The heart and vessels are accessed via median sternotomy, and a cardiopulmonary bypass machine is used; as this machine needs its "circulation" to be filled with blood, a child will require a blood transfusion for this surgery. The procedure involves transecting both the aorta and pulmonary artery; the coronary arteries are then detached from the aorta and reattached to the neo-aorta, before "swapping" the upper portion of the aorta and pulmonary artery to the opposite arterial root. Including the anaesthesia and immediate post operative recovery, this surgery takes an average of approximately six to eight hours to complete. Some arterial switch recipients may present with post-operative pulmonary stenosis, which would then be repaired with angioplasty, pulmonary stenting via heart cath or median sternotomy, and/or xenograft. Atrial switch
In some cases, it is not possible to perform an arterial switch, either because of late diagnosis, sepsis, or a contraindicative coronary artery pattern. In the case of sepsis or late diagnosis, a delayed Arterial Switch can sometimes be made possible by PAB, which may also require a concomitant construction of an aortic-to-pulmonary artery shunt.When an arterial switch is impossible, an atrial switch will be attempted using either the Senning or Mustard procedure. Both methods involve creating a baffle to redirect red and blue blood flow to the appropriate artery. Since the late 1970s the Mustard procedure has been preferred.
Moderate
Left anterior thoracotomy
Isolated pulmonary artery banding (PAB)
Left lateral thoracotomy
PAB (when coarctation or aortic arch repair also required)
Right lateral thoracotomy
Blalock-Hanlon atrial septectomy
Each of these procedures is performed through an incision between the ribs and visualized by echocardiogram; these are far less common than heart cath procedures. Pulmonary artery banding is used in a small number of cases of d-TGA, usually when the corrective surgery needs to be delayed, to create an artificial stenosis in order to control pulmonary blood pressure; PAB involves placing a band around the pulmonary trunk, this band can then be quickly and easily adjusted when necessary. An atrial septectomy is the surgical removal of the atrial septum; this is performed when a patent foramen ovale (PFO), or atrial septal defect (ASD) are not present and additional shunting is required to raise the oxygen saturation of the blood flowing eventually into the aorta. Major
Median sternotomy
PAB (when intracardiac procedures also required)
Concomitant atrial septectomy
In recent years, it is quite rare for palliative procedures to be done via median sternotomy. However, if a sternotomy is required for a different procedure, in most cases all procedures that are immediately required will be performed at the same time. Monitoring and maintenance
Nasogastric tube (NG tube or simply NG)
Intubation, oxygen mask, or nasal cannula
Intravenous drip (IV)
Arterial line
Central venous catheter
Fingerprick
Sphygmomanometer
Pulse oximeter
EKG
An NG tube is used to deliver nourishment, and occasionally medication, to the patient. Since the tube extends right into the stomach, it can also be used to monitor how well the patient is digesting their "food".