Name of the Procedure:

Repair of transposition of the great arteries, aortic pulmonary artery reconstruction (e.g., Jatene type); with removal of pulmonary band

Summary

This surgical procedure corrects a congenital heart defect known as transposition of the great arteries (TGA), where the main arteries going out of the heart are switched. The procedure includes reconstruction of the aorta and pulmonary artery, often known as the Jatene procedure, and involves the removal of a previously placed pulmonary band.

Purpose

This surgery aims to correct the abnormal positioning of the great arteries to restore normal blood flow and oxygenation throughout the body. The expected outcomes are improved heart function, increased oxygen levels in the blood, and a reduction in symptoms like cyanosis (blue skin) and shortness of breath.

Indications

• Diagnosed transposition of the great arteries (TGA)
• Symptoms such as cyanosis, difficulty breathing, and poor feeding in infants
• Echocardiogram or other imaging showing the need for arterial switch and/or removal of a pulmonary band

Preparation

• Patients (usually infants) must fast for a specified time before surgery.
• Complete pre-operative diagnostic tests, including echocardiograms, chest X-rays, and blood tests.
• Discuss medication adjustments with the healthcare provider.
• Anesthesia consultation to ensure safe sedation and pain control.

Procedure Description

1. Anesthesia: Administered general anesthesia to ensure the patient is asleep and pain-free.
2. Incision: A chest incision (sternotomy) is made to access the heart.
3. Cardiopulmonary Bypass: The heart is connected to a heart-lung machine to maintain blood circulation and oxygenation during the surgery.
4. Arterial Switch: The aorta and pulmonary artery are detached and reconnected in their correct positions.
5. Removal of Pulmonary Band: If a pulmonary artery band was placed previously, it is carefully removed.
6. Reconstruction: Coronary arteries are re-implanted to the new aorta.
7. Completion: The heart is restarted, and the chest is closed.

Duration

The procedure typically takes 6-8 hours.

Setting

This surgery is performed in a hospital, specifically in a pediatric surgical suite equipped for cardiac surgery.

Personnel

• Pediatric cardiac surgeon
• Surgical nurses
• Anesthesiologist
• Perfusionist (operates the heart-lung machine)
• Surgical assistants

Risks and Complications

• Common risks: Infection, bleeding, arrhythmias.
• Rare risks: Heart failure, need for additional surgeries, neurological complications.
• Management: Close postoperative monitoring in the ICU, medications for heart support, and infection control.

Benefits

• Improved heart function and blood flow.
• Normal oxygenation levels in the blood.
• Alleviation of symptoms like cyanosis and difficulty breathing.
• Most benefits are realized within weeks to months post-surgery.

Recovery

• Intensive Care Unit (ICU) monitoring for several days post-surgery.
• Gradual transition to a regular hospital room.
• Pain management with prescribed medications.
• Instructions for wound care, activity restrictions, and follow-up appointments.
• Full recovery typically takes several weeks to a few months.

Alternatives

• Balloon atrial septostomy: A temporary solution to improve oxygenation.
• Palliative procedures to improve symptoms without correcting the root cause.
• The arterial switch procedure is generally the preferred treatment for long-term outcomes.

Patient Experience

• During the procedure: The patient (infant) will be under general anesthesia and won't experience any sensations.
• After the procedure: Discomfort and pain managed with medication, frequent monitoring, and specialized care in the ICU.
• Family experiences: may include anxiety and stress, but receiving support from healthcare teams and counseling can help manage these emotions.