three-atrial heart surgery

Sanfangxin is a rare congenital heart malformation with an incidence of about 0.1% of congenital heart disease and a male to female ratio of 1.5:1. The anatomical feature of the three-room heart is that the left atrium or right atrium is divided into two atriums by fibrous septa or fibrosis. The left atrium is separated by a left type, and the right atrium is separated by a right type. The typical three-room heart refers to the left type, accounting for more than 90% of the total number of three-bedroom hearts. After the left atrium is separated, two atriums, "proximal" and "distal", are formed. The distal atrium (or true left atrium) contains the left atrial appendage and the mitral valve. The proximal atrium (or the atrium) is connected to the pulmonary vein, and the blood is discharged into the true left atrium through the septum. Treatment of diseases: Sanfangxin Indication The typical traffic between the proximal atrium and the true left atrium is narrow, and the symptoms appear early. The operation should be performed within 1 year of age. For some complex three-room hearts, when the common venous lumen of the lung is in the right atrium, there is severe stenosis or no access between the common pulmonary vein and the left atrium, or there is a small foramen oval between the right atrium and the left atrium. Insufficiency, large left-to-right shunt, with very limited blood flow to the left atrium and left ventricle, such sick children often have severe symptoms within a few months after birth, which is an indication for emergency surgery. For older children with chronic symptoms, elective surgery is available. Preoperative preparation Prepared for general open heart surgery. Severe three-hearted heart can develop congestive heart failure and repeated respiratory infections in infants and young children. For such patients, attention should be paid to improving heart function and controlling pulmonary complications before surgery. Surgical procedure Surgery was performed under conventional extracorporeal circulation and cardiac arrest using a mediastinal sternal median incision. It is clearer that the operation field of infants and young children under deep hypothermic circulatory circulation can be used in the following two ways. 1. Ditch incision three-square heart correction In the typical three-room heart without other cardiac malformations, the proximal atrium (total pulmonary vein cavity) is enlarged, and the left atrial incision can be selected for surgery. Satisfactory exposure is generally available to adults or older children. Conventional superior and inferior vena cava intubation, moderate hypothermic cardiopulmonary bypass, obstruction of the aorta, coronary artery perfusion with cold blood cardioplegic solution to protect the heart. (1) From the front of the right pulmonary vein, the anterior mitral valve surgery is used to cut the left atrium through the sulcus. The incision was opened with an appropriate size retractor to reveal an abnormal diaphragm and pulmonary vein opening in the left atrium, but the mitral and left atrial appendages were not visible. (2) It is convenient to cut the diaphragm and extend to the left lower pulmonary vein opening direction, and it is also convenient to improve the revealing of the true left atrial structure under the diaphragm. (3) After confirming the mitral valve and the left atrial appendage, the abnormal diaphragm that stops at the wall and the interatrial septum should be removed. When the septum near the left atrial wall is removed, the left pulmonary vein should be noted and the lower mitral annulus should be avoided to avoid traction. Too large to prevent damage to the mitral valve and the left atrial wall. (4) After the abnormal diaphragm was removed, the left atrial incision was sutured as usual. 2. Right atrial incision three-square heart correction When the atrial septal defect (or patent foramen ovale) is combined, it is more convenient to expose the abnormal diaphragm through the surgical incision path. (1) First, make a oblique incision into the right atrium in the anterior and posterior chamber of the right atrium. The right atrial structure was examined, including the tricuspid valve, the coronary sinus ostium, the fossa ovalis, and the atrioventricular structure. Atrial septal defect (or patent foramen ovale) is often located between the right atrium and the proximal atrium. (2) The posterior margin of the defect was cut open to open the interatrial septum, and the defect was enlarged. The front edge of the interatrial incision was retracted with a small hook to fully expose the sub-atrium and the true left atrial structure above and below the diaphragm. (3) Confirm whether the four pulmonary veins are in the auxiliary room, and the mitral valve can be clearly revealed after partially cutting the diaphragm. (4) After the diaphragm is removed, the structure around the diaphragm is shown. (5) Repair of atrial septal defect. For large atrial septal defect, after atrial septal defect is used to remove the abnormal septum in the left atrium, the autologous pericardium or polyester patch is used to repair the atrial septal defect. Generally, 4-0 suture can be used for continuous suture, starting from the leading edge and counterclockwise. Stitching. When the large atrial septal defect is in the front position, the left superior vena cava is opened in the left atrium. After the abnormal diaphragm is removed, the left superior vena cava opening must be inserted from the left atrium into the right atrium to close the atrial septal defect. (6) The right atrial incision was sutured as usual. 3. Combined malformation There are many pathological variations of the three-dose heart, and often combined with a variety of intracardiac malformations, such as the three-atrial heart with total pulmonary venous flow connection; the three-heart and other complex cardiac malformations coexist, with permanent left superior vena cava into the coronary sinus or directly Connected to the left atrium through the apical coronary sinus. Almost any combination of deformities is likely to be encountered. Therefore, we must try to find out all the pulmonary veins and venous connection and drainage sites before surgery, including the possible left superior vena cava; all or part of the pulmonary veins in the confluence of the posterior atrium and the proximal atrium; and the proximal atrium and the true left atrium, near The relationship between the lateral atrium and the right atrium. complication 1. Abnormal diaphragm resection is not enough, leaving residual obstruction, which was reported in the early stage, and the treatment should be re-surgical resection. 2. Arrhythmia, more common in supraventricular, such as knot rhythm, atrial flutter or rapid atrial fibrillation, etc., mostly temporary, generally do not need to be treated, and more can be self-recovery. If hemodynamic changes are caused, coping should be dealt with, such as using digitalis drugs to control rapid atrial fibrillation and improve cardiac function.

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