OVERVIEW
OVERVIEW
Corrected malalignment of the great arteries is a relatively rare form of congenital heart disease in which the ventricular great arteries are not connected in a consistent manner, which can coexist with inconsistencies in the atrioventricular connection, but vena cava blood still ends up flowing into the pulmonary artery, and pulmonary venous blood ends up flowing into the aorta, with hemodynamics identical to that of normal individuals. Asymptomatic individuals do not require surgical correction, but if other cardiovascular malformations are present, surgery is required.
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Department
Cardiac Surgery, Pediatric Surgery
Clinical symptoms
Corresponding symptoms in those with other cardiovascular malformations, otherwise asymptomatic.
Hazards
Spontaneous complete atrioventricular block may occur.
Complications
Spontaneous complete atrioventricular block, etc.
Examination
X-ray, echocardiography, cardiovascular angiography, electrocardiogram, etc.
Diagnosis
Cardiovascular angiography and echocardiography and other imaging tests can clarify the diagnosis.
Treatment principle
Control heart failure and arrhythmia; those with other cardiovascular malformations can be corrected by surgery.
Cure
Treatment can correct the associated other malformations.
Dietary recommendations
Those who need surgical treatment can supplement nutrition to enhance the tolerance of surgery.
Etiology
Causes
The disease is a congenital heart disease.
Symptoms and Diagnosis
Typical symptoms
There may be no clinical signs and symptoms in the absence of other cardiac anomalies. In combination with other malformations, there may be corresponding symptoms, such as cyanosis in pulmonary artery stenosis and feeding difficulty, dyspnea and shortness of breath in ventricular septal defects.1. Left-to-right shunt with ventricular septal defects is often associated with shortness of breath, feeding difficulty, dyspnea, decreased activity, weight loss, pulmonary infection and heart failure.2. Right-to-left shunt with pulmonary artery stenosis is commonly associated with cyanosis and hypoxic episodes.3. Left Atrioventricular valve closure with intact interventricular septum, murmur is loudest in the parasternal 4th intercostal space and not in the apical region, arrhythmia is often present.
Diagnostic basis
1. Physical examination of the patient can be due to the combination of other cardiovascular malformations appear corresponding symptoms, physical examination can have abnormal heart sounds and other manifestations. 2. imaging examination (1) X-ray film: can show the location of the heart and the size of the heart, can be seen in the heart shadow of the left upper ascending aorta shadows full, the disappearance of the normal aortic node shadow. In the case of ventricular septal defect, the heart shadow is enlarged, the upper part of the left edge is protruding to the upper left, and the left 2nd arch disappears. (2) Echocardiography: It can determine the type of corrective aortic malposition, understand the position of the malpositioned pulmonary artery, aorta, mitral valve, tricuspid valve, and clarify whether there is any combination of other cardiac malformations. (3) Cardiac catheterization: right heart catheterization and cardiovascular angiography can show the contour, position and interrelationship of ventricles, aorta and shunt to make a clear diagnosis. However, it is difficult to insert the right heart catheter into the pulmonary artery, and it is often easy to cause arrhythmia, so attention should be paid.
Treatment
Treatment guidelines
Accompanied by other cardiovascular malformations can be corrected by surgery.
Surgery
Combined with other malformations such as ventricular septal defect and right-sided outflow tract obstruction, it can be corrected by surgery, such as ventricular septal defect repair. Aortic bimodulation may be performed at the same time to restore the normal circulatory burden to each of the left and right ventricles. A temporary pacing lead can be placed at the end of the procedure to fulfill the therapeutic needs in case of postoperative arrhythmias.
Prognosis
The prognosis improves with treatment of postoperative arrhythmias.
Nursing care
Daily care
1. During the recovery period, the living environment should be kept quiet and comfortable to ensure sufficient sleep and reduce external stimuli. 2. Maintain a good state of mind, young children should pay attention to soothing, avoiding crying and alleviating their fear and anxiety about the disease. 3. After the recovery period, appropriate exercise can be conducted according to the physical condition, which can help improve physical fitness and mental outlook. 4. Pay attention to personal hygiene to prevent secondary infection. 5.
Dietary regimen
1. For those who need surgical treatment, appropriate nutrition can be supplemented before and during the recovery period, and a light and easy-to-digest diet high in protein, calories and vitamins can help to improve tolerance to the surgery and promote recovery. After the recovery period, normal diet can be resumed gradually.2. Newborns and other young children should be breastfed, complementary food should be added in time, and artificial feeding should be carried out when necessary to meet the needs of surgery and growth and development.