What is the Arterial Switch Procedure for Transposition of the Great Arteries (also known as Transposition of the Great Vessels)?
The arterial switch operation is for correcting the congenital heart defect called transposition of the great arteries (TGA). This heart problem occurs when the aorta (the blood vessel that supplies blood to the body) comes out of the right (instead of the left) ventricle, while the pulmonary artery (the blood vessel that transports blood to the lungs) comes out of the left ventricle. The surgery is usually done in the first two weeks of life.
Preparing for the Procedure
Prior to surgery, the baby will have tests to diagnose the heart defect including an EKG, a chest x-ray and an echocardiogram. If the baby needs a bigger hole in the atrium to let the blood mix together, a balloon atrial septostomy may be performed. In addition, blood tests to determine blood type and compatibility are done to prepare for the use of blood during surgery. Other blood tests to be sure the baby is stable may also be done.
During the Procedure
During the procedure, the baby is placed under general anesthesia and special monitoring IVs are used. The chest is opened through the sternum (breastbone). The heart/lung machine is connected. Once the heart is stopped and emptied, the aorta and the pulmonary artery are cut off (divided). The coronary arteries are then removed from their attachment to the aorta. They are moved to their new location. The aorta and pulmonary arteries are then switched to connect to the appropriate ventricles. The heart is allowed to fill with blood and take over its normal function. Temporary pacemaker wires and drainage tubes are placed and the chest is closed. The baby is then allowed to awaken from anesthesia slowly after surgery. The child may stay on the respirator overnight until his or her breathing is adequate and heart function has stabilized.
After the Procedure
After surgery, the baby will recover from the surgery and anesthesia, and from the use of the heart-lung bypass machine. The baby may need support from IV medicines and a temporary pacemaker. Once the breathing tube (endotracheal tube) is out, one of the main goals will be to encourage the baby to eat normally and gain weight.