Intrapulmonary arterial access

The advantage of intrapulmonary access is that it does not require dissection of the free coronary artery and incision sutures that are difficult to perform on small coronary arteries, especially in cases where the coronary artery opening is located on the side wall of the pulmonary artery and thus is shorter. Treating diseases: congenital heart disease Indication Treatment of congenital heart disease in infants with coronary artery originating from the pulmonary artery. Contraindications Heart function is severely incomplete or critically ill, older people. Preoperative preparation Electrocardiogram, echocardiography and multi-row CT were used to determine the diagnosis before operation. Surgical procedure Take the left side as an example. The midline incision of the sternum, cut the happy bag, establish extracorporeal circulation combined with moderate hypothermia or deep hypothermia. The left side wall of the pulmonary artery was cut near the pulmonary valve to reveal the opening of the left coronary artery. Then, the annular aorta and the pulmonary artery wall with a diameter of about 5-6 mm were cut off in the immediate vicinity of the left aortic artery and the pulmonary artery, and the aorta was directly sutured. The wall and the small window of the pulmonary artery wall form an artificial main-pulmonary artery spasm. A transverse incision of the pulmonary artery is made above the main-pulmonary artery fistula. When the left wall of the pulmonary artery is reached, the lower incision is made to connect with the transverse incision below the pulmonary artery wall, so that a parallel rectangular wall flap is formed on the anterior wall of the pulmonary artery. The suture is sutured to the posterior wall of the pulmonary artery. The right and left ends of the flap are sutured around the opening of the main-pulmonary artery and the left coronary artery, so that the blood can pass from the ascending aorta through the main-pulmonary artery and then through the pulmonary artery to the anterior wall of the pulmonary artery. The sewn channel enters the left coronary artery. The defect area left in the anterior wall of the pulmonary artery is covered with pericardial or vellus lamella. The blood flow channel in the pulmonary artery can also be replaced by pericardium (Hamilton, 1979) or a free autologous subclavian artery (arciniegas, 1980). wall. complication Due to myocardial ischemia resulting in moderate mitral regurgitation, systolic murmurs in the apical region can still be heard in most cases.

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