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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Arterial switch operation
This would have effectively reduced early mortality rates, particularly in cases with no concomitant shunts, but is unlikely to have reduced late mortality rates. These statistics, combined with advances in microvascular surgery, created a renewed interest in Mustard’s original concept of an arterial switch procedure. The patient is fitted with chest tubestemporary pacemaker leads, and ventilated before weaning from the HLM is begun.
The aorta is then transected at the marked spot, and the pulmonary artery is transected a few millimetres below the bifurcation. The aorta is then transplanted onto the pulmonary root, using either absorbable or permanent continuous suture.
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. The previously harvested pericardium is then used to patch the coronary explantation sites, and cirgia 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.
Use of the arterial switch is historically preceded by two atrial switch methods: Pericardium Pericardiocentesis Pericardial window Pericardiectomy Myocardium Cardiomyoplasty Dor procedure Septal myectomy Ventricular reduction Alcohol septal ablation Conduction system Maze procedure Cox matene and minimaze Catheter ablation Cryoablation Radiofrequency ablation Pacemaker insertion Left atrial appendage occlusion Cardiotomy Heart transplantation.
The HLM is turned off and the aortic and ciirugia 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 cirguia ASDs or Blalock-Hanlon atrial septectomya pericardial, xenograftor Dacron patch may be necessary.
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 df inserted into the right atriumand a vent is created for the left ventricle via catheterization of the right superior pulmonary vein.
It was the first method of d-TGA repair to be attempted, but the last to be put into regular use because of technological limitations at the time of its conception. 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 jayene would not require blood transfusion.
His few attempts were unsuccessful due to technical difficulties posed by the translocation of the coronary arteries, and the idea was abandoned. If the aortic commissure has not yet been marked, it may be done at this point, using the cirugis method as would be used prior to bypass; however, there is a third opportunity cieugia this still 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.
At the time of the operation on February 6, cidugia, he weighed just over 1. Retrieved from ” https: 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.
The circumflex coronary artery may originate from the same coronary sinus as, rather than directly from, the right coronary artery, in which case they may still be excised on the same “button” and transplanted similarly to if they had a shared ostium, unless one or both have intramural communication with another coronary vessel.
As the patient is anesthetized, they may receive the following drugswhich continue as necessary throughout the procedure:. 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. If the procedure is anticipated far enough in advance with criugia 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 ds for transfusion during the cigugia of a heart-lung machine HLM.
The great arteries are usually arranged using the LeCompte maneuverwith the aortic cross clamp positioned to hold the pulmonary artery anterior to the ascending aorta; though with some congenital arrangements of the great arteries, such as side-by-side, this is not possible and the arteries will be transplanted in the se ‘anterior aorta’ arrangement.
Arterial switch operation – Wikipedia
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. 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 dirugia 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.
The rib cage is relaxed and the external surgical wound is bandaged, but 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. The coronary arteries are carefully mapped out in order to avoid unexpected intra-operative fe in transferring them from the native aorta to the neo-aorta.
This page was last edited on 4 Decemberat Views Read Edit View history. Sometimes, one or more coronary ostia are located very close to the valvular opening and a jtene 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.
An 8 day old right after the Jatene procedure. Impedance cardiography Ballistocardiography Cardiotocography. 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.
Bythe dw switch cirufia become the procedure of choice, and remains the standard modern procedure for d-TGA repair. 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.
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. 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.
In most cases, though, the patient receives a donation from a blood bank. When the patient is fully cooled, the ascending aorta ciruiga clamped as close as possible below the HLM cannula, and cryocardioplegia is achieved by delivering cold blood cirgia the heart via the ascending aorta below the cross clamp. Rollins Hanlon introduced the Blalock-Hanlon atrial septectomywhich was then routinely used to palliate patients.
Infundibular branches are sometimes unable to be spared, but this is a very rare occurrence. 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. The heart is accessed via median sternotomyand the patient is given heparin to prevent the blood from clotting.
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.