Double Glenn shunt and semi-Fontan procedure

Curing disease: Indication 1. The optimal age for surgery is 4 to 6 months. 2, double Glenn shunt and semi-Fontan surgery can be used for total pulmonary veins and pulmonary artery connection with surgical risk factors, such as pulmonary vascular resistance> 3U / m2, mean pulmonary artery pressure > 20mmHg, atrioventricular valve insufficiency, poor cardiac function, heart Internal ectopic syndrome, etc. Contraindications 1, pulmonary hypertension, pulmonary vascular resistance > 4U / m2. 2. Pulmonary artery and ventricular hypoplasia. Preoperative preparation 1. Conventional preoperative preparation for open heart surgery with extracorporeal circulation. 2, patients with congestive heart failure, the application of digitalis and diuretics. 3, there are severe hair loss, tissue rescue after birth, continuous intravenous infusion of prostaglandin E1, keeping the arterial catheter open. The application of this drug, the opening of the arterial catheter can improve the blood flow in the lungs, and the palliative operation after the disease is stable can greatly improve the effect of the body-pulmonary shunt. 4. Diagnosis was determined by echocardiography and cardiac catheterization, and left atrial and right atrial pressure were measured. Cardioangiography is used to understand pulmonary artery development and the presence or absence of malformations of the vena cava and brachiocephalic arteries. Surgical procedure 1, two-way cavity pulmonary shunt The median incision in the chest, cut the happy bag, explore the development of pulmonary arteries on both sides, with or without patent ductus arteriosus and left superior vena cava. Patients who underwent cardiac catheterization before surgery were tested for mean pulmonary artery pressure and left ventricular end-diastolic pressure. The ascending aorta near the innominate artery was inserted into the arterial perfusion tube, and the superior vena cava tube was inserted above the azygous vein to block and ligature the azygous vein, and the inferior vena cava tube and the right superior pulmonary vein were inserted through the lower right atrium. Left heart decompression tube. Completely separate the pulmonary trunk and bilateral pulmonary arteries to the outlet of the pericardium. After routine extracorporeal circulation, the standard or modified subclavian artery and pulmonary artery shunted subclavian artery or expanded polytetrafluoroethylene tube were ligated. (1) The superior vena cava was cut 1 cm in the right atrium, and a 0.8-1.0 cm longitudinal incision was made on the distal side of the distal atrium to suture the proximal end of the superior vena cava. A traction line is sutured at the inner and outer sides of the distal vena cava to prevent retraction. (2) Blocking the trunk of the pulmonary artery root, and making a transverse incision in the purse of the mouth above it, and then inserting the suction tube into the right pulmonary artery from the incision, and there is no blood surgery field when the anastomosis is maintained. Make a longitudinal incision to the left of the upper edge of the right pulmonary artery, 3 to 4 cm long, and make a traction line at each edge of the incision. Sometimes it is necessary to remove a small portion of the upper edge of the right pulmonary artery to enlarge the anastomosis. The top of the right longitudinal incision of the superior vena cava was sutured to the right end of the superior incision of the right pulmonary artery with a 6-0 polypropylene thread. The posterior margins of the two incisions were sutured continuously from right to left, and the leading edge was sutured intermittently. (3) The proximal and distal right pulmonary artery can also be blocked with a non-invasive vascular clamp under the superior vena cava to the right atrium, and then the superior vena cava distal end and the right pulmonary artery incision anastomosis. In the infant, the pulmonary artery can be cut off, and the proximal and distal ends of the pulmonary trunk can be sutured. In large children, the pulmonary artery is partially ligated to suture the upper incision or the pulmonary artery is ligated for central shunt, so that the arterial oxygen saturation must be maintained. More than 80%. In the case of a small atrial septal defect or severe mitral regurgitation, the atrial septal defect should be enlarged to 2.0 cm in diameter or mitral valve repair under hypothermic cardiac arrest. 2, half Fontan surgery (1) According to the above surgical procedure, the bidirectional pulmonary pulmonary shunt was performed first, then the extracorporeal circulation was used to cool down, and the right atrial incision was made under the low temperature stop. The expanded PTFE patch was used to continuously suture the superior vena cava. A longitudinal incision was made in the posterior aspect of the superior vena cava, and the proximal end of the superior vena cava and the lower edge of the right pulmonary artery were deflected to the right side for end-to-side anastomosis. The posterior margin of the anastomosis was sutured continuously with 5-0 or 6-0 polypropylene fiber. The leading edge is sutured intermittently. (2) Apply the pericardial patch to repair the gap after the anastomosis and suture the right atrium incision. complication 1, superior vena cava syndrome continuous monitoring of the superior vena cava pressure, if the upper vena cava pressure is found to exceed 15mmHg, this syndrome will occur. General medical treatment can be cured. 2, chylothorax should be closed drainage. 3, children over the age of 6 years after the bi-directional pulmonary artery shunt after arterial oxygen saturation saturation is less than 80% and (or) oliguria, should be quickly re-operation plus central shunt to make arterial oxygen saturation The degree is increased to 80% to 85% to prevent severe metabolic acidosis and renal failure. 4, postoperative cerebral venous hypertension reflex will produce systemic hypertension, you should quickly increase the dose of sodium nitroprusside to reduce the burden after systemic circulation. 5, when severe mitral regurgitation remains, mitral valve repair or replacement should be performed again.

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