TGA with VSD and Pulmonary Stenosis: Rastelli and Nikaidoh Procedures

For TGA with VSD and LVOT obstruction, these kids essentially have pulmonary stenosis with a VSD, and timing depends on the kid's oxygen saturation — they will need a Rastelli or a Nikaidoh operation, both requiring an implant, and the intent is to give the biggest implant possible since a smaller implant means an earlier return for a change. If saturations are above 75% and the kid is growing and doing well, they can wait and have surgery at around one year of age; if saturations are less than 75% with significant failure to thrive, they should come for surgery at any age or weight. On late presenters: we are also a resource-limited country — four or five surgeons doing this work for half of India — and face the same problem of kids coming late every day. My suggestion is education programmes, including pulse oximeter screening at birth, 1 month, and 6 months, referring for an echo early if abnormal. Late-presenting PDAs and cyanotic conditions apart from TGA are usually still operable, even if at slightly higher risk, but VSD shunt lesions can become inoperable if too late — however, even when a kid looks clinically inoperable, we always offer a cardiac catheterisation to confirm, since a significant proportion will still turn out to be operable, if high risk. And even an inoperable VSD child, with good, appropriately timed medical management (diuretics, pulmonary vasodilators), can still survive 25–35 years, whereas without that care they will die much earlier.

Approximately 5,500 USD.

With either a Rastelli operation or a Nikaidoh operation, both of which involve placing an implant to redirect blood flow correctly.

The child's oxygen saturation, rather than a fixed age. If saturation is above 75 percent and the child is growing well, surgery can generally wait until around one year of age. If saturation falls below 75 percent, or the child has significant failure to thrive, surgery should happen at any age or weight.

Because a smaller implant means the child will need a repeat procedure sooner to replace it as they grow, so the intent is to use as large an implant as the child can safely receive.