separation surgery

Treatment of diseases: congenital mitral valve malformation Indication 1. Select left ventricle or mixed ventricle double portal with left aortic transposition or ectopic, bilateral atrioventricular valve normal and uncomplicated cases of subaortic stenosis and pulmonary valve and annulus stenosis, such as separation surgery. 2. The main chamber of the ventricle with double inlets is large enough, and Kurosawa believes that the end-diastolic volume of the main chamber of the ventricle must exceed 170% of normal. 3. It is best to have normal pulmonary vascular resistance, but in some cases the pulmonary vascular resistance is >4U/m2. It is not suitable for the connection of the whole vena cava with the pulmonary artery, but it is suitable for the separation surgery. 4. In most cases, staged separation surgery can be performed within 3 months after birth. A small number of infants with multiple lungs should first use internal medicine to treat heart failure, and elective stage separation surgery at 2 years old. If you have refractory heart failure, you can have surgery within 3 months after birth. Contraindications 1. The ventricle double lumen of the ventricle is small or combined with severe pulmonary hypertension to produce obstructive pulmonary vascular disease. 2. Pulmonary artery hypoplasia or poor ventricular function. 3. There is significant myocardial damage. 4. There are severe liver and kidney dysfunction. Preoperative preparation 1. Patients with mild or no pulmonary stenosis who have congestive heart failure in infants and children, medical treatment with digitalis and diuretics. 2. When ventricular function is reduced, the use of angiotensin-converting enzyme inhibitors, such as thioglycolic acid or enalapril maleate (benzoic acid), is often effective. 3. Review echocardiography to check the size of the ventricle, the development of the two pulmonary arteries, the presence or absence of pulmonary stenosis or atrioventricular valve regurgitation, to determine the indications for the separation of surgery and to develop a surgical plan. Surgical procedure The mid-thoracic incision was inserted into the ascending aorta perfusion tube near the innominate artery, directly into the right and inferior vena cava right angle tube, and the left heart decompression tube was inserted in the right superior pulmonary vein or patent foramen ovale. After opening the chest, the ventricle double entrance surface morphology was observed, and the left ventricle main cavity and the right atrium were often enlarged. The abnormal connection of the vena cava and pulmonary veins and the atrioventricular valve insufficiency were examined. The outer diameter of the heart was measured, the thickness of the ventricular wall was calculated, and a woven polyester velvet patch of appropriate size was cut as a separate patch. Prevent the patch from being too large to the right ventricle to affect the ventricular function or the patch is too small to produce patch tear. Right atrial incisions are generally used, and a few authors have a fish-mouth incision through the ventricle. When the right atrial incision is poorly exposed, an arcuate incision of the right atrioventricular valve posterior valve is performed along the annulus. Intracardiac exploration was performed through the right atrioventricular incision through the right atrioventricular incision. The bilateral atrioventricular valves were connected to the right and left papillary muscles and the chordae, respectively. There was no atrioventricular valve straddle, and there was between the right and left papillary muscles. Coarse muscle trabeculae. Sewing a few needle markings at the ventricular septum for the purpose of separating the two ventricles to the same size, avoiding obstruction from the right atrium through the right atrioventricular valve to the pulmonary artery and the left atrium through the left atrioventricular valve to the outflow lumen, and Prevent heart block and coronary artery damage. At the beginning of the design separation, the suture site should be thick and large beam tissue between the atrioventricular valve and the breast muscles on the lower side of the main chamber of the ventricle. The relationship between the upper two semilunar valves and the ventricular ventricle and the cardiac conduction tissue is known. Intermittent suture stitching with a 4-0 padded polyester thread is generally used. Sometimes the fingers are pressed against the outside of the heart to make the heart turn over, which is beneficial to sew from the difficult area (ie, the trabecular muscle of the humerus) and to sew backwards and upwards to the trabecular muscle trabeculae that can withstand tension between the two atrioventricular valves. Separate the marking line according to the sew beforehand, and then suture the ventricular ventricle from the iliac crest to the left side of the lower pulmonary artery area until the sutures at both ends. Stitching in the danger zone must be close to the semilunar valve originating from the outflow lumen, away from the contralateral half moon valve. According to the Kurosawa suture method, the suture should be kept behind the cardiac conduction tissue, and the anterior superior edge of the patch sulcus to the ventricular ventricle should be in the outflow lumen (on the right ventricular surface of the outflow lumen) to avoid heart block. It is generally necessary to use 20 to 30 sutures with a gasket, and then pass through the edge of the patch to push down the ligation. An arcuate incision of the right atrioventricular valve was sutured continuously with a 5-0 polypropylene thread, and the foramen ovale and right atrium incision were sutured. If the main ventricle incision is made, it is necessary to make a suture with a septum with a septum to prevent bleeding after a heartbeat. In patients with mild pulmonary stenosis, pulmonary valve incision and dilation can be performed. If there is a severe pulmonary valve and its annulus, the suture patch should be sutured to the right side of the semilunar valve of the two arteries. The pulmonary artery trunk is then cut, the proximal end is sutured, and the same band is placed between the ventricular incision and the distal end of the pulmonary artery. The aortic extracardiac duct. In the past 10 years, there have been a few reports of staged separation surgery during infancy. The first operation time is 3 to 6 months after birth. The operation method is to use two triangular patches, one placed on the apex between the bilateral atrioventricular valves, and the intermittent suture is sutured from the edge of the patch. Inside the ventricle, the surface of the ventricle is ligated with a spacer; the other is placed between the two major and half moon lobes, and the suture is continuously sutured with a 4-0 polypropylene thread (Fig. 6.36.2-6), and the closed chamber interval is about 70%. The second stage ventricular septal defect was repaired 6 to 8 months after the operation. complication 1. Low cardiac output syndrome The incidence of low cardiac output syndrome after ventricular double-entry separation is high, and it is also the main cause of early death. It should be closely observed and treated in time. The factors that produce this syndrome are multifaceted, such as improper selection of cases, excessive separation of patches, damage to the aortic valve, chordae of the atrioventricular valve, cardiac block, cardiopulmonary bypass, and aorta Long time and poor myocardial protection. However, the main reason is the poor ventricular function and heart block that are reconstructed after surgery. Once it occurs, it is treated with medication first, and left ventricular assisted circulation is necessary. For patients with heart block, a temporary pacemaker is used. 2. After the operation, cyanosis, obvious heart enlargement and severe heart failure, the ventricular double-inlet separation patch should be considered. It is necessary to urgently confirm the diagnosis by echocardiography, and should be repaired as soon as possible. 3. If you have a long-term heart block, you should place a permanent pacemaker.