What Makes the Arterial Switch Procedure Vital for Correcting TGA in Infants?

January 25, 2024 by Medical Content Team0
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The artery switch procedure is important for babies with a heart problem called transposition of the great arteries (TGA). Statistics show that almost all the time, around 99 out of 100 babies get better after having this surgery. It’s a big help for babies with this heart issue, making their hearts work better and letting them live healthier lives. 

This blog delves into the vital role of the arterial switch procedure in treating TGA, highlighting its importance in correcting this condition. It covers details about the surgery, including potential risks, post-operative care, and the broader impact on the well-being of infants and their families.

What Is An Arterial Switch Procedure?

An arterial switch is a surgical procedure and the primary treatment to correct the transposition of the great arteries (TGA). Almost all children with TGA undergo the arterial switch repair (the Jatene repair).

Soon after birth, babies with TGA become very sick because of a severe lack of oxygen. Before proceeding to an arterial switch, your baby’s condition can be improved by two temporary measures:

  • Starting a medication called prostaglandin
  • Doing a balloon atrial septostomy
  • An arterial switch procedure is an open heart surgery usually done within the first week of life

Why Is An Arterial Switch Procedure Done?

The arterial switch procedure is performed to correct the transposition of the great arteries (TGA), where the aorta and pulmonary arteries are connected to the wrong heart chambers. This surgery is crucial to repositioning these arteries, allowing proper blood circulation throughout the body. By switching the vessels, oxygen-rich blood flows from the left ventricle to the aorta, while oxygen-depleted blood moves from the right ventricle to the pulmonary artery. This corrective surgery ensures oxygenated blood reaches the body and brain, enabling normal cardiac function and overall well-being in affected infants.

How Is An Arterial Switch Procedure Done?

During an arterial switch procedure, surgeons reposition the aorta, pulmonary artery, and vital vessels in the heart, correcting transposition of the great arteries (TGA). The surgery involves carefully detaching and reconnecting these vessels to their correct chambers. Under anesthesia, the heart is temporarily stopped while a heart-lung bypass machine maintains blood circulation. 

Surgeons switch the arteries, ensuring oxygen-rich blood flows to the body and lungs. Afterward, they check for proper function, restore blood flow, and close the incisions. This meticulous procedure establishes average blood circulation, enabling the heart to function effectively.

Dr. Dinesh Mittal is a well-known cardiac surgeon who has successfully performed multiple arterial switch procedures. Dr. Mittal has performed over 500 arterial switch procedures over his extended career, specializing in congenital heart surgery. His skill and excellent success rates in these procedures have earned him a reputation as a reliable name in pediatric cardiac treatments.

What Are The Risks Of This Procedure?

Although the arterial switch is a major surgical procedure, the results are excellent. Ninety-nine percent of the surgeries are successful.

This operation will require the use of a cardiopulmonary bypass (heart-lung machine). Many children have minor complications such as:

  • Nausea
  • Feeding problems (such as trouble swallowing)
  • Bruising from intravenous (IV) sites. An IV line is a small tube put into a vein in your child’s arm or leg to give medications or fluids

“While the arterial switch procedure is generally safe, potential risks include bleeding, infection, and adverse reactions to anesthesia. Specific complications like coronary artery issues or arrhythmias may occur. However, rest assured, we meticulously assess and manage these risks. Our team’s expertise and stringent protocols minimize complications, ensuring the best possible outcome for your child’s cardiac health,” says Dr. Dinesh.

What Does The Preparation For An Arterial Switch Procedure Involve?

Before your newborn’s surgery, you will meet with several healthcare team members. The team will check with you to make sure you understand what is happening and that you have a chance to ask all of your questions.

Pre-operative tests

Before surgery, all newborns have:

  • blood work
  • an X-ray
  • an echocardiogram
  • an electrocardiogram
  • an MRI imaging of the head (and sometimes an ultrasound)

These tests are done routinely to help the team prepare for surgery.

The surgical team

You will also meet the surgeon and the anesthesiologist. The anesthesiologist will discuss general issues around having an anaesthetic and specific issues about your child. These will include things like pre-operative sedation, blood transfusion, and monitoring procedures during the surgery.

Blood transfusion

Most children who need heart surgery will need blood products during their surgery. This can involve transfusing:

  • Red blood cells to improve the amount of oxygen in the blood
  • Platelets to help blood clotting
  • Plasma

Food, drink, and medication before the procedure

If your baby can feed by mouth or through a tube, your nurse will make sure your baby stops feeding (fasting) at the right time before the surgery. Your baby will be kept hydrated through an IV line. The team will also make sure your baby gets the necessary medications.

On the day of the procedure

The anaesthesiologist looking after your child will speak to you on the morning of surgery and answer any of your last-minute questions. The operating room nurse will also meet you and check on your child. For safety reasons, parents usually do not come with children into the cardiac operating room for heart surgery. You will be asked to wait in a dedicated or pre-set room.

During the procedure

The team:

  • Puts in place IV lines and other catheters
  • Gives medications
  • Clean the area where the incision (cut) (usually the sternum) will be made with antiseptic

During this open heart surgery, the anaesthesiologist watches your child and monitors while communicating with other members of the surgery team to make sure everything is stable.

Heparin (a blood thinner) is given because your child needs to be on a heart-lung machine. The heart is stopped during this time while the surgeon repairs the defect. The perfusionist, the anaesthesiologist, and the surgeon care for your child. They ensure that the heart-lung machine injects oxygen into the blood and delivers it to the body and brain.

When the repair is complete, the heart can beat again, and the heart-lung machine is turned down and off. If the heart is not entirely functioning the way it should, medications are used to improve heart function.

The cardiologist does an echocardiogram to ensure the repair works as it should. The surgeon then makes sure there is no bleeding and closes the incision. Most heart surgery takes between three and six hours.

What Happens After An Arterial Switch Procedure?

Following an Arterial Switch Procedure:

  • Patients are monitored in the ICU before transitioning to a regular room
  • Prescribed drugs manage pain and prevent infections
  • Regular visits with cardiologists or surgeons ensure proper healing
  • Gradually increasing physical activity under medical guidance aids recovery
  • Tailored nutritional plans support healing and heart health
  • Counseling and support groups assist both patients and families emotionally

Sarah Johnson shared, “Dr. Dinesh Mittal changed our world! Our little one had a heart condition, but after the surgery he performed, our baby is thriving! The doctor was so kind, explaining everything in simple words. We trusted him completely, and our child lives a normal, healthy life. Dr. Mittal’s expertise truly saved our little hero!”

Rajesh Patel mentioned, “Dr. Dinesh Mittal is a miracle worker! Our baby had a heart problem that scared us, but meeting Dr. Mittal eased our worries. He did this special operation; now, our little one is like any other kid. The doctor was so caring, and he made sure we understood everything. We’re forever grateful for his skill and kindness!”

These testimonials reflect gratitude for Dr. Dinesh Mittal’s expertise, care, and successful treatment of infants with heart conditions through the arterial switch procedure.

What Is The Cost Of Arterial Switch Surgery In India?

The cost of arterial switch surgery in India for Indian patients typically ranges from Rs.3,20,000 to Rs.4,25,000, while for international patients, it ranges between USD 6,500 and USD 8,000. These figures cover the surgical procedure expenses and basic medical care. However, the final cost might vary based on individual patient requirements, hospital facilities, post-operative care, consultations, and any unforeseen complications, influencing the overall expenditure.

Conclusion

The Arterial Switch Procedure is a crucial surgery correcting the transposition of the great arteries in infants. It facilitates proper blood circulation and enables normal cardiac function. Despite potential risks, the surgery boasts a high success rate. Post-operative care involves meticulous monitoring, medication, gradual physical activity, and tailored nutrition to ensure optimal recovery. Emotional support is equally vital for patients and families navigating this journey, fostering a holistic approach toward healing and overall well-being.

FAQs

  1. Is the Arterial Switch Procedure the only treatment for transposition of the great arteries (TGA)?

Yes, it’s the primary surgical treatment for TGA.

  1. Are there long-term complications after the Arterial Switch Procedure?

There can be rare complications, but most patients recover well.

  1. Can infants born with transposition of the great arteries (TGA) undergo this procedure at any age?

It’s typically performed within the first week of life, but in some cases, it can be done later.

  1. Will my child need lifelong medication after an Arterial Switch Procedure?

In most cases, children won’t need ongoing medication after successful surgery.

  1. Are alternative surgeries or procedures available for transposing the great arteries (TGA) aside from the Arterial Switch?

There are other palliative procedures, but the Arterial Switch is the primary corrective surgery for TGA.

Read More : Understanding Heart Failure Surgery: What are the Procedures, Risks, and Costs Involved?


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