CIRUGIA DE JATENE PDF
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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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 dde artery to be anastamosed without residual tension; the pulmonary artery is then transplanted to the neo-pulmonary root.
An 8 day old right after the Jatene procedure.
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 jatenee this still later in the procedure. Valve repair Valvulotomy Mitral valve repair Valvuloplasty aortic mitral Valve replacement Aortic valve repair Aortic valve replacement Ross procedure Percutaneous aortic valve replacement Mitral valve replacement production of septal defect in heart enlargement of existing septal defect Atrial septostomy Balloon septostomy creation of septal defect in heart Blalock—Hanlon procedure virugia from heart chamber to blood vessel atrium to pulmonary artery Fontan procedure left ventricle to aorta Rastelli procedure right ventricle to pulmonary artery Sano shunt compound procedures for transposition of great vessels Arterial switch operation Mustard procedure Senning procedure for univentricular defect Norwood procedure Kawashima procedure shunt from blood vessel to blood vessel systemic circulation to pulmonary artery shunt Blalock—Taussig shunt SVC to the right PA Glenn procedure.
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.
Use of the arterial switch is historically jatee by two atrial switch methods: As the patient is anesthetized, they may receive the following drugswhich continue as necessary throughout the procedure:. 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: Scottish pathologist Matthew Baillie first described TGA inpresumably as a posthumous diagnosis.
dee The vessels are again examined, and the pulmonary root is inspected for left ventricular outflow tract obstruction LVOTO. 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.
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.
The aorta is then transplanted onto the pulmonary root, using either absorbable or permanent continuous suture. In most cases, the coronary implantation sites will be at left and right anterior positions at the base of the neo-aorta; however, if the circumflex coronary artery branches from the right coronary arterythe circumflex coronary artery will be distorted if the pair are d implanted higher than normal on the neo-aorta, and in some cases they may need to be implanted above the aortic commissure, on the native aorta itself.
Retrieved from ” https: In most cases, though, the patient receives a donation from a blood bank. A generous section of pericardium is harvestedthen disinfected and sterilized with a weak solution of glutaraldehyde ; and the coronary and great artery anatomy are examined.
Heart valves and septa Valve repair Valvulotomy Mitral valve repair Valvuloplasty aortic mitral Jatfne replacement Aortic valve repair Aortic valve replacement Ross procedure Percutaneous aortic valve replacement Mitral valve replacement production of septal defect in heart enlargement of existing septal defect Atrial septostomy Balloon septostomy creation of septal defect in heart Blalock—Hanlon procedure shunt from heart chamber to blood vessel atrium to pulmonary artery Fontan procedure left ventricle to aorta Rastelli procedure right ventricle to pulmonary artery Sano shunt compound procedures for transposition of great vessels Arterial switch operation Mustard procedure Senning procedure for jatenw defect Norwood procedure Kawashima procedure shunt from blood vessel to blood vessel systemic circulation to pulmonary artery shunt Blalock—Taussig shunt SVC to the right PA Glenn procedure.
Impedance cardiography Ballistocardiography Cardiotocography. The aortic clamp is temporarily removed while small sections of the neo-aorta are cut away to accommodate the coronary ostia, and a continuous absorbable suture is then used to anastomose each coronary “button” into the prepared space.
When the septal defects have been repaired and the atrial incision is closed, the previously removed cannula are replaced and the HLM is restarted.
Arterial switch operation – Wikipedia
When the patient is fully cooled, the ascending aorta is clamped as close as possible below the HLM cannula, and cryocardioplegia is achieved by delivering cold blood to the heart via the ascending aorta below the cross clamp.
The circumflex coronary artery may originate from the same coronary jatwne as, rather than directly from, the right dd 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 jqtene both have intramural communication with another coronary vessel.
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 coronary arteries are carefully mapped out in order to avoid unexpected intra-operative complications in transferring them from the native aorta to the neo-aorta. The patient will continue to fast for up to a few days, and breastmilk or infant formula can then be gradually introduced via nasogastric tube NG tube ; the primary goal after a successful arterial switch, and before hospital discharge, is for the infant to gain back the weight they have lost and continue to gain weight at a normal or near-normal rate.
The HLM is turned off and the aortic and atrial cannula are removed, then an incision is made in the right atrium, through which the congenital or palliative atrial septal defect ASD is repaired; where a Rashkind balloon atrial septostomy was used, the ASD should be able to be closed with sutures, but cases involving large congenital ASDs or Blalock-Hanlon atrial septectomya pericardial, xenograftor Dacron patch may be necessary.
Arterial switch operation
The great arteries are usually arranged using the LeCompte maneuverwith the aortic cross clamp positioned to hold the pulmonary artery anterior to the ascending aorta; though with some congenital arrangements of the great arteries, such ciruia side-by-side, this is not possible and the arteries will be transplanted in the non-anatomic ‘anterior aorta’ arrangement. The world’s smallest infant to survive an arterial switch was Jerrick De Leon, born 13 weeks premature.
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. The ductus arteriosus and right pulmonary branchup to and including the first branches in the hilum of the right cirugiqare separated from the surrounding supportive tissue cigugia allow mobility of the vessels.
Anestesia en la operación de Jatene, experiencia en el Cardiocentro del Hospital “William Soler”
Jatene procedure An 8 day old right after the Jatene procedure. Mustard first conceived of, and attempted, the anatomical repair arterial switch for d-TGA in the early s.
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 firugia type.
Rollins Hanlon introduced the Blalock-Hanlon atrial septectomywhich crugia then routinely used to palliate patients. This would have effectively reduced early mortality rates, particularly in cases with no concomitant shunts, but is unlikely to have reduced late mortality rates.
This procedure yielded early and late mortality rates comparable to the Senning procedure; however, a late morbidity rate was eventually discovered in relation to the use of synthetic graft material, which does not grow with the recipient and eventually causes obstruction.