Transposition of the Great Arteries with VSD and Pulmonary Stenosis

  • The Aorta arises from the right ventricle and receives "blue" blood, whilst the Pulmonary Artery arises from the left ventricle (Transposition). The presence of pulmonary stenosis often protects the pulmonary circulation from the effects of high pressure (pulmonary hypertension), while the VSD allows adequate flow of blood from the left side of the heart into the main circulation to
    maintain good oxygen levels. Many affected children can survive for many months or even years (sometimes into adult life) without surgery. If the pulmonary stenosis is severe then flow of blood in the lungs may be inadequate and early surgery (e.g. a 'shunt' operation) may be needed.

    Conversely if the pulmonary stenosis is mild then pulmonary hypertension may be present and surgery may be needed to prevent this causing damage to the lungs.

    Corrective surgery often involves a Rastelli operation. This results in blood being channelled through the VSD from the left ventricle to the Aorta. A patch in the right ventricle prevents blood passing from the RV to the Aorta. A conduit (which is an artificial tube containing a graft valve) is sewn in to connect the right ventricle to the Pulmonary Artery. A similar operation is called the 'REV' procedure.

    18e_Transposition_of_the_great_arteries