DE LA PARTE PEREZ, Lincoln. ANESTHESIA IN JATENE’S SURGERY, AN EXPERIENCE AT THE CARDIOLOGY CENTER OF “WILLIAM SOLER” HOSPITAL. Recursos Materiales y Humanos del Servicio de Cirugia cardiovascular 7. Organización para la corrección anatómica u Operación de Jatene siempre que. Cirugía de switch arterial: una historia de grandes esperanzas. mArsHALL L. JAcoBs1. Forty years ago, when Adib Jatene, in Sao Paulo, Bra- zil performed the.
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If there is a VSD which has not yet been repaired, this is performed via the atrial incision and tricuspid valveusing sutures for a small defect or a patch for a large defect. The aortic clamp is temporarily removed while small sections of the neo-aorta are cut away to accommodate the jatdne ostia, and a continuous absorbable suture is then used to anastomose each coronary “button” into the prepared space.
Eber was the first to recount a small series of successful arterial switch procedures, and the first large successful series was reported by Guatemalan surgeon Aldo R. The rib cage is relaxed and the external surgical wound is bandaged, but the sternum and chest incision are left open to provide extra room in the pleural cavityallowing the heart room to swell and preventing pressure caused by pleural effusion.
As the patient is anesthetized, they may receive the following drugswhich continue as necessary throughout the procedure:. Infundibular branches are sometimes unable to be spared, but this is a very rare occurrence. The patient will require a number of imaging procedures in order to determine the individual anatomy of the great arteries and, most importantly, the coronary arteries.
The success of this procedure is largely dependent on the facilities available, the skill and experience of the surgeon, and the general health of the patient. Mustard first conceived of, and attempted, the anatomical repair arterial switch for d-TGA in the early s.
The left ventricle is then vented and the cross clamp removed from the aorta, enabling full-flow to be re-established and rewarming to begin; ed this point the patient will receive an additional dose of Firugia to keep blood pressure under control.
If the aortic commissure has not yet been marked, it may be done at this point, using the same method as would be used prior to bypass; however, there is a third opportunity for this still later in the procedure. The cardiopulmonary bypass is then initiated by inserting a cannula into the ascending aorta as distally from the aortic root as possible while still supplying all arterial branches, another cannula is inserted into the right atriumand a vent is created for the left ventricle via catheterization of the right superior pulmonary vein.
The circumflex coronary artery may originate from the same coronary sinus as, rather than directly from, the right coronary artery, in which case they may still be excised on the same “button” and transplanted similarly to if they had a shared ostium, unless one or both jattene intramural communication with another coronary vessel.
It was the first method of d-TGA repair to be attempted, but the last to be put into regular use because of technological limitations at the time of its conception. These statistics, combined with advances in microvascular surgery, created a renewed interest in Mustard’s original concept of an arterial switch procedure. However, in cases where the individual has been diagnosed but surgery must be delayed, maternal or even autologousin certain cases blood donation may be possible, as long as the mother has a compatible blood type.
If the procedure is anticipated far enough in advance with prenatal diagnosis, for exampleand the individual’s blood type is known, a family member with a compatible blood type may donate some or all of the blood needed for transfusion during the use of a heart-lung machine HLM.
Arterial switch operation – Wikipedia
This surgery may be used in combination with other procedures for treatment of certain cases of double outlet right ventricle DORV in which the great arteries are dextro – transposed.
The Jatene procedure is ideally performed cirugis the second week of life, before the left ventricle adjusts to the lower pulmonary pressure and is therefore unable to support the systemic circulation. InAmerican surgeons Alfred Blalock and C.
The ductus arteriosus and right pulmonary branchup to and including the first branches in the hilum of the right lungare separated from cirubia surrounding supportive tissue to allow mobility of the vessels.
Anestesia en la operación de Jatene, experiencia en el Cardiocentro del Hospital “William Soler”
Silk marking sutures may be placed in the pulmonary trunk at this time, to indicate the commissure of the aorta to the neo-aorta ; alternatively, this may be done later in the procedure. Impedance cardiography Ballistocardiography Cardiotocography.
Jatene procedure An 8 day old right after the Jatene procedure. Use of the arterial switch is historically preceded by two atrial switch methods: His few attempts were unsuccessful due to technical difficulties posed by the translocation of the coronary arteries, and the idea was abandoned.
Arterial switch operation
The patient is fitted with chest tubestemporary pacemaker leads, and ventilated before weaning from the HLM is begun.
criugia While the patient is cooling, the ductus arteriosus is ligated at both the aortic and pulmonary ostiathen transected at its center; the left pulmonary branchincluding the first branches in the hilum of the left lung, is separated from the supportive tissue; and the aorta is marked at the site it will be transected, which is just below the pulmonary bifurcationproximal to where the pulmonary artery will be transected.
A blood transfusion is necessary for the arterial switch because the HLM needs its “circulation” filled with blood and an infant does not have enough blood on their own to do this in most cases, an adult would not require blood transfusion.
The previously harvested pericardium is then used to patch the coronary explantation sites, and to extend – and widen, if necessary – the neo-pulmonary root, which allows the pulmonary artery to be anastamosed without residual tension; the pulmonary artery is then transplanted to the neo-pulmonary root. Although the atrial switch procedures dramatically reduced both early and late mortality rates, these statistics remained high, partly due to the wait time required between birth and surgery pre-operative mortality: As with any procedure requiring general anaesthesia, arterial switch recipients will need to fast for several hours prior to the surgery to avoid the risk of aspiration of vomitus during the induction of anesthesia.
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