Pulmonary valve stenosis surgery

1. In patients with pulmonary stenosis, the symptoms are obvious, and the systolic pressure difference between the right ventricle and the pulmonary artery should be more than 5.3kpa (40mmhg). 2. Some patients have clinical symptoms that are not obvious, but those with ECG showing right ventricular hypertrophy and strain should consider surgery. 3. If the pressure gradient is less than 5.3kpa or the right ventricular pressure is lower than 6.6kpa (50mmhg), it is clinically asymptomatic. 4. Severe pulmonary stenosis, the patient's peripheral circulation is obviously purpura, and even coma, emergency treatment can be treated when oxygen and infusion are not effective. Treatment of diseases: pulmonary valve insufficiency Indication 1. In patients with pulmonary stenosis, the symptoms are obvious, and the systolic pressure difference between the right ventricle and the pulmonary artery should be more than 5.3kpa (40mmhg). Surgery should be done early, and it is appropriate for preschool. 2. Some patients have clinical symptoms that are not obvious, but those with ECG showing right ventricular hypertrophy and strain should consider surgery. 3. If the pressure gradient is less than 5.3kpa or the right ventricular pressure is lower than 6.6kpa (50mmhg), clinically asymptomatic, ECG and x-ray no obvious changes in the right ventricle, generally do not require surgery, but should be followed up regularly. In view of the poor natural prognosis of this disease and the high safety of surgery in recent years, there is a tendency to relax the indications for surgical treatment. 4. Severe pulmonary stenosis, the patient's peripheral circulation is obviously purpura, and even coma, emergency treatment can be treated when oxygen and infusion are not effective. Preoperative preparation Severe patients, such as cyanosis or poor cardiac function, intermittent oxygen supply before surgery, limited activity, a small amount of polarized fluid, heart failure, cardiac therapy, diuresis and other drugs, after the heart function and general conditions improved, Then choose surgery. Surgical procedure 1. Position, incision: supine position, sternal midline incision, longitudinally cut happy bag, revealing the heart. 2. Extracardiac exploration: to identify the common pulmonary artery and annulus, right ventricular outflow tract, the size of each compartment and whether there is a combined deformity. In patients with simple pulmonary stenosis, the common pulmonary artery is significantly dilated, the vessel wall is thinned, and a rough systolic tremor can be found in front of the pulmonary artery root. The light can be pressed to the mouth of the fish mouth and the thickened valve. . Pulmonary artery rings are more dysplastic, relatively narrow, the funnel muscles are thick, the right ventricle is enlarged, and the ventricular wall is thick and the right atrium is also enlarged. 3. Surgical methods: (1) Pneumatic flap incision under low temperature anesthesia: separate the superior and inferior vena cava, and place the blocking band. In the anterior wall of the pulmonary artery, 1 suture was used on the 1-0 silk thread, the lower, the left, and the right, as the traction line. The traction line at the lower end is sutured about 0.5 cm above the pulmonary valve annulus, and the distance between the upper and lower sutures is 3 to 4 cm. The anterior wall of the pulmonary artery was clamped under the four traction lines with a non-invasive vascular clamp and cut open. After hyperventilation, the inferior vena cava is blocked first, then the superior vena cava is blocked, and after the residual blood in the right ventricle is drained, the artificial assisted breathing is stopped. Remove the non-invasive vascular clamp, exhaust the blood in the pulmonary artery, and the assistant pulls the pulmonary artery incision to the side of the heart to make the pulmonary valve mouth clear. The surgeon uses the sharp edge to accurately cut or cut along the valve junction fusion, and keeps 1 to 2 mm between the incision and the attachment edge of the leaflet to prevent the wall of the pulmonary artery from being cut. After the valve is incision, the surgeon uses the index finger to penetrate the right ventricular outflow tract through the valve to find out whether there is a funnel stenosis. When the annulus is narrow, it can be dilated with a finger or a long vascular clamp. After the operation of the heart is completed, the surgeon and the assistant will lift up the four traction lines and open the superior vena cava. When the blood in the pulmonary artery incision is overflowed, the two edges of the incision are clamped with the non-invasive arteriotomy. After the heart beats, the heart is gradually opened. Vena cava. This operation can be completed in 3 to 5 minutes. The pulmonary artery incision was sutured continuously with a 1-0 silk thread. (2) Pulmonary valve incision under cardiopulmonary bypass: establishment of extracorporeal circulation. Longitudinal incision of the pulmonary artery trunk, see the mouth of the pulmonary stenosis of the fish, and cut along the fusion junction. If the annulus is small, the annulus can be enlarged with a finger or a vascular clamp. Normal saline was injected into the pulmonary artery incision, and the air in the right ventricle and pulmonary artery was discharged, and the pulmonary artery incision was continuously sutured back and forth. End the extracorporeal circulation. 4. Close the chest: flush the pericardial cavity, suture the pericardium, place the mediastinum and pericardial cavity drainage, and close the chest layer by layer. complication There are many reasons for fatigue. The manual workers are too light to cause fatigue because the sodium in the salt can enhance the excitability of the nerves and muscles. Insufficient sleep can make people feel weak, but people with neurasthenia who feel long-term use of sleeping pills will feel weak.

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