Jatene Procedure

Definition

Jatene Procedure is an open heart surgery procedure used to correct transposition of the great arteries. It is also called an Arterial Switch that was developed by a Canadian cardiac surgeon William Mustard. The name of the procedure was from a Brazilian cardiac surgeon, Adib Jatene, who was the one to use it successfully.

jatene procedure or arterial switch

Transposition of the Great Arteries

In the cardiovascular disorder, transposition of the great arteries, the two arteries – pulmonary artery and aorta – switched places. Normally, the pulmonary artery branches from the right ventricle and the aorta from the left ventricle. In this disorder, the arteries switched. The pulmonary artery is located in the left ventricle and the aorta from the right ventricle.

Unoxygenated blood entering the right atrium drains to the right ventricle and is distributed to the different parts of the body by the aorta without oxygenation from the lungs. Thus, a corrective Jatene procedure is necessary for a normal heart circulation and function.

Jatene Procedure or Arterial Switch

Jatene procedure or arterial switch is used to correct transposition of the great arteries by switching the transposed pulmonary artery and aorta. Ideally, this procedure is performed on an eight to fourteen (8-14) days old infant. The procedure takes about 6-8 hours to complete, including the anesthesia and post operative recovery. During the surgery, the aorta and pulmonary artery are both transected. Before swapping or switching the two arteries, the coronary arteries are separated from the aorta and attached to the neo-aorta.

Laboratory Tests

1. Blood typing
2. Angiography
3. MRI
4. CT Scan

Procedure

Before the Procedure / Pre-operative

1. General anesthesia
   

   sequential steps in jatene procedure

2. Aprotinin (prevent excessive bleeding)
3. Solumedrol (reduce swelling and inflammation)
4. Regitine (prevent hypertension)
5. Prophylactic antibiotics (to prevent infection)

During the Procedure / Intra-operative

1. Median sternotomy is used to view the heart and vessels.
2. Heparin administration to prevent blood from clotting.
3. For a continuous systemic and heart circulation during the operation, a cardiopulmonary bypass machine is also used.
4. Since the machine needs its own circulation to be filled with blood, a blood transfusion is necessary to be done.
5. Aorta and pulmonary artery are both transected.
6. The coronary arteries are separated from the aorta and attached to the neo-aorta.
7. Aorta and pulmonary artery are switched.

After the procedure / Post-operative

1. Chest tubes placement.
2. Temporary pacemaker and ventilation.
3. Muscle relaxants (induce temporary paralysis)
4. Opioid analgesics (alleviate pain)
5. Inotrope (assist the heart in contracting adequately)
6. Nasogatric Tube Feeding (gradually introduce breast milk or formula milk)