Arterial switch operation

A surgical procedure to correct transposition of the great arteries

The arterial switch operation is a complex surgical procedure used to correct transposition of the great arteries (TGA), a congenital heart defect where the two main arteries leaving the heart are reversed. This operation is typically performed in the first few weeks of life and is considered the standard treatment for TGA.

History

The arterial switch operation was first successfully performed by Dr. Jatene in 1975. Prior to this, the Senning procedure and the Mustard procedure were used, which involved creating a baffle within the atria to redirect blood flow. However, these procedures did not correct the underlying anatomical problem and often led to complications later in life.

Indications

The primary indication for the arterial switch operation is dextro-transposition of the great arteries (d-TGA), where the aorta and the pulmonary artery are switched. This condition results in two separate circulatory systems, which is incompatible with life unless there is some mixing of blood, such as through a ventricular septal defect (VSD) or an atrial septal defect (ASD).

Procedure

The arterial switch operation involves several key steps:

• Cardiopulmonary bypass: The patient is placed on a heart-lung machine to maintain circulation and oxygenation during the surgery.
• Transection and reattachment: The aorta and pulmonary artery are transected and reattached to their correct ventricles. The aorta is connected to the left ventricle, and the pulmonary artery is connected to the right ventricle.
• Coronary artery transfer: The coronary arteries, which supply blood to the heart muscle, are carefully detached from the aorta and reattached to the new aortic root.
• Closure: The heart is closed, and the patient is gradually weaned off the cardiopulmonary bypass machine.

Postoperative Care

After the operation, patients require intensive monitoring in a pediatric intensive care unit (PICU). Common postoperative concerns include arrhythmias, myocardial ischemia, and pulmonary hypertension. Long-term follow-up is necessary to monitor heart function and detect any late complications.

Outcomes

The arterial switch operation has a high success rate, with survival rates exceeding 95% in experienced centers. Most children who undergo the procedure have normal heart function and lead healthy lives. However, some may require additional interventions or surgeries later in life.

Complications

Potential complications of the arterial switch operation include:

• Coronary artery problems: Due to the reimplantation of the coronary arteries, there is a risk of coronary artery stenosis or occlusion.
• Neoaortic root dilation: Over time, the neoaortic root may dilate, leading to aortic regurgitation.
• Pulmonary artery stenosis: Narrowing of the pulmonary artery can occur at the site of reattachment.

Related pages

• Congenital heart defect
• Cardiopulmonary bypass
• Pediatric cardiology

Gallery

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  Muscle testing in applied kinesiology

Arterial_switch_operation

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  Postoperative Jatene procedure in a neonate
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  Arterial Switch Operation - Step 1
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  Arterial Switch Operation - Step 2