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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Bythe arterial switch had become the procedure of choice, and remains the standard modern procedure for d-TGA repair. Scottish pathologist Matthew Baillie first described TGA inpresumably as a posthumous diagnosis. The vessels are again examined, and the pulmonary root is inspected for left ventricular outflow tract obstruction LVOTO.
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.
Impedance cardiography Ballistocardiography Cardiotocography. As with any procedure requiring general anaesthesia, arterial switch recipients will need to fast for several hours prior to the cirutia to avoid the jatsne of aspiration of vomitus during the induction of anesthesia. This procedure yielded early ciirugia late mortality rates comparable to the Senning procedure; however, ajtene late morbidity rate was eventually discovered in relation to the use of synthetic graft material, which does not grow with the recipient and eventually causes obstruction.
A generous section of pericardium is harvestedcidugia disinfected and sterilized with a weak solution of glutaraldehyde ; and the coronary and great artery anatomy are examined.
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. In most cases, though, the patient receives a donation from a blood bank. The world’s matene infant to survive an arterial switch was Jerrick De Leon, born 13 weeks premature.
Arterial switch operation
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.
This would have effectively reduced early mortality rates, particularly in cases with no concomitant shunts, but is unlikely to have reduced late mortality rates. 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 jaene.
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.
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. 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.
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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. 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 ciruga below the cross clamp. The ductus arteriosus and right pulmonary branchup to and including the first branches in the hilum of the right jaeneare separated from the surrounding supportive tissue to allow mobility of the vessels.
The patient will require a number of imaging procedures in order to determine the individual anatomy of the great natene and, most importantly, the coronary arteries.
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 jjatene of the blood needed for transfusion during the use of a heart-lung machine HLM.
Although the atrial switch procedures dramatically reduced both early and late mortality rates, these statistics remained high, partly due to the wait time required between birth and surgery pre-operative mortality: From Wikipedia, cirugi free encyclopedia.
Sometimes, one or more coronary ostia are located df 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 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. Retrieved from ” https: 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 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 crugia to blood lossand the process of collecting a sufficient amount of blood may take several weeks to a few months. 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.
If the aortic commissure has not yet cirutia 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.
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 atriumand a vent is created for the left ventricle via catheterization of the right superior pulmonary vein.
Use of the arterial switch is dw preceded by two atrial switch methods: 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 jatrne Atrial septostomy Balloon septostomy creation of septal defect in heart Blalock—Hanlon procedure shunt from heart chamber to blood cirrugia 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 matene pulmonary artery shunt Blalock—Taussig shunt SVC to the right PA Re procedure.
InAmerican surgeons Alfred Blalock and Ciruiga.
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. 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.
Jatene procedure An 8 day old right after the Jatene procedure.
Anestesia en la operación de Jatene, experiencia en el Cardiocentro del Hospital “William Soler”
Rollins Hanlon introduced the Blalock-Hanlon atrial septectomywhich was then routinely used to palliate patients. The aorta is then transected at the marked jatee, and the pulmonary artery is transected a few millimetres below the bifurcation. His few attempts were unsuccessful due to jqtene difficulties posed by the translocation of the coronary arteries, and the idea was abandoned. The aorta is then transplanted onto the pulmonary root, using either absorbable or permanent continuous suture.
Heart valves and septa Valve repair Valvulotomy Mitral valve repair Virugia aortic mitral Valve replacement Aortic valve repair Aortic valve replacement Ross procedure Percutaneous aortic valve replacement Mitral valve replacement production cirugiw 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 cjrugia 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.
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.