Starnes surgery

The goal of Starnes surgery is to dispose of the right ventricle to eliminate tricuspid regurgitation and to relieve the right ventricle from compressing the left ventricle and to establish a new source of blood flow to the lungs. Treatment of diseases: pulmonary atresia Indication Starnes surgery is available for: For neonates with functional pulmonary atresia, Starnes surgery is used after the rescue cases are stabilized. Then, bidirectional cavopulmonary bypass or 2 to 4 years old total vena cava and pulmonary artery connection were performed 4 to 6 months after birth. Contraindications In cases of non-functional pulmonary atresia, no such operation is required, and atrial ventricular folding should be performed. Preoperative preparation 1. For critically ill newborns with functional pulmonary atresia, rescue should be actively organized, rapid intubation and high ventilation assisted breathing should be performed to form respiratory alkalosis, and prostaglandin E1 or carbon monoxide should be used to treat hypoxemia. And reduce pulmonary vascular resistance. 2. Continuous intravenous infusion of dopamine or dobutamine, intermittent intravenous sodium bicarbonate, for the treatment of heart failure and metabolic acidosis. 3. If the symptoms are not significantly improved, surgery should be performed. Surgical procedure The midline incision of the sternum. The ascending aorta was inserted into the arterial infusion tube and directly inserted into the right and inferior vena cava right angle tubes. After the extracorporeal circulation, the blood flow was cooled, and after stopping the aorta and the heart was stopped, the right atrial oblique incision was made and the right atrium was removed (Fig. 6.35.1-1A). Through the patent foramen ovale into the left heart decompression tube, intracardiac exploration often found severe tricuspid regurgitation, room and functional right ventricle significantly increased, and a normal open pulmonary valve. The fossa ovalis was removed, and the diameter of the atrial septal defect was 1.6-2.0 cm. Cut the pericardial or expanded polytetrafluoroethylene patch to the appropriate size. A 6-0 polypropylene thread was used to sew from the outside of the coronary sinus, and a continuous suture of the Todaro ligament and the ventricular septal atrial portion edge and the tricuspid annulus was made with the patch. The right atrium incision was sutured. After rewarming and open aorta, after the heart was re-jumped and stopped circulating, a 3.5-4.0 cm inner diameter expanded polytetrafluoroethylene was used as a central shunt, one end of which was anastomosed to the pulmonary artery, and the other end was anastomosed to the ascending aorta. An unnamed artery and a right pulmonary artery shunt can also be performed. Newborns should routinely perform modified ultrafiltration after stopping the circulation, ultrafiltration of excess fluid and inflammatory mediators in the body, and improve heart and lung function.

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