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Overstay more than package days, 2. Any other Specialty Consultations, 3. Special Equipment, 4. Additional Procedure/Surgery. 5. Blood Components.
What is arterial switch procedure?
The arterial switch procedure is performed to correct transposition of the great arteries.
An arterial switch procedure is an open heart surgery that restores a normal blood circulation in your baby’s body.
During the surgery, arteries are put back in their correct place: the aorta is detached from the right atrium and connected to the left atrium; the pulmonary artery is detached from the left atrium and tied to the right atrium; the coronary arteries are cut out of the pulmonary artery and attached to the aorta.
Despite being a major surgery, arterial switch procedures have a great success rate (99%).
The main treatment to correct transposition of the great arteries (TGA) is the arterial switch procedure.
Why is it done?
Without surgical correction, a newborn with TGA would suffer from lack of oxygen in the body and from heart failure, and would not be able to live long.
Before your newborn’s surgery, you will meet with the doctor. The timing of these visits may vary but the team will check with you to make sure you understand what is happening and you have a chance to ask all of your questions.
Before surgery all newborns have:
All of these tests are done routinely to help the team prepare for surgery.
The surgical team
You will also meet the surgeon and the anaesthesiologist. The anaesthesiologist will discuss general issues around having anesthetic and specific issues about your child. These will include things like pre-operative sedation, blood transfusion and monitoring procedures during the surgery.
Most children who need heart surgery will need blood products during their surgery. This can involve transfusing:
Red blood cell to improve the amount of oxygen in the blood
platelets to help blood clotting
Food, drink and medication before the procedure
If your baby has been able to 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.
During the procedure
Once your child is asleep, the team:
puts in place IV lines and other catheters
Cleans with antiseptic the area where the incision (cut) will be made (usually the sternum).
During this open heart surgery, the anaesthesiologist watches your child and the 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. During this time, the heart is stopped while the surgeon repairs the defect. The perfusionist, the anaesthesiologist and surgeon care for your child. They make sure that the heart-lung machine injects oxygen into the blood and is delivering the blood to the body and brain.
When the repair is complete, the heart is allowed to beat again and the heart-lung machine is turned down and off. If the heart is not quite functioning the way it should, medications are used to improve heart function. An echocardiogram is done by the cardiologist to make sure that the repair is working the way it should. The surgeon then makes sure there is no bleeding and closes the incision. Most heart surgery takes between three and six hours.
After the procedure
The anaesthesiologist will transfer your child to the cardiac critical care unit (CCCU) when:
The team is happy and confident that the repair is good.
Heart function is good and stable.
Your child is doing well on the ventilator.
The care is then handed over to the team in that unit.
Recovery after the surgery
Your baby will likely spend a few days in the CCCU when recovering from their heart surgery until they feel better. Your baby will then be transferred to the cardiac inpatient unit to finish their recovery. The cardiac team:
Makes sure your baby feels no pain by giving pain medication (most of the time acetaminophen; sometimes small doses of morphine as needed)
Looks after your newborn’s medications
Manages the tubes (drains) that were placed in your baby’s chest during surgery
Takes care of the chest wound (sternal incision) and any other incision sites
Makes sure that your newborn is able feed well by mouth
Before going home
Your baby is ready to go home when they are breathing comfortably and can feed well by mouth. During the recovery, the cardiac team will teach you how to:
look after the sternal incision
give any medicines that your baby may need once at home
answer your newborn’s common needs, such as giving a bath, changing diapers and safely holding your baby
Risks of an arterial switch procedure
Many children have minor complications such as:
Feeding problems (such as trouble swallowing)
Bruising from intravenous (IV) sites. An I V line is a small tube that is put into a vein in your child's arm or leg to give medications or fluids.
Complications of anaesthesia and heart surgery include:
In transposition of the great arteries (TGA), the “great” arteries, the aorta and the right ventricle, are reversed in their origins from the heart. The aorta is connected to the right ventricle and the pulmonary artery is connected to the left ventricle — exactly the opposite of a normal heart's anatomy.
The surgery to repair TGA is known as an arterial switch operation. A pediatric heart surgeon performs the surgery. The surgery lasts about 4 to 6 hours. It takes place in an operating room in a hospital.
For most patients, an echocardiogram (cardiac ultrasound) and chest x-ray is all that's needed to form a diagnosis. But in certain circumstances, other tests may be necessary: Electrocardiogram (ECG or EKG) Cardiac catheterization.
Individuals who have undergone a heart transplant are considered disabled for one year following surgery under Listing 4.09. After a year, it's possible they may remain disabled under another listing or a medical-voational allowance.
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