atrial septal defect repair

1. The diagnosis of atrial septal defect is clear, and surgery should be performed regardless of symptoms. 2. Pulmonary hypertension is still mainly from left to right shunt, and surgery should be sought. 3. Patients with heart failure should actively control heart failure before surgery, create conditions for surgery, and strive for active surgery. 4. Patients with cardiac rhythm disorders should undergo surgery under drug treatment and controlled heart rhythm conditions. 5. Surgery should be performed at any age, but surgery should be performed as soon as possible, with preschool age as the most appropriate. Treatment of diseases: atrial septal defect in children with atrial septal defect atrial septal defect Indication 1. The diagnosis of atrial septal defect is clear, and surgery should be performed regardless of symptoms. 2. Pulmonary hypertension is still mainly from left to right shunt, and surgery should be sought. 3. Patients with heart failure should actively control heart failure before surgery, create conditions for surgery, and strive for active surgery. 4. Patients with cardiac rhythm disorders should undergo surgery under drug treatment and controlled heart rhythm conditions. 5. Surgery should be performed at any age, but surgery should be performed as soon as possible, with preschool age as the most appropriate. Contraindications In patients with severe pulmonary hypertension, a reverse shunt (right to left shunt) occurs, and clinically occurring purpura is a surgical contraindication. Preoperative preparation 1. If you have heart failure, you should be treated with heart, diuretic, and 3 months after heart failure control. 2. Patients with pulmonary hypertension should be treated with vasodilators before surgery to reduce pulmonary artery pressure. 3. Patients with heart rhythm disorders, medication treatment. Surgical procedure 1. Position, incision: supine position, open the incision in the middle of the sternum, and cut the happy bag in the longitudinal direction. 2. Cardiac exploration: extracardiac exploration for the presence or absence of malformation, such as ectopic pulmonary venous return to the right atrium, left superior vena cava, patent ductus arteriosus and right ventricular outflow tract or pulmonary stenosis. 3. Establish extracorporeal circulation. 4. Open the right atrium: use the hook to pull the happy incision, there are three types of atrial septal defect, and determine the location of the coronary sinus, with or without ectopic connection of the pulmonary vein. 5. Repair of various types of atrial septal defect (1) Central type: The defect is located near the fossa ovalis, which can be single or mesh-shaped. The repair method can be directly and intermittently sutured [Fig. 2-2]; if the defect is large, it can be repaired with the corresponding size of the autologous pericardium or polyester cloth. When suturing or patching the last stitch, the saline anesthesiologist should be injected into the left atrium to dilate the lungs, so that the left atrium is filled with liquid to drain the air in the left atrium, and then tighten the knot. (2) sinus type: this type of defect is close to the superior vena cava, so when the defect is repaired, the right atrial incision should extend to the superior vena cava and cut open to the boundary. With the patch repair, the first needle should be sutured at the junction of the right atrium and the superior vena cava, the upper vena cava side is sutured with several double-ended needles, and the rest are sutured continuously. This type of defect is easy to be combined with left superior vena cava and pulmonary vein ectopic connection, and should be carefully examined during surgery. (3) Lower cavity type: This type is a low defect and the lower edge is absent. Therefore, the next stitch should be sewn on the left atrial wall tissue. (4) with partial pulmonary vein ectopic connection: If the atrial septal defect is large enough, the other edge of the defect can be directly sutured in the right atrium of the pulmonary vein opening; if the defect is small, it can be expanded and then sutured; if the direct suture has tension deformation, even For pulmonary venous obstruction, patch repair is applied. (5) Primary atrial septal defect: the primary atrial septal defect is located in the lower part of the interatrial septum, close to the tricuspid and mitral valves, and the coronary venous opening is located on the posterior lateral side, often with mitral anterior flap. In order to avoid damage to the conduction beam, the primary atrial septal defect is always repaired with a patch. After the right atrium is opened, the primary hole is revealed. If there is a mitral valve, the silk can be sutured at the root of the suture. Generally, the suture is 3 to 4 needles. Excessive suture can affect the mitral function (stenosis or insufficiency). The patch is cut into a slab-like shape corresponding to the size of the defect with a self-contained pericardium or polyester cloth, and a relatively flat surface is placed at the junction of the mitral and tricuspid valves. In order to avoid suturing the conduction beam, a shallow suture method is used, that is, the needle is moved under the endocardium in the risk zone of the conduction beam injury (middle of the mitral valve to the coronary sinus). The rest does not have this concern. The suturing method can be sutured intermittently or continuously sutured. 6. Stitching the right atrial incision: Before the end of the intracardiac operation, the left atrial air should be discharged first. The right atrium incision was sutured continuously, and before the last needle was knotted, physiological saline was injected into the right atrium, and the air in the right atrium was drained and knotted. 7. End of extracorporeal circulation and chest closure: establishment of extracorporeal circulation.