Name of the Procedure:

Repair of Pulmonary Artery Arborization Anomalies by Unifocalization; Without Cardiopulmonary Bypass

Summary

This surgical procedure aims to correct abnormalities in the branching of the pulmonary artery. By reconfiguring the blood vessels in the lungs, the surgery improves blood flow without the need for a heart-lung machine (cardiopulmonary bypass).

Purpose

The procedure addresses congenital issues where the pulmonary arteries have developed abnormally. The goal is to enhance pulmonary blood flow and oxygenation, improving overall heart and lung function.

Indications

• Congenital conditions such as Pulmonary Atresia or Major Aortopulmonary Collateral Arteries (MAPCA).
• Symptoms like difficulty breathing, low blood oxygen levels, or heart complications.
• Patients, often children, with specific anatomical structures that make unifocalization feasible.

Preparation

• Fasting for at least 8 hours before the procedure.
• Possible adjustments to medications, especially blood thinners.
• Pre-surgical imaging studies like CT scans or MRIs to map pulmonary blood vessels.

Procedure Description

1. Preparation: General anesthesia is administered.
2. Incision: A surgical incision is made in the chest.
3. Isolation: Abnormal blood vessels connecting systemic circulation to the lungs are identified.
4. Unifocalization: These vessels are gathered and rerouted to create a more direct path to the pulmonary arteries.
5. Closure: The chest incision is closed, and the patient is moved to recovery.

Tools include standard surgical instruments, specialized clamps, and sutures. No cardiopulmonary bypass machine is used.

Duration

The procedure typically lasts between 4 to 6 hours.

Setting

Performed in a hospital's cardiac surgery operating room.

Personnel

• Cardiac surgeons
• Pediatric specialists (if applicable)
• Anesthesiologists
• Surgical nurses
• Perfusionists to monitor heart and lung function, if needed

Risks and Complications

• Bleeding
• Infection
• Lung complications
• Blood clots
• Anesthesia risks
• Rarely, failure to improve pulmonary blood flow

Benefits

• Improved oxygen levels in the blood
• Enhanced overall heart and lung function
• Potentially reduced need for future surgeries

Recovery

• Initial ICU stay for close monitoring
• Post-operative medications for pain and to prevent infection
• Gradual increase in activity as tolerated
• Follow-up appointments to monitor progress

Alternatives

• Staged surgical approach using cardiopulmonary bypass
• Palliative measures such as medication management
• Less invasive catheterization procedures Each alternative carries different risks, benefits, and recovery trajectories compared to direct unifocalization without bypass.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel pain. Post-surgery, there may be discomfort and pain managed with medication. As recovery progresses, most patients feel significant improvements in breathing and activity levels. Regular follow-ups ensure any complications are quickly addressed.