Name of the Procedure:

Repair of transposition of the great arteries, atrial baffle procedure (e.g., Mustard or Senning type) with cardiopulmonary bypass

Summary

This procedure corrects a congenital heart defect where the two main arteries leaving the heart are switched, a condition known as transposition of the great arteries (TGA). The atrial baffle procedure involves creating a "baffle" or tunnel within the heart to redirect blood flow properly, ensuring oxygen-rich blood circulates through the body.

Purpose

The purpose of this procedure is to correct the abnormal blood flow caused by TGA. By redirecting the blood flow within the heart, the procedure aims to ensure that oxygen-rich blood reaches the body's tissues and organs. It aims to improve heart function and increase the patient's overall health and quality of life.

Indications

• Diagnosis of transposition of the great arteries (TGA)
• Symptoms such as cyanosis (bluish tint to the skin due to lack of oxygen), difficulty breathing, or poor feeding in infants
• Echocardiogram or other imaging tests confirming TGA

Preparation

• Fasting for a specific period before the surgery
• Preoperative blood tests and imaging studies such as an echocardiogram or MRI
• Consultation with a cardiologist and anesthesiologist to review medical history and medications

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made in the chest to access the heart.
3. The cardiopulmonary bypass machine is set up to take over the heart’s functions during the surgery.
4. An atrial septostomy may be performed to create a baffle or tunnel within the atria.
5. Depending on the type, either the Mustard or Senning technique is used to construct the baffle.
   • In the Mustard technique, synthetic material is used to create the baffle.
   • In the Senning technique, the patient's tissue is used to form the baffle.
6. The heart is carefully monitored and adjusted to ensure proper blood flow through the newly created pathways.
7. The incision is closed, and the patient is gradually taken off the cardiopulmonary bypass.

Duration

The procedure typically takes 4-6 hours.

Setting

This surgery is performed in a hospital’s cardiac surgery operating room.

Personnel

• Cardiac surgeon
• Anesthesiologist
• Perfusionist (handles the cardiopulmonary bypass machine)
• Surgical nurses
• Cardiologist (post-operative care)

Risks and Complications

• Bleeding
• Infection
• Heart rhythm problems
• Stroke
• Need for additional surgeries
• Long-term complications, such as issues with the baffle or heart valves

Benefits

• Improved oxygenation and overall heart function
• Enhanced quality of life and normal activity levels
• Reduction or elimination of symptoms like cyanosis and fatigue

Recovery

• Initial recovery in the Intensive Care Unit (ICU) for close monitoring
• Hospital stay of about 1-2 weeks
• Gradual return to normal activities over a few months
• Regular follow-up appointments with a cardiologist
• Restrictions on certain activities, especially vigorous exercise, during recovery

Alternatives

• Arterial switch operation (a different surgical technique for TGA)
• Palliative procedures if the patient is not a candidate for complex surgery
• Pros and cons of alternatives:
  • Arterial switch may offer more anatomical correction but involves higher surgical complexity.
  • Palliative procedures may be less invasive but do not fully correct the condition.

Patient Experience

• Patients will be asleep and pain-free during the procedure thanks to general anesthesia.
• Post-operative discomfort will be managed with pain medication.
• Experience of fatigue and soreness at the incision site during early recovery.
• Emotional and psychological support, along with guidance from healthcare professionals, will be provided to help acclimate to post-surgery life.