Ross surgery

In younger cases, the autologous pulmonary artery is used to replace the aortic root, and then the right ventricle or pulmonary artery is connected to the right ventricle and pulmonary artery. This type of surgery is also called autologous valved pulmonary aorta for aortic root replacement. Treatment of diseases: aortic stenosis preoperative preparation In addition to general routine procedures for open heart surgery, two-dimensional echocardiography and color Doppler examination should be performed before surgery to understand the pathological anatomy of the aortic valve, the size of the annulus and left ventricle, and whether or not the aortic regurgitation is combined. The extent of this in order to choose the appropriate surgical approach. Attention should be paid to monitoring the circulation, respiration and metabolism of critically ill infants before surgery. In the case of cardiac insufficiency, patients should be treated with diuretic diuresis. If necessary, positive inotropic drugs should be given. Newborn patients with critical illness need emergency treatment. Once the diagnosis is established, the prostaglandin E1 should be administered first through the central vein, the arterial catheter should be opened, and the right-to-left shunt of the transcatheter can be restored, which can reduce pulmonary hypertension and maintain systemic perfusion, so that it can be obtained from systemic low perfusion and acidosis. ease. These infants often need tracheal intubation and mechanical ventilation, and appropriate application of vasoactive drugs such as dopamine can help improve respiratory and circulatory function. Surgical procedure Moderate stenosis cases can be treated according to general open heart surgery, general anesthesia tracheal intubation, artificial ventilation to maintain breathing, and surgery to take supine position. Do not apply vasodilators in severely stenotic cases, taking care to prevent hypotension and affect coronary perfusion flow. Before the free valved pulmonary artery, the anatomical relationship of the adjacent pulmonary artery root is first familiar. The left coronary artery trunk is sent from the left aortic sinus and then traverses behind the root of the pulmonary artery, and the anterior descending branch and the circumflex branch are issued. The first interval branch, sometimes 2 to 3 The spacer can be immediately released from the proximal end of the anterior descending artery, and penetrates into the ventricular septum behind the pulmonary valve annulus. 1. Before the extracorporeal circulation intubation, the aorta, pulmonary artery and its branches are fully dissociated, a marker line is preset before the main pulmonary artery bifurcation, and then the extracorporeal circulation is started. If the aortic valve can be closed, infusion of cardiac arrest in the aortic root induces cardiac arrest. 2. Transect the main pulmonary artery at the marked line to ensure that the incision is above the junction of the pulmonary valve. Check the pulmonary valve for no abnormality. The root of the main pulmonary artery is sharply separated from the root of the aortic artery. Then the pulmonary artery is pulled forward and then separated. In the surrounding tissue, the posterior wall of the main pulmonary artery and the left coronary artery are completely removed until the right ventricular muscle can be seen. 3. Using the curved vascular clamp to guide through the pulmonary valve, determine the anterior wall of the right ventricular outflow tract. Incision was made 6-8 mm below the lowest point of the pulmonary valve annulus, and the anterior wall of the right ventricle was cut open. When the incision was extended to the aorta, be careful not to damage the conus of the right coronary artery. 4. Be careful not to damage the left coronary artery trunk, anterior descending branch and first spacer branch after the right ventricular outflow tract. In order to avoid damage to the above blood vessels, an oblique incision can be made under the intima under the right ventricular outflow tract. The intima layer can be cut from the right ventricular outflow tract posterior wall annulus 6-8 mm, and then the curved incision can be performed with a small round knife. The separation is performed almost parallel to the posterior wall, so that the posterior wall muscle incision has a sloped surface and can be about 10 mm wide. The anterior and posterior wall incisions of the right ventricular outflow tract are disconnected, and the muscle margin behind the removed pulmonary valve is thinner. It is necessary to pay attention to the examination and put it into the physiological saline diluted heparin solution to soak and set aside. 5. Block the ascending aorta, protect the myocardium and keep the heart completely relaxed. Refer to the same type of aortic root transplantation, cut off the ascending aorta under the obstruction forceps, and remove the aortic root to preserve the width of the artery wall. ~4mm. The aortic valve was removed, the aortic annulus and left ventricular outflow tract were explored, and the left and right coronary arteries were cut from the aortic wall 2 to 3 mm from the coronary artery opening to avoid excessive dissociation. 6. Referring to the application of the same kind of aortic dissection aortic artery, the autologous pulmonary valve was removed and transplanted into the aortic root, and the left and right coronary arteries were respectively anastomosed to the corresponding parts of the transplanted pulmonary artery. 7. Reconstruct the right ventricular-pulmonary artery channel with the same aortic valve, and pay attention to the protection of the coronary artery under the incision and its branches.

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