Transposition of great arteries is a condition in which the major arteries (pulmonary artery and aorta) leaving the heart are connected to the wrong ventricle which leads to the pumping of oxygen-rich blood back to lungs, whereas the blood lacking oxygen is pumped to all over the body. It is congenital heart disease. The condition is also known as dextro-transposition of greater arteries.
Soon after the birth babies suffering from this problem become very sick due to the lack of oxygen supply. The condition is managed initially by starting a medication known as prostaglandin and by doing balloon atrial septostomy.
Arterial switch operation is a surgical procedure done to get permanent relief from the disease. Almost all the children suffering from the transposition of arteries undergo this procedure. It is done within a week of the child’s life.
Pre-Procedure Preparations for Arterial Switch Operation
Before the procedure is performed, the parents are given all the information about the disease and the procedure. Few pre-operative tests are done such as:
- Complete blood count
- X-ray
- An echocardiogram
- An electrocardiogram
- MRI of head
These tests help the surgical team to get prepared.
If the baby is able to take the feed, the nurse makes sure that it is stopped at the right time before surgery and IV fluids are started.
How is the Arterial Switch Operation Procedure Done?
The procedure involves correcting the position of the pulmonary artery and the aorta. The coronary arteries are then attached to the aorta in the new position. The hole between the atria is then closed and the patent ductus arteriosus is tied off. Following is the step by step procedure,
- The child is given anesthesia and is monitored closely by the anesthesiologist to assure everything is stable.
- The child is put on a heart-lung machine.
- First of all the pulmonary artery and the aorta are cut off from the place they are attached to the heart.
- The coronary arteries are then detached from the aorta.
- The aorta and the coronary arteries are attached to the base of the new pulmonary artery.
- And the pulmonary artery is placed in the front of the new aorta.
- Then the pulmonary artery is attached to the new aorta and the holes left by the detachment of the coronary arteries are patched.
- In case the baby is suffering from the ventricular septal defect, the surgeon will close it during the procedure.
After the Arterial Switch Operation Procedure
After the arterial switch operation, the patient is transferred to the CCCU unit, where they are kept for a few days until they feel better.
The baby can be taken home once he starts breathing and taking feed properly. The hospital team teaches the parents how to give the medications and take care of the incision site.
The Risk Associated With An Arterial Switch Operation
The arterial switch is a major surgical procedure but has an excellent result rate. The success rate is also high.
The children suffer from minor complications such as,
Feeding problem due to difficulty in swallowing.
- Nausea
- Bruising at the site of IV puncture, done to give the medications and fluids.
Serious Complication Of Arterial Switch Operation Due To Anesthesia And Surgery Are:
- Vocal cord injury
- Drug reactions
- Bleeding and clotting
- Cardiac arrest and stroke
- Brain injury
- Difficult respiration
- Reaction to blood transfusions
- Heart rate problems
Arterial switch operation is now a treatment of choice for the babies suffering from the transposition of great arteries, as the prognosis is very good(1).
