surgery, what could you do to keep this stable to maybe to a bigger surgery.
Interviewee: If the baby is unstable around the time of birth or a surgery needs to be delayed actual open surgery needs to be delayed for any reason. And generally we would create a hole in the wall between the upper chambers of the heart and this is done by the pediatric cardiologist. Usually done at the bedside in the neonatal intensive care unit but the pass of balloon up to the belly button or through the one of the blood vessels at the leg and the extensive up deflated up into the left upper chamber of the heart, blow up the balloon and pull it to the right upper chamber and this creates a good size hole in the wall between the upper chambers of heart and it allows the blue blood to mix with the pink one.
Interviewer: So advice to you can do something more corrective.
Interviewee: Yeah, that’s correct and traditionally in the pass surgery for transposition of the great vessels especially if it so called simple transposition which means there is nothing else wrongs except for the transposition itself and this is the majority of babies with transposition. In the past that surgery was generally delayed into three to six months of age. But for about approximately the last 15 years or so we have a different surgical approach to transposition that allows us to correct the problem and generally that correction is done in the first week of life.
Interviewer: Do you actually reverse the connections or you make little tangles, well how do you approach there problem?
Interviewee: Oh the history of surgery for transposition in the great vessels is interesting. From the beginning the doctors that treating these patients felt the logical solution to the problem was moving those arteries back where they belong. And the tricky part of that was not moving the arteries themselves but moving the heart blood supply which is also reverse in transposition of the great vessels. The original operation that was design to do that field for a variety of different reasons and so other operations were substituted but in the last 10 or 15 years we’ve gone back to taking those large arteries and putting them back and connecting them to the appropriate pumping chambers.
Interviewer: What is the name for that surgery?
Interviewee: Yes, it’s called the arterial switch or anatomic repair.
Interviewer: So basically you just putting a back regard to be done in first place?
Interviewee: Yes, that’s correct.
Interviewer: And if your other variations that you can do maybe you have to do the whole thing is sometime to do something a little bit lessens them.
Interviewee: For unusual exceptions for unusual anatomy there are many different possibilities but generally speaking for transposition especial simple transposition the best solution and the solution which we almost always use would be to put those great vessels back where they belong. Occasionally if a passage way inside the heart is block and that type of there approaches not possible then to fit in the surgery may need to be delayed a time buying operation might need to be done and some other surgical procedures which by pass those blockages can be use to inset. The majority of patients with transposition don’t have those complicated arrangement but about one-third of them well.
Interviewer: So in other ways it sounds that you need a team approach, the surgeon, the cardiologist, other people involve because if you look at this to make decisions with the families involve, how much you do, is that correct?
Interviewee: That’s absolutely true and one of the things that has been found out of heart surgery is that the earlier in life you make a diagnosis and formulate a plan for the child. The better the long term is all sources so if the patients starts off with one plan and then switch this plans in six months of age or nine months of age or a year of age. The results in the long run are not as good as if at one or two days of age, the diagnosis is made, a plan is formulated and then that plan is carry all over the period of time.
Interviewer: Thank you.
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