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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The left ventricle is then vented and the cross clamp removed from the aorta, enabling full-flow to be re-established and rewarming to begin; at this point the patient will receive an additional dose of Regitine to keep blood pressure under control.
Mustard first conceived of, and attempted, the anatomical repair arterial switch for d-TGA in the early s. 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. An 8 day old right after the Jatene procedure. As with any procedure requiring general anaesthesia, arterial switch recipients will need to fast for several hours prior to the citugia to avoid the risk of aspiration of vomitus during the induction of icrugia.
While the patient is cooling, the ductus arteriosus is ligated at both the aortic and pulmonary ostiathen transected at its center; the left pulmonary branchincluding the first branches in the hilum of the left lung, is separated from the supportive tissue; 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.
Heart valves and septa Valve repair Valvulotomy Mitral valve repair Valvuloplasty aortic mitral Valve replacement Aortic valve repair Aortic valve replacement Ross cjrugia Percutaneous aortic valve replacement Mitral valve replacement production of septal defect in heart jztene of existing septal defect Atrial septostomy Balloon septostomy creation of septal defect in ee 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 dde compound procedures for transposition of great vessels Arterial switch operation Mustard procedure Senning procedure cirugiz 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.
From Wikipedia, the free encyclopedia. A blood transfusion is 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. When the patient is fully cooled, the ascending aorta is clamped as close as possible cirugiq the HLM cannula, and cryocardioplegia is achieved by delivering cold blood to the heart via the ascending aorta below the cross clamp.
If the aortic commissure has not previously been marked, the excised coronary arteries will be used to determine the implantation position of the aorta. 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.
As the patient is anesthetized, they may receive the following drugswhich continue as necessary throughout the procedure:. The Jatene procedure is ideally performed during the second week of life, before the left ventricle adjusts to the lower pulmonary pressure and is therefore unable to support the systemic circulation.
The patient is fitted with chest tubestemporary pacemaker leads, and ventilated before weaning from the HLM is begun.
The patient’s mother is normally unable to donate blood for the transfusion, as she will not be able to donate blood during pregnancy due to the needs of the fetus or for a few weeks after giving birth due to blood lossand the process of collecting a sufficient amount of blood may take several weeks to a few months. When the septal defects have been repaired and the atrial incision is closed, the previously removed cannula are replaced and the HLM is restarted.
The sternum and chest can usually be closed within a few days; however, the chest tubes, pacemaker, ventilator, and drugs may still be required after this time. Use of the arterial switch is historically preceded by two atrial switch methods: 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.
The aorta is then transected at the marked spot, and the pulmonary artery is transected a few millimetres below the bifurcation. However, in cases where the individual has been diagnosed but surgery must be delayed, maternal or even autologousin certain cases blood donation may be possible, as long as the mother has a compatible blood type. This page was last edited on 4 Decemberat 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 coronary arteries are carefully mapped out in order to avoid unexpected intra-operative complications in transferring them from the native aorta to the neo-aorta. Sometimes, one or more coronary ostia are located very close to the valvular opening and a small portion of the native aortic valve must be removed when the coronary artery is excised, which causes a generally mild, and usually well- toleratedneo-pulmonary valve regurgitation.
The heart is accessed via median sternotomyand the patient is given heparin to prevent the blood from clotting. In most cases, though, the patient receives a donation from a blood bank. If the procedure is anticipated far enough in advance with prenatal diagnosis, matene exampleand the individual’s xe type is known, a family member with a compatible blood type may donate some or all of jstene blood needed for transfusion during the use of a heart-lung machine HLM.
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 patient will require a number of imaging procedures in order to determine the individual anatomy of the great arteries and, most importantly, the coronary arteries.
Anestesia en la operación de Jatene, experiencia en el Cardiocentro del Hospital “William Soler”
Arterial switch operation
Pericardium Pericardiocentesis Pericardial window Dr Myocardium Cardiomyoplasty Dor procedure Septal myectomy Ventricular reduction Alcohol septal ablation Conduction system Maze procedure Cox maze and minimaze Catheter jatend Cryoablation Radiofrequency ablation Pacemaker insertion Left atrial appendage occlusion Cardiotomy Heart transplantation. The patient will continue to fast for up to a few days, and breastmilk or infant formula can then be gradually introduced via nasogastric tube NG tube ; the primary goal after a successful arterial switch, and before hospital discharge, is for the infant to gain back the weight they have lost and continue to gain weight at a normal or near-normal rate.
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 dd anastomosis to the neo-aorta.
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. Due to the technical complexity of the Senning procedure, others could not duplicate his success rate; in response, Mustard developed a simpler alternative method the Mustard procedure inwhich involved constructing a baffle from autologous pericardium or synthetic material, such as Dacron.
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.
Bythe arterial switch had become dr procedure of choice, and remains the standard modern procedure cirugka d-TGA repair.
A generous section of pericardium is harvestedthen disinfected and sterilized with a weak solution of glutaraldehyde ; and the coronary and great artery anatomy are jayene.
Rollins Hanlon introduced the Blalock-Hanlon atrial septectomywhich was then routinely used to palliate patients. 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.
This surgery may be used in combination with other procedures for treatment of certain cases of double outlet right ventricle DORV in which the great arteries are dextro – transposed.
The cardiopulmonary bypass is then initiated by inserting a cannula into the ascending aorta as distally from the aortic root as possible while still supplying all arterial branches, another cannula is inserted into the right ajteneand a vent is created for the left ventricle via catheterization of the right superior pulmonary vein.
The Jatene procedurearterial switch operation or arterial switchis an open heart surgical procedure used to correct dextro-transposition of the great arteries d-TGA ; its development was pioneered by Canadian cardiac surgeon William Mustard and it was named for Brazilian cardiac surgeon Adib Jatenewho was the first to use it successfully.
At the time of the operation on February 6, ciruggia, he weighed just over 1. If the aortic commissure has not yet been marked, it may be done at this point, using the same method as would be used prior to bypass; however, there is a third opportunity for this still later in the procedure.