Corrected version below:

TRANSPOSITION OF THE GREAT ARTERIES (TGA/TOGA)

The “great arteries” are the AORTA and the PULMONARY ARTERY. In Transposition Of The Great Arteries, the LV leads to the PA and the RV leads to the Aorta. Most common cardiac cause for cyanosis on DOL 1, and usually presents within hours. EKG shows RVH. The two circuits do not connect and are “running in parallel” (see image). Mixing needs to occur in order to support life. Often a VSD is present, but if not, then a septal “defect” needs to be created. To treat, create an ASD to allow mixing. Mixing at the PDA also helps (though not as much) so create the presence of BOTH (ASD and the PDA) by also giving PGE. The ASD (or existing VSD) allows a RIGHT to LEFT shunt (deoxygenated circuit to oxygenated circuit) to be created. CXR shows an EGG SHAPED and vascular congestion (due to blood flow from the LV to the PA). There is no associated murmur. In the image below, note the circuits running in parallel. Treatment is an ASD (represented by the crossed arrows).

PEARL: If you suspect a cardiac cause for cyanosis on DOL 1, this is probably your answer!