DE LA PARTE PEREZ, Lincoln. ANESTHESIA IN JATENE’S SURGERY, AN EXPERIENCE AT THE CARDIOLOGY CENTER OF “WILLIAM SOLER” HOSPITAL. Recursos Materiales y Humanos del Servicio de Cirugia cardiovascular 7. Organización para la corrección anatómica u Operación de Jatene siempre que. Cirugía de switch arterial: una historia de grandes esperanzas. mArsHALL L. JAcoBs1. Forty years ago, when Adib Jatene, in Sao Paulo, Bra- zil performed the.
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A blood transfusion icrugia necessary for the arterial switch because the HLM needs its “circulation” filled with blood and an infant does not have enough blood on their own to do this in most cases, an adult would not require blood transfusion. The HLM is turned off and the aortic and atrial cannula are removed, then an incision is made in the right atrium, through which the congenital or palliative atrial septal defect ASD is repaired; where a Rashkind balloon atrial septostomy was used, the ASD should be able to be closed with sutures, but cases involving large congenital ASDs or Blalock-Hanlon atrial septectomya pericardial, xenograftor Dacron patch may be necessary.
Bythe arterial switch had become the procedure of choice, and remains the standard modern procedure cieugia d-TGA repair. As the patient is anesthetized, they may receive the following drugswhich continue as necessary throughout the jahene.
The heart is accessed via median sternotomyand the patient is given heparin to prevent the blood from clotting. When the septal defects have been repaired and the atrial incision is closed, the previously removed cannula are replaced and the HLM is restarted.
If there is a VSD which has not yet been repaired, this is performed via the atrial incision and tricuspid valveusing sutures for a small defect or a patch for a large defect. The previously harvested pericardium is then used to patch the coronary explantation sites, and to extend – and widen, if necessary – the neo-pulmonary root, which allows the pulmonary artery to be anastamosed without residual tension; the pulmonary artery is then transplanted to the neo-pulmonary root.
Arterial switch operation
The success of this procedure is largely dependent on the facilities available, the skill and experience of the surgeon, and the general health of the patient. The rib cage is relaxed and the jatee surgical wound is bandaged, ed the sternum and chest incision are left open to provide extra room in the pleural cavityallowing the heart room to swell and preventing pressure caused by pleural effusion. Mustard first conceived of, and attempted, the anatomical repair arterial switch for d-TGA in the early s.
Eber was the first to recount a small series of successful arterial switch procedures, and the first large successful series was reported by Guatemalan surgeon Aldo R. Views Read Edit View history. InAmerican surgeons William Rashkind and William Miller transformed the palliation of d-TGA patients with the innovative Rashkind balloon atrial septostomywhich, unlike the thoracotomy required by a septectomy, is performed through the minimally invasive surgical technique of cardiac catheterization.
Silk marking sutures may be placed in the pulmonary trunk at this time, to indicate the commissure of the aorta to the neo-aorta ; alternatively, this may be done later in the procedure. The coronary ostia and a large “button” of surrounding aortic wall are then excised from the aorta, well into the sinus of Valsalva ; and the proximal sections of the coronary arteries are separated from the surface of the heart, which prevents tension or distortion after anastomosis to the neo-aorta.
These statistics, combined with advances in microvascular surgery, created a renewed interest in Mustard’s original concept of an arterial switch procedure. When the patient is fully cooled, the ascending aorta is clamped as close as possible below the HLM cannula, and cryocardioplegia is achieved by delivering cold blood to the heart via the ascending aorta below the cross clamp. His few attempts were unsuccessful due to technical difficulties posed by the translocation of the coronary arteries, and the idea was abandoned.
Egyptian cardiac surgeon Magdi Yacoub was subsequently successful in treating TGA with intact septum when preceded by pulmonary artery banding and systemic-to-pulmonary shunt palliation. If a ventricular septal defect VSD is present, it may be repaired, at this point via either the aortic or pulmonary valve ; it may alternatively be repaired later in the procedure.
In the event of sepsis or delayed diagnosisa combination of pulmonary artery banding PAB and shunt construction may be used to increase the left ventricular mass sufficiently to make an arterial switch possible later in infancy. Coronary jatsne are examined closely, and the ostia and proximal arterial course are identified, as are any infundibular branches, if they exist.
The vessels are again examined, and the pulmonary root is inspected for left ventricular outflow tract obstruction LVOTO. Clrugia sternum and chest can usually be closed within a few days; however, the chest tubes, pacemaker, ventilator, and drugs may criugia be required after this time.
From Wikipedia, the free encyclopedia. In most cases, the coronary implantation sites will be at left and right anterior positions at the base of the neo-aorta; however, if the circumflex coronary artery branches from the right coronary arterythe circumflex coronary artery will be distorted if the pair are not implanted higher than normal on the neo-aorta, and in some cases they may need to be implanted above the aortic commissure, on the native aorta itself.
A generous section of pericardium is harvestedthen disinfected and sterilized with a weak solution of glutaraldehyde ; and the coronary and great artery anatomy are examined. The coronary arteries are carefully re out in order to avoid unexpected intra-operative complications in transferring them from the native aorta to the neo-aorta.
However, in cases where the individual has been diagnosed but surgery must be delayed, jwtene or even autologousin certain cases blood donation may be possible, as long as the mother has a compatible blood type. The aorta is then transplanted onto the pulmonary root, using either absorbable or re continuous suture.
This would have effectively reduced early mortality rates, particularly in cases with no concomitant shunts, but is unlikely to have reduced late mortality rates.
Anestesia en la operación de Jatene, experiencia en el Cardiocentro del Hospital “William Soler”
The aortic clamp is temporarily removed while small sections of the neo-aorta are cut away to accommodate the coronary ostia, and a continuous absorbable suture is then used to anastomose each coronary “button” into the prepared space.
The ductus arteriosus and right pulmonary branchup to and including the first branches in the hilum of the right lungare separated from the surrounding supportive tissue to allow mobility of the vessels. Valve repair Valvulotomy Mitral valve repair Valvuloplasty aortic mitral Valve replacement Aortic valve repair Aortic valve replacement Ross procedure Percutaneous aortic valve replacement Mitral valve replacement production of septal defect in heart enlargement of existing septal defect Atrial septostomy Balloon septostomy creation of septal defect in heart Blalock—Hanlon procedure shunt from heart chamber to blood vessel atrium to pulmonary artery Fontan procedure left ventricle to aorta Rastelli procedure right ventricle to pulmonary artery Sano shunt compound procedures for transposition of great vessels Arterial switch operation Mustard procedure Senning procedure for univentricular defect Norwood procedure Kawashima procedure shunt from blood vessel to blood vessel systemic circulation to pulmonary artery shunt Blalock—Taussig shunt SVC to the right PA Glenn procedure.
The aorta is then transected at the marked spot, and the pulmonary artery is transected a few millimetres below the bifurcation.
If the procedure is anticipated far enough in advance with prenatal diagnosis, for exampleand the individual’s blood type is known, a family member with a compatible blood type may donate some or all of the blood needed for transfusion during the use of a heart-lung machine HLM.
While the patient is cooling, the ductus arteriosus is ligated at both the aortic and pulmonary ostiathen transected at its center; the left pulmonary branchdw the first branches in the hilum of the left lung, is separated from the supportive cirugiia and the aorta is marked at the site it will be transected, which is just below the pulmonary bifurcationproximal to where the pulmonary artery will be transected. Pericardium Pericardiocentesis Pericardial window Pericardiectomy Myocardium Cardiomyoplasty Dor procedure Septal myectomy Ventricular reduction Alcohol septal ablation Conduction system Maze procedure Cox maze and minimaze Catheter ablation Cryoablation Radiofrequency ablation Pacemaker insertion Left atrial appendage occlusion Cardiotomy Heart transplantation.
As with any procedure requiring general anaesthesia, arterial switch recipients will need to fast for several hours prior to the surgery to avoid the risk of aspiration of vomitus during the induction of anesthesia. Rollins Hanlon cirhgia the Blalock-Hanlon atrial septectomywhich was then routinely used to palliate patients.