Our Summary

This research paper discusses a combined heart-lung transplant performed on a patient who had undergone seven previous open-heart surgeries. The patient was born with a heart defect (transitional atrioventricular septal defect) and had complications from previous surgeries to repair the mitral valve. These complications, which affected the pulmonary veins and blood vessels, necessitated the heart-lung transplant.

The eighth surgery was complicated and took longer than usual due to the presence of vascular adhesions (scar tissue). The placement of the heart-lung block was also complicated and had to be done in a specific way to avoid further complications.

Despite this, the patient was able to leave the hospital after two weeks and was still doing well nine months later. The successful outcome suggests that heart-lung transplants might become a more common solution for patients with similar complications in the future.

FAQs

  1. What is a sternotomy and how many times was it performed on the patient in the study?
  2. What complications arose from the eighth-time sternotomy and how were they addressed?
  3. What is the significance of the patient’s recovery and what does it imply for future cases of multiple cardiac palliations?

Doctor’s Tip

A helpful tip a doctor might give a patient about sternotomy is to follow post-operative care instructions closely to ensure proper healing and minimize the risk of complications. This may include avoiding heavy lifting or strenuous activity, keeping the incision site clean and dry, and taking prescribed medications as directed. It is also important to attend follow-up appointments with your healthcare provider to monitor your recovery progress.

Suitable For

Patients who have undergone multiple cardiac surgeries and may have significant vascular adhesions are typically recommended sternotomy. This includes patients with complex congenital heart defects, such as atrioventricular septal defects, who have developed pulmonary vascular disease as a complication of previous surgeries. Additionally, patients who require heart-lung transplantation due to end-stage heart and lung failure may also undergo sternotomy. These patients may have a history of multiple sternotomies and require careful consideration of surgical planning and technique to ensure a successful outcome.

Timeline

Before sternotomy:

  • Patient is born with a transitional atrioventricular septal defect
  • Undergoes multiple surgeries to repair and replace the mitral valve
  • Develops pulmonary vein stenosis and pulmonary vascular disease

After sternotomy:

  • Eighth-time sternotomy performed due to significant vascular adhesions
  • Prolonged operation required, heart-lung block placed anterior to phrenic nerves
  • Patient ready for discharge after two weeks
  • Continues to do well over nine months later

Overall, the patient experiences multiple surgeries and complications before undergoing sternotomy, which is followed by a complex and prolonged operation. Despite the challenges, the patient ultimately recovers well and is able to be discharged within a relatively short period of time.

What to Ask Your Doctor

Some questions a patient should ask their doctor about sternotomy include:

  1. What are the potential risks and complications associated with undergoing a sternotomy procedure, especially if I have had multiple previous sternotomies?
  2. How will my previous surgeries and medical history impact the success of a sternotomy procedure?
  3. What is the expected recovery time and post-operative care following a sternotomy, considering my specific medical condition?
  4. Are there any alternative treatment options to consider instead of undergoing another sternotomy?
  5. How will the presence of significant vascular adhesions affect the surgical procedure and outcome?
  6. What measures will be taken to minimize the risk of complications during and after the sternotomy procedure?
  7. How will the placement of the heart-lung block anterior to the phrenic nerves impact my recovery and long-term health?
  8. What is the likelihood of needing additional surgeries or treatments in the future following a sternotomy procedure?
  9. How will the sternotomy procedure affect my overall quality of life and ability to function in daily activities?
  10. What is the long-term prognosis for patients who have undergone multiple sternotomies, particularly in cases where pulmonary vascular disease is present?

Reference

Authors: Riggs KW, Chin CW, Bryant R, Zafar F, Chin C, Schecter MG, Morales DLS. Journal: World J Pediatr Congenit Heart Surg. 2021 Jan;12(1):136-138. doi: 10.1177/2150135118815876. Epub 2019 Apr 24. PMID: 31018757