Repair of transposition of the great arteries, aortic pulmonary artery reconstruction (eg, Jatene type)
CPT4 code
Name of the Procedure:
Repair of Transposition of the Great Arteries (TGA), Aortic Pulmonary Artery Reconstruction (eg, Jatene Type)
Summary
This is a surgical procedure to correct a congenital heart defect called Transposition of the Great Arteries (TGA), where the two main arteries leaving the heart are reversed. The surgery involves switching the aorta and pulmonary artery to their correct positions, ensuring normal blood flow through the heart and the rest of the body.
Purpose
Medical Condition: Transposition of the Great Arteries (TGA). Goals/Outcomes: The primary goal is to correct the arterial switch to ensure proper blood circulation, oxygenation, and overall heart function. Successful outcomes include improved cardiovascular health and increased life expectancy.
Indications
- Newborns diagnosed with TGA via prenatal ultrasound or echocardiogram.
- Symptoms like cyanosis (blue tint to the skin due to lack of oxygen), difficulty breathing, or poor feeding.
- Additional heart conditions, such as Ventricular Septal Defect (VSD), which often accompany TGA.
Preparation
- Fasting for a specific period before the procedure.
- Medication adjustments as advised by the healthcare provider.
- Preoperative diagnostic tests, including echocardiograms, blood tests, and possibly a cardiac MRI.
Procedure Description
- Anesthesia: General anesthesia will be administered.
- Incision: A midline incision is made along the sternum to access the heart.
- Cardiopulmonary Bypass: The patient is connected to a heart-lung machine to maintain blood flow and oxygenation during the surgery.
- Arterial Switch Operation: The aorta and pulmonary artery are carefully detached and switched to their correct positions.
- Reconstruction: The coronary arteries, which feed the heart muscle, are reattached to the newly positioned aorta.
Closure: The heart and chest incisions are closed, and the patient is gradually weaned off the heart-lung machine.
Tools/Equipment: Surgical instruments, heart-lung machine, monitors for vital signs. Anesthesia: General anesthesia, administered and monitored by an anesthesiologist.
Duration
The procedure typically takes around 6-8 hours, depending on the complexity of the case.
Setting
Performed in a hospital, specifically in a cardiovascular operating room equipped for pediatric cardiac surgery.
Personnel
- Cardiovascular surgeon
- Pediatric cardiologist
- Anesthesiologist
- Surgical nurses
- Perfusionist (operates the heart-lung machine)
- Postoperative care team
Risks and Complications
- Common: Bleeding, infection, arrhythmias (irregular heartbeats).
- Rare: Blood clots, coronary artery issues, neurological complications, need for additional surgeries.
- Management: Immediate medical intervention, medications, or further procedures as necessary.
Benefits
- Restoration of normal heart function and blood circulation.
- Significant improvement in oxygen levels and overall health.
- Potential for normal growth and development in infants.
Recovery
- Initial stay in the Intensive Care Unit (ICU) for close monitoring.
- Gradual transition to a regular hospital room as condition stabilizes.
- Total hospital stay of 2-3 weeks on average.
- Postoperative care including medication management, wound care, and follow-up appointments.
- Full recovery allowing for normal activities within a few months, though regular check-ups are essential.
Alternatives
- Balloon Atrial Septostomy: Temporarily improves blood mixing but requires subsequent corrective surgery.
- Arterial Switch without Reconstruction: Generally ineffective compared to the Jatene procedure.
- Medication alone: Typically only supportive and not curative.
Pros/Cons: While other options may provide temporary relief or be less invasive, they do not offer the long-term benefits and potential for normal heart function achieved by the Jatene procedure.
Patient Experience
During the procedure, the patient will be under general anesthesia and will not feel pain. Postoperatively, the infant may experience discomfort managed by pain relief medications. The recovery period involves close monitoring, various supportive measures, and potential restrictions on physical activity initially to ensure proper healing.