Name of the Procedure:

Anastomosis of Pulmonary Artery to Aorta (Damus-Kaye-Stansel Procedure)

Summary

The Damus-Kaye-Stansel (DKS) procedure is a heart surgery that involves connecting the pulmonary artery to the aorta to improve blood flow in patients with certain congenital heart defects. It helps to reroute blood around blockages or defects that impede normal circulation.

Purpose

The procedure addresses congenital heart defects, such as double outlet right ventricle (DORV), transposition of the great arteries (TGA), and other complex anomalies that hinder blood flow from the heart. The goal is to ensure that oxygen-rich blood reaches the body's tissues, improving overall circulation and oxygenation.

Indications

• Congenital heart defects like DORV, TGA, or single ventricle defects.
• Patients with severe aortic obstruction where conventional repairs are not feasible.
• Criteria include significant symptoms like cyanosis (blue-tinted skin from low oxygen), heart failure, or poor growth and development in children.

Preparation

• Patients may need to fast for several hours before the procedure.
• Medication adjustments, including stopping certain drugs.
• Diagnostic tests such as echocardiograms, chest X-rays, and blood tests to assess heart function and overall health.

Procedure Description

1. The patient is placed under general anesthesia.
2. The surgeon makes an incision in the chest to access the heart.
3. The heart is connected to a heart-lung machine to take over the blood circulation during the surgery.
4. The surgeon then connects the pulmonary artery to the aorta, ensuring a direct blood flow from the heart's main chamber to the body's main artery.
5. Any additional repairs to heart defects or arteries are performed.
6. The heart is then taken off the heart-lung machine, and the chest incision is closed.

Duration

The procedure typically takes 4 to 6 hours.

Setting

The surgery is performed in a hospital operating room, often in specialized pediatric cardiac surgery centers.

Personnel

• Cardiothoracic surgeons
• Pediatric cardiologists
• Anesthesiologists
• Surgical nurses and perfusionists

Risks and Complications

• Bleeding
• Infection
• Arrhythmias (irregular heartbeats)
• Heart block requiring a pacemaker
• Stroke or neurological complications
• Post-operative heart or lung dysfunction

Benefits

• Improved blood flow and oxygenation throughout the body.
• Reduction in symptoms such as cyanosis and heart failure.
• Enhanced growth and development in pediatric patients.
• Benefits are usually realized within a few weeks post-surgery.

Recovery

• Intensive care unit (ICU) stay for monitoring immediately after surgery.
• Pain management with medications.
• Gradual increase in activity levels.
• Follow-up appointments to monitor heart function.
• Restrictions may include avoiding strenuous activity for several weeks to months.

Alternatives

• Other surgical options like the Rastelli procedure, depending on the specific heart defect.
• Catheter-based interventions may be considered for less severe cases.
• Heart transplantation for very complex cases that are not amendable to surgical correction.
• Each alternative has its own risks and benefits; the choice depends on the patient's condition and overall health.

Patient Experience

• During the procedure, the patient will be under anesthesia and will not feel pain.
• Post-surgery, there may be some discomfort which is managed with pain medication.
• A hospital stay of 1 to 2 weeks is common.
• Physical activity will be limited initially, but most children can return to regular activities after a few months.