body pulmonary shunt

Infants should be operated under shunt within 3 months. 3-6 months of babies, such as obstruction in the outflow tract and valve, the pulmonary artery development is normal, can be radical surgery; if the annulus and pulmonary artery is too small, it is a shunt surgery. Those who have been born for more than 6 months can be treated with radical surgery. Intraoperative attention should be paid to the repair of ventricular deficiencies should be strict and accurate, to ensure that no residual leaks are left. Sputum suture should be used when suturing in the danger zone, leaving the edge 0.5cm, and the suture depth should be appropriate, reliable, and not allowed to reach the endocardium of the left ventricular surface, so as not to damage the conduction beam. Stop bleeding during surgery to prevent postoperative bleeding and complicated mediastinal infection. Epicardial pacing electrodes should be routinely installed for postoperative antiarrhythmia, and pacing can be performed at any time in the event of a conduction disorder. Treatment of diseases: pulmonary valve insufficiency pulmonary dysplasia primary-pulmonary septal defect Indication Infants should be operated under shunt within 3 months. 3-6 months of babies, such as obstruction in the outflow tract and valve, the pulmonary artery development is normal, can be radical surgery; if the annulus and pulmonary artery is too small, it is a shunt surgery. Those who have been born for more than 6 months can be treated with radical surgery. Preoperative preparation 1. Prevent or correct infections in the respiratory tract and other areas. 2. Encourage patients to drink more water to prevent dehydration and blood concentration. 3. Correct coagulopathy. 4. Patients with severe purpura can intermittently give oxygen. Surgical procedure 1. Position and incision: right lateral position, left fourth intercostal space (or right side incision), for posterior lateral incision. 2. Exposing the left pulmonary artery: longitudinally incision of the mediastinal pleura, revealing the left pulmonary artery trunk, so that complete separation; to achieve complete separation of the left pulmonary artery trunk, so that both the proximal and distal can be placed into a right angle vascular clamp or can be inserted into the block band. The left subclavian artery is then separated to the bifurcation. 3. Cut the left subclavian artery: Before separating the subclavian artery, first cut the mediastinal pleura along it, then bluntly separate the full length of the artery, so that it is completely free. Following the distal ligation and suture, such a short segment can also ligature its branches at the bifurcation, so that the blood vessel remains as long as possible, and the broken end of the subclavian artery is a bell mouth. The proximal blalock forceps controls bleeding, and the left subclavian artery is cut off at the proximal side of the distal suture. At this time, another blalock forceps is used instead of the original blalock forceps, but the direction of the forceps is opposite to the previous one to allow the blood vessels to be placed. The broken end is pulled to the side of the left pulmonary artery, which is advantageous for the anastomosis operation. 4. Anastomosis: The outer membrane of the subclavian artery was removed. The left pulmonary artery is then removed as the outer membrane of the anastomotic site. The wall of the pulmonary artery is thin, and care should be taken to avoid excessive stripping and damage the pulmonary artery wall. The left end of the left pulmonary artery was controlled with blalock forceps to control blood flow, and the distal end was controlled by a belt or thick wire to control blood flow. The pulmonary artery is cut longitudinally, and the incision should be slightly larger than the diameter of the subclavian artery. Use 5-0 non-invasive needle thread for continuous valgus suture on the posterior wall. The anterior wall is sutured with intermittent or continuous valgus. Before the last stitch is tightened, the distal tourniquet of the pulmonary artery is opened to return the blood. gas. The proximal hemostasis of the pulmonary artery was opened after ligation of the last stitch. Finally, open the subclavian artery hemostasis, generally no bleeding. If there is bleeding, hot saline gauze can be used to compress the heat to stop bleeding; blood leakage is fierce, hot compress can not stop bleeding, can be sutured to stop bleeding. 5. Place the drainage tube and close the chest.

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