Arterial Switch Operation

Arterial Switch Operation

An arterial switch operation, also known as a Jatene procedure, is an open-heart invasive surgical intervention which is used to correct transposition of great arteries. It is a congenital heart defect in which the aorta and the pulmonary artery switch positions.

Why it is Performed?

The surgery switches both the arteries back to their standard positions; the aorta is linked to the left ventricle, the pulmonary artery is linked to the right ventricle. Since the coronary arteries carry oxygen-rich blood, they also must be reattached to the new aorta. If not, it could prove to be life-threatening for the baby.

Who Qualifies for the Jatene Switch Procedure?

Neonates qualify for this operation as the heart defect is congenital.

How is the Procedure conducted?

During childbirth, the infant with transposition of great arteries (TGA) looks normal. However, there is some level of cyanosis (blueness). If the ductus arteriosus starts to close or if the Foramen Ovale (foetal heart) becomes restrictive, the infant can hint at exacerbating cyanosis and respiratory trouble. Medications like prostaglandin E1 may improve the condition of the newborn by causing the ductus arteriosus. If oxygen levels are too low even after prostaglandin treatment, Arterial Switch Operation (or Jatene procedure) is necessary.

A Balloon Septostomy is just a quick measure to help the neonate. When the newborn child is around one week old, an Arterial Switch Operation is performed which rectifies the imperfection by interfacing the aorta to one side ventricle and the pulmonary to the right ventricle.

The success of the surgery is indicated when the bright red, oxygenated blood flows into the coronary arteries. The foramen ovale is carefully closed and the patent ductus arteriosus (PDA), the gap between the two major blood vessels arising from the heart,  is cut off.

General anaesthesia and cardiopulmonary bypass are used to detach aorta and pulmonary artery from their original place and  place them in the position they were naturally supposed to be. The pulmonary root becomes the neo-aorta, and the aortic root becomes the neo-pulmonary artery.

What are the Possible Complications?

• If the valves start leaking, an anticoagulant medicine is needed to stop the blood clots from forming. The effect of anticoagulant is to be monitored by the surgeon through the blood tests.
• An irregular heartbeat may be observed, and this may need to be corrected by using medicines, a pacemaker or an ablation.
• Children with heart conditions are vulnerable to an infection called infective endocarditis.
• Pulmonary hypertension may occur as well. The doctor has to be kept informed at all times.

What is the Prognosis?

The sternum and chest are closed within few days, depending on the healing progress of the patient. Meanwhile, the patient will be fed intravenously. Breastmilk or formula milk may be introduced using nasogastric tube (NG) once the surgeon discharge the patient.