Name of the Procedure:

Aortoplasty (Gusset) for Supravalvular Stenosis

Summary

Aortoplasty, specifically using a gusset technique, is a surgical procedure to widen a narrowed segment of the aorta located just above the aortic valve. This is done to improve blood flow from the heart to the rest of the body.

Purpose

This procedure is performed to address supravalvular aortic stenosis, a condition where the section of the aorta above the aortic valve is abnormally narrow. The primary goal is to restore normal blood flow, reduce the workload on the heart, and prevent complications such as heart failure or compromised organ perfusion.

Indications

• Diagnosed supravalvular aortic stenosis
• Symptoms including chest pain, shortness of breath, or syncope (fainting)
• Evidence of heart strain or dysfunction on diagnostic imaging
• Failure of medical management and other non-surgical interventions

Preparation

• Fasting for at least 6-8 hours before the procedure
• Discontinuing certain medications as advised by the healthcare provider
• Undergoing preoperative tests such as echocardiogram, cardiac MRI, CT scan, and blood tests to assess overall health and heart function

Procedure Description

1. Anesthesia: The patient is placed under general anesthesia.
2. Incision: A surgical incision is made in the chest to access the heart and aorta.
3. Aortic Exposure: The narrowed segment of the aorta is identified above the aortic valve.
4. Gusset Patch: A gusset, a patch made from the patient’s own tissue or a synthetic material, is inserted into the narrowed area to widen it.
5. Closure: The patch is sutured in place, the incision is closed, and surgical drains may be placed.
6. Monitoring: Continuous monitoring of heart function throughout the surgery.

Tools and equipment include surgical instruments, a cardiopulmonary bypass machine (if needed), and monitoring devices.

Duration

The procedure typically takes 3-5 hours, depending on the complexity.

Setting

Performed in a hospital's operating room, often within a specialized cardiac surgery unit.

Personnel

• Cardiothoracic surgeon
• Anesthesiologist
• Surgical nurses
• Perfusionist (if cardiopulmonary bypass is used)

Risks and Complications

• Bleeding
• Infection
• Blood clots
• Stroke
• Re-narrowing of the aorta
• Heart rhythm problems
• Adverse reactions to anesthesia

Benefits

• Improved blood flow from the heart
• Reduction in symptoms such as chest pain and shortness of breath
• Decreased risk of heart failure and other complications
• Improved quality of life

Recovery

• Hospital stay for monitoring, typically 5-7 days
• Pain management with medications
• Instructions on wound care and activity restrictions
• Follow-up appointments for monitoring
• Gradual return to normal activities over 4-6 weeks

Alternatives

• Balloon angioplasty (less commonly used for this condition)
• Medical management, which may include medications to relieve symptoms (not curative)
• Heart transplantation (considered in very severe cases)

Pros and cons should be discussed with the healthcare provider, considering the severity of the stenosis and patient's overall health.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel any pain. Post-operatively, there may be discomfort at the incision site, manageable with pain medications. Most patients can expect an improved capacity for physical activity and symptom relief soon after recovery. Comfort measures include careful pain management and supportive care during the recovery period.