Extended aortic root replacement

Expanded aortic root replacement is mainly due to Ross's aortic root replacement and Konno's aortic-ventricular septoplasty. The aortic root is replaced with a valved aorta and the cusp connected by a valved tube. The anterior valve leaf expands the left ventricular outflow tract as a patch, so it is also called Ross-Konno surgery. Treatment of diseases: aortic regurgitation aortic valve stenosis Indication Extended aortic root replacement is applicable to: Complex left ventricular outflow tract obstruction, including diffuse aortic stenosis and tunnel aortic stenosis combined with aortic valve (ring) dysplasia. Preoperative preparation In addition to general routine procedures for open heart surgery, two-dimensional echocardiography and color Doppler examination should be performed before surgery to understand the pathological anatomy of the aortic valve, the size of the annulus and left ventricle, and whether or not the aortic regurgitation is combined. The extent of this in order to choose the appropriate surgical approach. Attention should be paid to monitoring the circulation, respiration and metabolism of critically ill infants before surgery. In the case of cardiac insufficiency, patients should be treated with diuretic diuresis. If necessary, positive inotropic drugs should be given. Newborn patients with critical illness need emergency treatment. Once the diagnosis is established, the prostaglandin E1 should be administered first through the central vein, the arterial catheter should be opened, and the right-to-left shunt of the transcatheter can be restored, which can reduce pulmonary hypertension and maintain systemic perfusion, so that it can be obtained from systemic low perfusion and acidosis. ease. These infants often need tracheal intubation and mechanical ventilation, and appropriate application of vasoactive drugs such as dopamine can help improve respiratory and circulatory function. Surgical procedure 1. Make a longitudinal incision at the lower end of the anterior wall of the aorta, straddle the aortic annulus, open the ventricular septum through the left aortic right sinus, and extend below the pulmonary valve to the anterior wall of the right ventricular outflow tract. 2. The left and right coronary artery opening and the surrounding aortic wall were cut "button" and the stenotic ascending aortic root and aortic valve were removed. 3. Select the appropriate size of the same aortic valved duct to reconstruct the left ventricular outflow tract. The posterior inferior border of the graft valve and the patient's aortic ventricle were sutured continuously with a 4-0 polypropylene thread. 4. The left coronary artery was first transplanted to the corresponding site of the newly ascending aorta with a 5-0 polypropylene line. 5. Repair and widen the ventricular septum with a mitral valve (aortic ventricle) carried by the same aortic graft; complete right coronary artery transplantation. If the allograft is a pulmonary artery or an autologous valved pulmonary artery, then another polyester sheet or a glutaraldehyde-treated pericardial patch can be used to repair the widened ventricular septum. 6. The aorta and the distal end of the graft tube were continuously anastomosed with a 4-0 polypropylene line. 7. The right ventricular conical incision was repaired with a pericardial patch treated with glutaraldehyde. 8. Exclude left and right heart system gas accumulation, open circulation, induce cardiac re-pulsation, gradually stop extracorporeal circulation, and close the chest as usual.