anatomical correction surgery

Anatomical correction of aortic ectopic is defined as the two major arteries originating from the corresponding ventricles, but the relationship is abnormal. In this malformation, the atrium and the ventricle and the ventricle are connected to the aorta, and the two arteries are abnormally related to each other. In the atrial orthotopic position, the aorta is located in the left front of the pulmonary artery; in the atrial reversal, the aorta is located in the right front of the pulmonary artery. When there is no malformation, hemodynamics is normal. The vast majority of this malformation combined with ventricular septal defect, right ventricular outflow tract obstruction and atrial septal defect and other cardiac malformations. Treatment of diseases: ventricular septal defect Indication Anatomically corrected aortic ectopic and uncomplicated malformation, no surgical treatment, combined with deformity should be treated surgically. 1. Ventricular septal defect combined with large ventricular septal defect, especially those with pulmonary hypertension or sub-aortic stenosis, should be performed in small infants or even neonatal period. 2. Patients with ventricular septal defect and right ventricular outflow tract obstruction should be scheduled to undergo surgery after 5 years of age. Surgery before the age of 5 often requires surgery to replace larger extracardiac catheters. In children with severe cyanosis, first improve the subclavian artery and pulmonary shunt. Contraindications 1. Large ventricular septal defect with severe pulmonary hypertension, indoor right to left shunt and cyanosis (or) clubbing at rest. 2. Patients with pulmonary stenosis and/or ventricular septal defect with pulmonary dysplasia can only be treated with body-pulmonary bypass. Preoperative preparation 1. Use digitalis and diuretics in newborn or small infants with large ventricular septal defect and heart failure. In cases of severe cyanosis, oxygen therapy is used. 2. Comprehensive analysis of echocardiography and cardiovascular angiography data, the use of right atrium or right ventricular approach to repair ventricular septal defect. Patients with right ventricular outflow tract obstruction and/or ventricular septal defect were prepared preoperatively with the same species of aortic valve. 3. According to the extracorporeal circulation, open heart surgery before routine surgery. Surgical procedure The median incision of the chest was inserted into the arterial infusion tube through the ascending aorta, directly inserted into the right and inferior vena cava right angle tube, and inserted into the left heart decompression tube through the right superior pulmonary vein. After blocking the aorta and cardiac arrest, the following surgery was performed. 1, ventricular septal defect repair The right ventricular longitudinal structure, the size and location of the ventricular septal defect, and the surrounding tissue of the defect were explored through the right ventricle longitudinal incision. The cut polyester patch is round or oval, and the patch is slightly smaller than the defect. In the ventricular septal defect of the perimembrane, a double-ended needle with a 4-0 polyester thread was used to make a sacral suture with a gasket at the edge of the defect. The dangerous area was sutured at the root of the tricuspid valve and the right nucleus of the lower edge of the defect. In the future, the needles are sequentially sewn through the edge of the patch and pushed down for ligation. The right ventricular incision was sutured. (1) In the lower ventricular septal defect of the pulmonary artery, a double-ended needle with a gasket can also be used to make a ring-shaped suture with a gasket at the edge of the defect. In the case of a small defect, the lower edge is muscle, and there is no risk of damage to the heart conduction bundle; if the defect is larger, the posterior structure and repair surgery are the same as the perimembranous ventricular septal defect, and the heart block is avoided. In the case of multiple ventricular septal defect, the left ventricular longitudinal incision is used to repair the defect patch. (2) In cases of aortic stenosis, aortic incision should be performed to remove the aortic inferior annulus fibrosus or to remove a thick muscle from the midpoint of the left and right coronary annulus. 2, ventricular septal defect repair and right ventricle to pulmonary artery extracardiac (1) combined ventricular septal defect and pulmonary valve and its annulus stenosis, can be through the right ventricle longitudinal incision, the upper end of the incision points to the pulmonary artery, remove the thick funnel muscles, reveal the ventricular septal defect. (2) After repairing the ventricular septal defect of the peritoneum, the right ventricle to the pulmonary artery with the valve duct. (3) Only the funnel is narrow, and the funnel can be removed and the pericardium should be used to widen the right ventricular outflow tract under the pulmonary artery. Do not injure the right coronary artery. 3. Intracardiac tunnel and extracardiac duct This procedure is suitable for anatomical correction of aortic ectopic combined with right ventricular double outlet or left ventricle double outlet and pulmonary valve and annulus. complication Low cardiac output syndrome In cases of anatomical correction of aortic ectopic ventricular septal defect and aortic stenosis, sometimes low cardiac output syndrome occurs after surgery, first treated with dopamine and diuretics, and ineffective in re-operation to relieve sub-aortic obstruction, but surgery The mortality rate is high. 2. The right ventricle to the pulmonary extracardiac tube suffered from sternal compression and the right ventricle was blocked and hypotension, and the chest should be postponed. After 2 to 3 days after surgery, the myocardial edema disappeared and the chest was closed under aseptic conditions. 3. Patients with multiple ventricular septal defect are prone to residual ventricular septal defect after surgery. It has been reported that there is a chance of self-closing; however, patients with large residual ventricular septal defect should be repaired again. 4. Late epicardial obstruction occurs mostly in 1 to 2 years after surgery, and the extracardiac catheter should be replaced again. At present, the same kind of aortic valve with the same type of flap is firstly treated with warfarin for 1 month, and aspirin is taken for a lifetime, resulting in a significant reduction in extracardiac obstruction. 5. Postoperative mitral regurgitation In patients with simultaneous ventricular septal defect and subaortic stenosis, intraoperative removal of the lower aortic cone can injure the mitral valve and cause regurgitation, light observation, severe operative mitral valve repair or replacement .

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