Name of the Procedure:

Total repair, truncus arteriosus (Rastelli type operation)

Summary

The Rastelli type operation is a surgical procedure to correct truncus arteriosus, a congenital heart defect where a single blood vessel comes out of the right and left ventricles instead of the normal two (aorta and pulmonary artery). This procedure involves creating separate pathways for blood flow to the lungs and the rest of the body.

Purpose

The purpose of the Rastelli type operation is to treat truncus arteriosus, a condition that impairs blood flow and oxygenation throughout the body. The procedure aims to improve oxygen levels, allow normal blood circulation, and enhance overall heart function.

Indications

• Diagnosis of truncus arteriosus.
• Symptoms like cyanosis (bluish skin), fatigue, and difficulty breathing.
• Suitable candidates include infants and young children typically diagnosed with this congenital defect.

Preparation

• Fasting: Patients may need to fast several hours before surgery.
• Medication Adjustments: Certain medications may need to be paused or adjusted.
• Diagnostic Tests: Pre-surgical assessments like echocardiograms, cardiac MRI, blood tests, and sometimes cardiac catheterization.

Procedure Description

1. Anesthesia: The patient is given general anesthesia.
2. Incision: A median sternotomy (incision through the breastbone) is made to access the heart.
3. Cardiopulmonary Bypass: The patient is connected to a heart-lung machine to maintain circulation and oxygenation during the surgery.
4. Coronary Artery Creation: The surgeon constructs a separate pathway to connect the left ventricle to the aorta using a conduit (such as a homograft).
5. Right Ventricle to Pulmonary Artery: Conduit placement from the right ventricle to the pulmonary arteries to carry deoxygenated blood to the lungs.
6. Closure: The heart is restarted, the bypass is gradually discontinued, and the chest is closed with sutures or staples.

Duration

The procedure typically takes about 4 to 6 hours.

Setting

This surgery is performed in a hospital setting, specifically in an operating room equipped for cardiac surgery.

Personnel

• Cardiothoracic Surgeon: Performs the procedure.
• Anesthesiologist: Administers and monitors anesthesia.
• Surgical Nurses and Technicians: Assist with the procedure.
• Perfusionist: Manages the heart-lung machine.
• Pediatric Cardiologist: May assist in planning and monitoring.

Risks and Complications

• Common Risks: Infection, bleeding, arrhythmias (irregular heartbeats).
• Rare Risks: Stroke, heart attack, issues with the conduits requiring further surgery.
• Management: Regular monitoring, medications, and sometimes additional interventions.

Benefits

• Improved blood flow and oxygenation.
• Enhanced heart function.
• Increased energy levels and ability to engage in normal activities.
• Benefits typically become noticeable within weeks following recovery.

Recovery

• Hospital Stay: Usually 1-2 weeks.
• Post-Procedure Care: Includes medications, wound care, and activity restrictions.
• Recovery Time: Full recovery may take several weeks to months.
• Follow-Up: Regular check-ups with a cardiologist to monitor heart function and overall health.

Alternatives

• Medical Management: Medications and monitoring as a temporary measure.
• Other Surgical Interventions: Different types of heart surgery depending on the specifics of the heart defect and patient condition.
• Pros and Cons: Medical management is less invasive but does not correct the defect, while other surgical options may vary in complexity and effectiveness.

Patient Experience

• During Procedure: The patient is under general anesthesia and will not feel pain.
• Post-Procedure: Initial pain and discomfort managed with pain relief medications.
• Recovery Period: Gradual improvement in symptoms, with tiredness and some restrictions on activity as part of the healing process. Regular support and care from medical professionals help manage recovery and ensure the best outcomes.