Name of the Procedure:

Repair of anomalous coronary artery from pulmonary artery (ALCAPA); Coronary artery translocation from pulmonary artery to aorta

Summary

This surgery involves moving an incorrectly positioned coronary artery from the pulmonary artery to the aorta. This correction ensures the heart receives oxygen-rich blood, improving heart function and overall health.

Purpose

The procedure addresses anomalous left coronary artery from the pulmonary artery (ALCAPA), a congenital heart defect. The main goal is to ensure the heart muscles receive adequately oxygenated blood to prevent heart damage or failure, thereby improving heart function.

Indications

• Symptoms such as chest pain, fatigue, sweating, difficulty in feeding (in infants), or rapid breathing.
• Diagnosis of ALCAPA through imaging or other diagnostic tests.
• Significant heart function impairment due to insufficient oxygen supply.

Preparation

• Fasting for a specific period before the surgery.
• Adjustments to regular medications as advised by the healthcare provider.
• Diagnostic tests including echocardiograms, angiograms, CT scans, or MRIs to map the coronary arteries.

Procedure Description

1. The patient is placed under general anesthesia.
2. A median sternotomy (chest incision) is performed to access the heart.
3. Cardiopulmonary bypass is initiated to take over heart and lung functions during surgery.
4. The anomalous coronary artery is carefully detached from the pulmonary artery.
5. The detached artery is rerouted and reattached to the correct position on the aorta.
6. The heart is then monitored for proper blood flow, and any leaks are repaired.
7. The chest is closed, and the patient is taken off cardiopulmonary bypass.
8. The incision is closed with sutures.

Tools utilized include surgical instruments like scalpels, clamps, and specialized tools for rerouting arteries, along with cardiopulmonary bypass machines.

Duration

The procedure typically takes about 4 to 6 hours.

Setting

Performed in a hospital's surgical suite or cardiac surgery center.

Personnel

• Cardiac surgeons
• Anesthesiologists
• Surgical nurses
• Perfusionists (for cardiopulmonary bypass)
• Post-operative care team

Risks and Complications

• Bleeding
• Infection
• Arrhythmias (irregular heartbeats)
• Heart attack or stroke during surgery
• Anesthesia-related complications
• Heart failure or the need for additional surgeries

Benefits

• Restoration of normal blood flow to the heart
• Improved heart function
• Reduced symptoms and prevention of heart failure
• Enhanced quality of life, with benefits typically noticed within weeks to months

Recovery

• Intensive care unit (ICU) stay for close monitoring post-surgery
• Hospital stay of approximately 7 to 10 days
• Pain management through medications
• Gradual increase in physical activity as advised
• Follow-up appointments for monitoring recovery and heart function
• Potential restriction on strenuous activities until fully healed

Alternatives

• Medical management with medications to manage symptoms (less effective and not curative)
• Other surgical or catheter-based interventions (depending on specific patient circumstances)
• Heart transplant (in severe cases with significant heart failure)

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel any pain. Post-surgery, discomfort and pain will be managed with medications. Recovery involves close monitoring and gradual reintroduction to daily activities. Most patients will experience significant improvement in symptoms and quality of life after the recovery period.