Talk:Dextro-Transposition of the great arteries

Untitled
I've recapitalized "Transposition of the Great Arteries" as the wikipedia naming guidelines recommend this method to be used for proper names.

Expanded the definition portion of the article.

I'm changing "deoxygenated" back to "oxygen-depleted"...I had used "deoxygenated" in my original version of the article, but found that it sounded awkward in the sentence, and since "oxygenated" occurs in the same sentence, it also sounds repetitive. I chose to use oxygen-depleted instead and found that it improved the sound of the sentence considerably. The two words are absolutely synonymous, so this shouldn't be a problem. With considerable work, this article has feature potential, so it should sound good as well as being factually accurate.

I've removed "(which rises anteriorly from the right ventricle)" and "(rises posteriorly from the left ventricle)" and given these specifics in the opening description, mostly to improve readability, but also to keep tings organized: this paragraph is talking about how the blood is flowing, not the anatomical specifics. The reader also has the illustration to refer to while reading this paragraph. I think this should work.

I have reluctantly removed the following paragraph:
 * "There are three basic variants:
 * TGA with intact ventricular septum (frequency of occurrence: 60%)
 * TGA with ventricular septal defect (20%)
 * TGA with ventricular septal defect and pulmonic stenosis (20%)"

There's a few reasons: there are a number of variants and this wording seems to limit it to these three, which are simply the most common variants; I suspect these statistics are based on the population of the continental US, not on actual worldwide statistics, I should like the demographics of the base of statistics, preferably, worldwide statistics should be shown, or if they cannot be found, it should be specified what demographic the statistics refer to. I have added a "Statistics" heading at the bottom of the page, to avoid having them scattered throughout the page, which can be confusing; I think the statistics should be displayed as a dynamic list. I am not saying that this info should be kept out, merely that I would like to see it added in a way that is more organized and relevent (ie: not based on a single country); this list created another repitition, because the same accompanying defects are discussed in the paragraph immediatly following...so, my suggestion is simply to stay on topic within each heading, and to give statistics their own heading.

I added the "logical fallicy/circular" link back in because I find it appropriately descriptive...if you want to remove it, please discuss it here first. The same is true for the "cardio" and "pulmonary" links in the same paragraph, they help to explain to the reader what is meant by the medical jargon, please use the discussion page first if you wish to change this.

Put the acronyms back into the simple/complex TGA section...I can't see why they were removed...it is a common wikipedia practice to provide a commonly used acronym if one exists, so that is what I have done.

Removed "These other heart defects are essential for survival because without them the body will never get any oxygenated blood" because the wording is bordering on POV, and have explained it more neutrally and in detail in a following paragraph.

I have temporarily removed the info on cc-TGA in preparation to move it to it's own page. This article has always been a d-TGA article - adding in the ccTGA info causes confusion, and at least as much info can be summoned up to create a substantial article for cc-TGA independantly...I have been working on this a bit, but I do not have the experience with it that I do with d-TGA, so all my knowledge of it comes from raw research. Any help on this would be appreciated.

Added lots of expansion in the clinical details, however, was unable to integrate a few details, as I am not sure how they work. Please explain the following symptoms so I (or someone else) can work them in: "Right ventricular heave", "Single loud S2 heart sound", and "Right axis deviation". Also, I'm not sure that there is any difference between hypertrophy or cardiomegaly, so I opted to use the one that would be easier for the average reader to pronounce, and therefore the easiest to read. If I am mistaken and there is a difference, please do let me know the difference as I have been unable to discern it.

Moved DiseaseDisorder Infobox into the description section in order to unclutter the top of the page, and I figured this was the most logical placement for it...if anyone else has any other ideas for this, I would be pleased to hear them.

Changed the illustration to one that displays the difference between normal and d-TGA anatomy, as well as being more descriptive. — Preceding unsigned comment added by Bcatt (talk • contribs) 05:36, 18 November 2005 (UTC)

Comments
Thanks for all your great work! I have a concern though -- you state "I've recapitalized 'Transposition of the Great Arteries' as the wikipedia naming guidelines recommend this method to be used for proper names." But from my experience here, most diseases only use capital letters when it is an eponymous disease. --Arcadian 14:25, 18 November 2005 (UTC)

Details
"Single loud S2 heart sound" is something that is heard (auscultated) with a stethoscope. "Right axis deviation" is a reading of an ECG. Hypertrophy means that the muscle of the heart (usually just one ventricle, or part of one) is thickened, cardiomegaly means that the whole heart is enlarged. These two concepts are not interchangeable.

I think the part about intensive care of children are good, but it should perhaps be an areticle of its own? --Ekko 21:03, 3 January 2006 (UTC)


 * As per "Single loud S2 heart sound" and "Right axis deviation", I was more concerned with these terms being confusing for the layperson (I was confused by them, and I am considerably more fluent in cardiology language than the average layperson...I had to hunt around to find out what they meant, and then only understood because of my experience with the world of CHDs), than for how they are diagnosed...however, I didn't know that right axis deviation was diagnosed by EKG, so this was quite helpful for me in figuring out how it can be integrated back into the article. However, I didn't think it was helpful to the readability of the article to have a list of unexplained diagnostic criteria. Sorry if I am being confusing - what I mean is that when the layperson reads: "Single loud S2 heart sound" with no link to any descriptive article, they will probably logically deduce that it is diagnosed with a stethoscope (so it wouldn't be any more helpful to put "single loud S2 heart sound diagnosed via stethoscope"), and they may also deduce that a "single" S2 heart sound (whatever that is!) indicates d-TGA just as much as it's loudness, when in fact, a single S2 heart sound is perfectly normal, and it is only the loudness that is suspect. So, it should be described as a "single S2 heart sound that is abnormally loud" (or louder than normal...or something to that effect). Likewise, the layperson would still not know what right axis deviation were if you told them that it is indicated on EKG, but they would be likely to understand it if told that "hypertrophy may result in the heart being turned right on it's axis (right axis deviation). Right axis deviation will appear in EKG results..." (or someting to that effect)


 * From my research, it appears that cardiomagaly is hypertrophy, but hypertrophy is not necessarily cardiomegaly.
 * IE:
 * cardiomegaly is the result of hypertrophy of the heart as a whole, or enough enlargement of one part as to give the heart an overall enlarged appearance
 * hypertrophy is enlargement which may or may not result in cardiomegaly
 * cardiomegaly relates specifically to the heart
 * cardiomegaly refers to the heart as a whole, not to a smaller portion of the heart
 * hypertrophy may relate to any tissue or organ
 * In order to work these back into the article, I need to know a few things:
 * are hypertrophy or cardiomegaly (including the edited out description of an "egg-shaped" appearance in a chest x-ray) ever present prenatally (specifically as a result of d-TGA), or is it a result of late diagnosis?
 * I think the S2 heart sound would be present prenatally (or at least immediatly postnatally), but I would like to confirm it first before trying to work it into the article
 * is right ventricular heave present prenatally, or does it develop as a result of late diagnosis?


 * On the intensive care and proposed move to a separate article...I would think it should only be completely moved if the article is too large (however, I was unable to check the size of the article because it would not show up in my search results - I don't know why????? Can anyone tell me what the current size of the article is?), but as it is, it is a description of the intensive care received specifically by d-TGA patients, and is written as summarily as possible while remaining sufficiently descriptive, with links (although some are not yet active) to expanded articles on each of the terms used (I do think that PICU in general needs its own article, but what is covered here is only the tip of the iceberg for what is done in the PICU (or even adult ICU for that matter)). Although, if the article is getting too large and needs to be divided up, I think the treatment section is the most logical part to move...if it turns out it should be moved, it should be to an article specificaly on d-TGA treatment (can't think of a search-friendly name for it though).


 * As per positioning of the great arteries, this is what I turned up in my research, which was the source for the description of d-TGA as having the aorta anterior and to the right of the pulmonary artery:
 * "The major anatomic classifications of TGA depend on the relationship of the great arteries to each other and/or the infundibular morphology. In approximately 60% of the patients, the aorta is anterior and to the right of the pulmonary artery (dextro-TGA [d-TGA]). However in a subset of patients, the aorta may be anterior and to the left of the pulmonary artery (levo-TGA [l-TGA])."
 * ...for the source you cited on your talk page, could you provide a longer quote, which also includes the mention of the CHDs it is in reference to? I tried looking it up myself, but that book is not available at the library, and all my other sources distinguish different classifications of TGA based on the position of the arteries in relation to each other (as the one above).


 * Thanks for your attention to this article bcatt 09:07, 26 January 2006 (UTC)


 * Short response:
 * I really don't know much about heart sounds
 * Right axis deviation is strictly an ECG term. It does not indicate anything about the position of the heart inside the body
 * It's not only hypertrophy that causes cardiomegaly. Dilatation would also make the heart look bigger.
 * I really don't think the care given to patients having a arterial or atrial switch differ much from intensive care given to other children with repaired complex heart defects
 * Your source that you cite simplifies this so much as to be meaningless. The relations of the arteries to each other does not tell you anything about whether it's l- or d-TGA (or anything else). My source is too longwinded (several pages) to cite. I will scan those pages and e-mail them (make sure you set up you adress in your preferences). --Ekko 21:41, 26 January 2006 (UTC)

bcatt 02:16, 27 January 2006 (UTC)
 * 1) I'm in the process of trying to find someone with more knowledge on heart sounds
 * 2) What I found regarding right axis deviation is as follows:
 * "right axis deviation:
 * This may result from hypertrophy of the right ventricle so that there is a swing of the cardiac axis to the right (axis >90 degrees).
 * This results from right ventricular hypertrophy. It is associated with pulmonary disorders such as cor pulmonale, where there is an increased strain on the right side of the heart. It is also associated with congenital heart defects.
 * ECG findings: the QRS in I becomes negative and the deflection in III and aVF will become positive."
 * but I think I misunderstood what right axis meant (in that it is not a physical axis (as any layperson would interpret it to be) but rather the direction of an electrical signal (or at least that is what it seems to be after a small amount of additional research)). My point was not "this is how it should be worded in the article" but rather "these are things that should be kept in mind when figuring out how to incorporate this into the article". I could use some help in figuring out a layperson-friendly description of what is meant by right axis deviation...its causes, effects, etc... so that it can be put back in.
 * 1) so if the first item describing the relationship between cardiomegaly and hypertrophy were changed to: "cardiomegaly is the result of hypertrophy or dilatation of the heart as a whole, or enough enlargement of one part as to give the heart an overall enlarged appearance"...those five points would be an accurate description of the relationship between cardiomegaly and hypertrophy?
 * 2) for intensive care, like I said, PICU should have it's own article because what is done for d-TGA patients does not nearly cover what is done overall in PICU, and perhaps cardiac PICU should have it's own article (I'm not sure about this though), but this information should stay in this article unless the article is too long (still don't know the size of the article...someone please advise). Reason being that an article should contain any relevant information on a topic (with information deserving its own article being summarized in articles it is relevant to) and the information under the treatment heading is not only relevant to the article, but is kept as summaries (without going into exhaustive detail - but enough info to provide the reader with an understanding). But, perhaps I am misunderstanding your suggestion, maybe you could describe in more detail what you are proposing?
 * 3) my email option is indeed set up, I look forward to this information, thank you.

Mustard
If we can put in a little about what makes the Mustard preferable, it would fill out the atrial switch section a little. Is it because of the technical complexity of the Senning? Have they developed a method to avoid the obstruction problems presented by use of synthetic material in the Mustard? I mention these two in the history section of the Jatene procedure article, so it would be good to integrate anything we can into there as well. bcatt 08:53, 10 February 2006 (UTC)

Reduction of Image Size
As a medical professional, images of babies with tubes & lines and such do not bother me at all, but I was concerned that others viewing this article might find the images offensive. Instead of removing them (since they do have value & add to the article), I felt that reducing their size was an appropriate middle ground. If anybody wants to see the larger size, they can just click on the image. My only other concern is with privacy issues (HIPAA in the U.S.).2112 rush 13:27, 10 April 2007 (UTC)


 * Could you explain more about you concerns with privacy issues? bcatt 06:16, 29 September 2007 (UTC)

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"Support" section
I am concerned that the "Support" section reads as an advertisement and does not follow Wikipedia guidelines on grammatical conventions. I believe it should be noted that support groups exist online and otherwise, but the two specific groups mentioned seem to be advertising themselves. 132.183.13.29 (talk) 19:09, 5 September 2018 (UTC)
 * As far as I can tell, this section has now been removed. Thanks for raising this query! Bibeyjj (talk) 22:24, 27 November 2020 (UTC)