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Objectives
Provide a brief overview of d-TGA Describe and discuss Arterial Switch Operation (ASO) Review post-op care and what to look for in the immediate post surgical period. Discuss parental needs and teaching prior to discharge
Survival dependent upon some type of communication. Mixing of oxygenated blood from pulmonary circulation and deoxygenated blood from systemic circulation. Occurs at Atrial level via Atrial septal defect (ASD)/Patent Foramen Ovale (PFO) and at great artery level via patent ductus arteriosus (PDA). At ventricular level if VSD present Prostaglandin to maintain patency of PDA Atrial septostomy if ASD/PFO restrictive continued severe hypoxemia.
Surgical development started in the early 1950s but were unsuccessful continued development in the 60s. 1975 breakthrough by Jatene and colleagues in Brazil with first successful arterial switch procedure in infants with TGA and VSD. Lecompte and colleagues made technical modification of Jatene procedure with direct anastamosis of both great arteries without interposition tube graft.
Parent Teaching
Initial Post-op: Discuss with parents/family lines, machines, medications etc. Encourage them to ask questions Update frequently as to baby status and progress Re-assure the parents about their babys progress
Parent teaching
Remember these patients usually need no further intervention and go home to live a normal life, participate in normal activities. In addition to orienting parents to their critically ill child initially post-op we need to begin preparing for discharge Discharge planning and teaching needs to be started on POD#2-3 (use extubation as a marker) Incision site care, activity restrictions e.g. no picking up the baby under the armpits for 6weeks. Plans for feeding: breast milk/ formula what is a normal intake for a baby at home. What do we expect the baby to be taking prior to discharge Set the parents up from early in the admission for rooming in i.e. they will be expected to provide complete care for the baby for at least 24 hours prior to discharge. Who to contact after discharge should there be any more questions. When is follow-up as an outpatient with the cardiologist.
Questions?
References
DeBord, S., Cherry, C., Hickey, C. (2007). The arterial switch procedure for transposition of the great arteries. AORN Journal, 86, 211-226. Everett, A & Lim, D. (2007). Iillustrated Field Guide to congenital heart disease and repair (2nd ed.0. Charlottesville, VA: Scientific Software Solutions. Hazinski, MF (2012). Nursing care of the critically ill child, (3rd ed). St. Louis:MO: Elsevier Losay, J., Touchot,A., Serraf, A., Litvinova, A., Lambert, V., Piot, J.D., Lacour-Gayet, F., Capderou,A. & Planche,C. (2001). Late outcome after arterial switch operation for transposition of the great arteries. Circulation, 104, I121-I126. Martins, P. & Castela, E. (2008). Transposition of the great arteries. Orphanet Journal of Rare Diseases, 3. Doi: 10.1186/1750-1172-3-27 Wernovsky, G: Transposition of the great arteries: In Allen, HD, Driscoll, DJ., Feltes, TF, & Shaddy, RE. editors. (2008). Moss and Adams heart disease in infants, children, and adolescents, including the fetus and young adult, (7th ed)., Philadelphia, PA: Lippincott Williams & Wilkins. Wheeler, D., Dent, C., Manning, P., & Nelson, D. (2008). Factors prolonging length of stay in the cardiac intensive care unit after the arterial switch operation. Cardiology in the Young, 18, 41-50.