Getting Familiar with the Complications of Arterial Switch Operation
Congenital heart disease(CHD) has become one of the most common birth anomalies. This can vary from a small defect to a severe malformation in the heart of a neonate. And in India, the estimated number of children born with CHD is more than 200,000 per year. The transposition of great arteries is one such condition. An arterial switch operation is a procedure that can treat such an anomaly. However, before undergoing the surgery, you should have an idea of the procedure and the complications associated with it. In this blog, we’ve discussed the same in brief, so that you can make an informed decision with your doctor.
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Understanding the arterial switch procedure
The arterial switch is a surgical procedure and the primary treatment for great artery transposition (TGA). Almost all TGA children have their arterial switches repaired.
Babies with TGA become extremely ill soon after birth due to a severe lack of oxygen. The following are the two temporary measures that will help improve your baby's condition. Your doctor will conduct these procedures before proceeding with an arterial switch:
- Beginning of a medication known as prostaglandin
- Carrying out a balloon atrial septostomy
An arterial switch procedure is a type of open heart surgery that is typically performed within the first week of life.
During the procedure, the pulmonary artery and aorta return to normal positions. The coronary arteries are properly connected to the new aorta.
The surgeon will also correct any significant ventricular septal defects (holes between the ventricles) in your baby during the arterial switch procedure(if there are any).
Complications associated with the arterial switch procedure
The arterial switch requires extensive surgery, but the outcomes are excellent. Almost all the surgeries are successful.
This procedure will need the use of a cardiopulmonary bypass (heart-lung machine).
However, many children might have minor issues such as:
- Feeding issues (such as trouble swallowing)
- Bruising at intravenous (IV) sites. An intravenous (IV) line is a small tube that is inserted into a vein in your child's arm or leg to administer medications or fluids.
Also, Read - Adenotonsillectomy Indications in Children
The following are rare but serious complications of anesthesia and heart surgery:
-Bruising, clotting, and strokes
-Injury to the vocal cords
-Heart rhythm issues
-Blood transfusion reactions
Apart from these, long-term complications include pulmonary artery stenosis, coronary artery obstruction, new aortic valvar insufficiency, arrhythmia, and aortic arch obstruction, which have all decreased significantly in recent years.
The most difficult aspect of the surgery is transferring the coronary arteries. A baby's heart is about the size of a fist. That's why it's not easy to see how small and delicate the coronary arteries are. The coronary arteries play a critical role in supplying blood to the heart. Any damage or even minor dilation of the coronary arteries can be fatal. To allow for proper localization and repositioning of both coronary arteries, great care must be taken.
Associated heart defects may also add to the surgery's complexity. The majority of patients with transposition of the great arteries also have an atrial septal defect and patent ductus arteriosus. These are usually addressed at the same time as the surgery. A ventricular septal defect may exist in some cases and must be repaired. Some patients have pulmonary valve stenosis or even narrowing beneath the pulmonary valve. This may significantly complicate the procedure and, in some cases, necessitate a completely different surgical approach. And some patients may have an associated aortic coarctation. This can also make the surgery more difficult.
Fortunately, the outcomes for a child undergoing an arterial switch operation are generally very good today. The majority of children do well and live normal, healthy lives.
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