Name of the Procedure:

Repair of Double Outlet Right Ventricle with Intraventricular Tunnel Repair

• Common Names: Double Outlet Right Ventricle (DORV) Repair
• Technical Terms: Intraventricular Tunnel Repair

Summary

Repair of Double Outlet Right Ventricle (DORV) with intraventricular tunnel repair is a surgical procedure to correct a complex congenital heart defect where both the aorta and the pulmonary artery are connected to the right ventricle. The surgery involves constructing a tunnel within the heart to reroute blood flow properly.

Purpose

Condition Addressed:

• Double Outlet Right Ventricle (DORV)

Goals/Outcomes:

• Redirect blood flow from the left ventricle to the aorta
• Improve oxygenation of blood
• Normalize heart function

Indications

Symptoms/Conditions:

• Cyanosis (bluish skin due to low oxygen)
• Congestive heart failure
• Poor growth and development in infants
• Difficulty breathing

Patient Criteria:

• Diagnosed with DORV
• Ineffectiveness of less invasive treatments

Preparation

Pre-procedure Instructions:

• Fasting for at least 8 hours prior to surgery
• Adjustments or discontinuation of certain medications based on doctor's advice

Diagnostic Tests/Assessments:

• Echocardiogram
• Cardiac MRI or CT scan
• Blood tests
• Electrocardiogram (ECG)

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. Incision: A median sternotomy (incision through the breastbone) is made to access the heart.
3. Heart-Lung Machine: The patient is connected to a cardiopulmonary bypass machine.
4. Intraventricular Tunnel Construction: A pathway (tunnel) is created inside the heart using patches to reroute blood from the left ventricle to the aorta.
5. Closure: The sternotomy is sutured closed and a sterile dressing is applied.

Tools/Equipment:

• Surgical instruments
• Cardiopulmonary bypass machine
• Patches for tunnel creation

Duration

Typically, the procedure takes 4 to 6 hours.

Setting

The surgery is performed in a hospital operating room, equipped with specialized cardiac surgical facilities.

Personnel

• Cardiothoracic Surgeon
• Cardiac Anesthesiologist
• Surgical Nurses
• Perfusionist
• Operating Room Technicians

Risks and Complications

Common Risks:

• Bleeding
• Infection
• Arrhythmias (abnormal heart rhythms)

Rare Risks:

• Stroke
• Heart attack
• Need for additional surgeries

Management of Complications:

• Medications
• Additional surgical interventions
• Intensive care monitoring

Benefits

• Improved oxygenation and blood flow
• Enhanced heart function
• Better quality of life and growth in children

Recovery

Post-procedure Care:

• Intensive Care Unit (ICU) monitoring
• Pain management with medications
• Gradual reintroduction of activities

Expected Recovery Time:

• Hospital stay of about 1-2 weeks
• Full recovery typically takes several months with follow-up appointments and cardiac rehabilitation

Alternatives

Other Treatment Options:

• Medication management
• Less invasive catheter-based interventions

Pros and Cons of Alternatives:

• Medications and catheter-based treatments may provide temporary relief but not a permanent solution.
• Surgical repair offers a long-term solution but comes with higher risks and a longer recovery period.

Patient Experience

During the Procedure:

• Under general anesthesia, no awareness or pain during the surgery

After the Procedure:

• Pain and discomfort at the incision site, managed with pain relievers
• Experience of fatigue and weakness during initial recovery
• Regular follow-up visits to monitor heart function

Pain management and comfort measures will be provided to ensure a smoother recovery process.