and may never be able to satisfy particular standards for completeness. you can help by adding missing items with reliable sources. when pge is administered to a newborn, it prevents the ductus arteriosus from closing, therefore providing an additional shunt through which to provide the systemic circulation with a higher level of oxygen. antibiotics may be administered preventatively. however, due to the physical strain caused by uncorrected d-tga, as well as the potential for introduction of bacteria via arterial and central lines, infection is not uncommon in pre-operative patients. diuretics aid in flushing excess fluid from the body, thereby easing strain on the heart. analgesics normally are not used pre-operatively, but they may be used in certain cases. they are occasionally used partially for their sedative effects. cardiac glycosides are used to maintain proper heart rhythm while increasing the strength of each contraction. sedatives may be used palliatively to prevent a young child from thrashing about or pulling out any of their lines. nikaidoh bex who introduced the possibility of aortic translocation in 1980. but nikaidoh has put the procedure in practice in 1984. it results in an anatomical normal heart, even better than with an aso, because also the cones are switched instead of only the arteries as with an aso. the procedure is contra-indicated by certain coronary anomalies. in 1984, nikaidoh introduced a surgical approach for the management of tga, vsd, and pulmonary stenosis (ps), which he called "aortic translocation and biventricular outflow tract reconstruction". the repair consisted of harvesting the aortic root from the right ventricle, with or without the coronary arteries attached, and relieving the lvoto by dividing the outlet septum and pulmonary valve annulus. the lvot is then restored by posteriorly translocating the aortic root and closing the vsd. finally, the right ventricular outflow tract is reconstructed with a pericardial patch. this is a technically challenging procedure, but results in a more "normal" anatomic repair. the main thing is the repositioning of the native aortic root over to the lv cavity, avoiding the creation of a long tortuous intraventricular tunnel. this technique appears to prevent the development of lvoto, which is a frequent complication of the rastelli repair. the addition of the lecompte maneuver may prevent branch pulmonary artery stenosis that may occur secondary to compression of the pa by the posteriorly displaced, translocated aortic root. it creates a direct rv to pa anastomosis and avoiding the use of a conduit, which should decrease the incidence of rvot reinterventions. lecompte since 1981 lecompte has put his lecompte manoeuvre in use. this is used with the rev (réparation à l'etage ventriculaire). this surgery is like the rastelli procedure, but with the use of the pulmonary artery without a conduit. rastelli when an arterials switch operation (aso) is not possible e.g. in case of lvoto an option is the rastelli procedure. the pulmonal artery is shifted with help of conduit to the right ventricle. it has been used since 1960s. it has a disadvantage that the conduit does not grow, so re-operation is necessary. arterial switch arterial switch procedure immediate post-operative (jatene procedure) d-tga + vsd neonate the jatene procedure surgery is the preferred, and most frequently used, method of correcting d-tga. it is ideally performed on an infant between 8–14 days old. the heart and vessels are accessed via median sternotomy, and a cardiopulmonary bypass machine is used; as this machine needs its "circulation" to be filled with blood, a child will require a blood transfusion for this surgery. the procedure involves transecting both the aorta and pulmonary artery; the coronary arteries are then detached from the aorta and reattached to the neo-aorta, before "swapping" the upper portion of the aorta and pulmonary artery to the opposite arterial root. including the anaesthesia and immediate post operative recovery, this surgery takes an average of approximately six to eight hours to complete. some arterial switch recipients may present with post-operative pulmonary stenosis, which would then be repaired with angioplasty, pulmonary stenting via heart cath or median sternotomy, and/or xenograft. one day post-operative (jatene procedure) d-tga + vsd neonate atrial switch in some cases, it is not possible to perform an arterial switch, either because of late diagnosis, sepsis, or a contraindicative coronary artery pattern. in the case of sepsis or late diagnosis, a delayed arterial switch can sometimes be made possible by pab, which may also require a concomitant construction of an aortic-to-pulmonary artery shunt. when an arterial switch is impossible, an atrial switch will be attempted using either the senning or mustard procedure. both methods involve creating a baffle to redirect red and blue blood flow to the appropriate artery. since the late 1970s the mustard procedure has been preferred. post-operative following corrective surgery, but prior to cessation of anaesthesia, two small incisions are made immediately below the sternotomy incision which provide exit points for chest tubes used to drain fluid from the thoracic cavity, with one tube placed at the front and another at the rear of the heart. the patient returns to the icu post-operatively for recovery, maintenance, and close observation; recovery time may vary, but tends to average approximately two weeks, after which the patient may be transferred to a transitional care unit (tcu), and eventually to a cardiac ward. post-operative care is very similar to the palliative care received, with the exception that the patient no longer requires pge or the surgical palliation procedures. additionally, the patient is kept on a cooling blanket for a period of time to prevent fever, which could cause brain damage. the sternum is not closed immediately which allows extra space in the thoracic cavity, preventing excess pressure on the heart, which swells considerably following the surgery; the sternum and incision are closed after a few days, when swelling is sufficiently reduced. follow-up the infant will continue to see a cardiologist on a regular basis. although these appointments are required less frequently as time goes on, they will continue throughout the lifetime of the individual, and may increase in the event of complications or as the individual approaches middle age. the cardiology exam may include an echocardiogram, ekg, and/or cardiac stress test in addition to consultation. additionally, some individuals may require ongoing medication therapy at home, which may include diuretics (such as furosemide or spironolactone), analgesics (such as paracetamol), cardiac glycosides (such as digoxin), anticoagulants (such as heparin or aspirin), or other medications. if the individual has undergone stenting, an anticoagulant will be a necessity to prevent build-up around the stent(s), as the body will perceive the foreign body as a wound and attempt to heal it. some patients who had alternate corrective surgery, such as the mustard or senning procedure, may have issues with sa and va nodal transmissions in later life. typical symptoms include palpitations and problems with low heart rates. this is commonly solved with a pacemaker unit, providing scar tissue from the original operation does not block its functionality. more recently, ace inhibitors have been prescribed to patients in the hope of relieving stress on the heart. prognosis with simple d-tga, if the foramen ovale and ductus arteriosus are allowed to close naturally, the newborn will likely not survive long enough to receive corrective surgery. with complex d-tga, the infant will fail to thrive and is unlikely to survive longer than a year if corrective surgery is not performed. in most cases, the patient's condition will deteriorate to the point of inoperability if the defect is not corrected in the first year. while the foramen ovale and ductus arteriosus are open after birth, some mixing of red and blue blood occurs allowing a small amount of oxygen to be delivered to the body; if asd, vsd, pfo, and/or pda are present, this will allow a higher amount of the red and blue blood to be mixed, therefore delivering more oxygen to the body, but can complicate and lengthen the corrective surgery and/or be symptomatic. modern repair procedures within the ideal timeframe and without additional complications have a very high success rate. epidemiology heart defects are the most common birth defect, occurring in approximately 1% of live births. 5–7% of these are dextro-transposition of the great arteries. such defects appear to be more common in men than women. approximately one million people worldwide are currently living with a chd.having a child with a chd increases an individual's chances of having another child with a chd from 1% to 3%. subsequent children born with a chd increase that individual's chances further.