33781 Repair of transposition of the great arteries, aortic pulmonary artery reconstruction (eg, Jatene type); with repair of subpulmonic obstruction

Name of the Procedure:

Repair of transposition of the great arteries, aortic pulmonary artery reconstruction (eg, Jatene type); with repair of subpulmonic obstruction

Summary

This procedure corrects the abnormal position of the major arteries of the heart, allowing oxygen-rich blood to be properly circulated through the body. The Jatene procedure, also known as an arterial switch operation, includes fixing any obstructions that hinder blood flow from the right side of the heart to the lungs.

Purpose

The procedure is done to treat Transposition of the Great Arteries (TGA), a congenital heart defect where the aorta and pulmonary artery are switched. The goal is to restore normal blood flow, ensuring that oxygenated blood is delivered to the body and deoxygenated blood is sent to the lungs.

Indications

• Newborns diagnosed with Transposition of the Great Arteries (TGA)
• Symptoms such as cyanosis (blue skin due to lack of oxygen) and difficulty breathing
• Echocardiogram confirming the structural heart abnormality
• Ineffective initial management or balloon atrial septostomy

Preparation

• Fasting for several hours before surgery
• Discontinuation of certain medications as advised by the doctor
• Pre-operative tests including echocardiogram, chest X-ray, and blood tests

Procedure Description

1. General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. An incision is made in the chest to access the heart.
3. The arteries, aorta, and pulmonary artery are switched to their correct positions.
4. Any obstruction that is present is repaired to allow unobstructed blood flow.
5. The heart may be temporarily stopped using a heart-lung machine.
6. The incision is closed, and the patient is taken off the heart-lung machine.

Tools and technology used include scalpels, retractors, sutures, and a heart-lung bypass machine.

Duration

The procedure typically takes 6-8 hours.

Setting

This surgery is performed in a hospital operating room, often within a pediatric cardiac surgery unit.

Personnel

• Cardiothoracic Surgeon
• Pediatric Cardiologist
• Anesthesiologist
• Surgical Nurses
• Perfusionist (operates the heart-lung machine)

Risks and Complications

• Bleeding
• Infection
• Arrhythmias (abnormal heart rhythms)
• Coronary artery complications
• Need for additional surgeries
• Heart failure

Benefits

• Restoration of normal blood flow
• Improved oxygen levels in the blood
• Better overall heart function
• Normal growth and development in infants

Recovery

• Close monitoring in the intensive care unit (ICU) for several days
• Hospital stay of 1-2 weeks
• Gradual resumption of feeding and activity as tolerated
• Follow-up appointments with a cardiologist
• Possible medications to support heart function

Alternatives

• Balloon atrial septostomy (temporary fix)
• Rastelli procedure (for certain anatomical variations)
• Medical management (typically not sufficient alone for TGA)

Patient Experience

Patients will be under general anesthesia during the surgery, so there will be no pain felt during the procedure. Post-surgery, pain and discomfort will be managed with medications. There will be an incision and some visible stitching, with expected soreness around the chest area. Most discomfort improves as the child heals.