Patent Ductus Arteriosus Ligation and Cutoff Suture

After the diagnosis of patent ductus arteriosus, surgery is performed at any age in principle, but the best age for surgery is 5 to 7 years old (ie preschool). Before the age of 5, if the condition is serious and it is difficult to maintain life without surgery, it should be treated as soon as possible. If the patient has heart failure, it is best to perform surgery after 3 months of stable heart failure; if heart failure cannot be controlled, surgery should be performed under the supervision of medication. In the case of bacterial endocarditis, a large dose of intravenous antibiotics is administered, and the endocarditis is controlled for 3 months. If endocarditis cannot be controlled, salvage surgery is performed at the same time as the high-dose antibiotic is applied. If the catheter is slender, it is usually used for ligation. When the diameter of the catheter is greater than 1cm, and the length of the catheter is less than 0.5cm, the ligation may break the catheter, and the suture should be used. For patients with obvious pulmonary hypertension, severe sutures are usually used; recanalization is likely to occur after ligation. Treatment of diseases: pediatric patent ductus arteriosus, congenital patent ductus arteriosus, patent ductus arteriosus Indication 1. After the diagnosis of patent ductus arteriosus, surgery is performed at any age in principle, but the best age for surgery is 5 to 7 years old (ie, preschool). Before the age of 5, if the condition is serious and it is difficult to maintain life without surgery, it should be treated as soon as possible. If the patient has heart failure, it is best to perform surgery after 3 months of stable heart failure; if heart failure cannot be controlled, surgery should be performed under the supervision of medication. In the case of bacterial endocarditis, a large dose of intravenous antibiotics is administered, and the endocarditis is controlled for 3 months. If endocarditis cannot be controlled, salvage surgery is performed at the same time as the high-dose antibiotic is applied. 2. If the catheter is slender, it is usually used for ligation. When the diameter of the catheter is greater than 1cm, and the length of the catheter is less than 0.5cm, the ligation may break the catheter, and the suture should be used. For patients with obvious pulmonary hypertension, severe sutures are usually used; recanalization is likely to occur after ligation. Contraindications 1. There are other congenital cardiovascular malformations (such as tetralogy of Fallot, aortic arch interruption, etc.). The patent for the incontinence is the compensatory effect of the patient's survival. The catheter should not be ligated until the other malformations are cured. 2. In children under two years of age, the catheter may be automatically closed. If there are no special serious complications (such as uncontrollable heart failure, endocarditis, etc.), surgery should not be performed. 3. When there is a right-to-left shunt in the pulmonary hypertension, the ligation of the catheter can have consequences. However, if the pulmonary hypertension patients have two-way shunt, and the left-to-right shunt is the main, and the lungs are still congested, the surgical problems can be carefully considered, not necessarily the contraindications for surgery. Preoperative preparation 1. If there is endocarditis and heart failure, it should be controlled for 3 months before surgery. 2. Patients with pulmonary hypertension, preoperative application of vasodilator drugs to reduce pulmonary artery pressure. 3. Heart rate is faster, preoperative use of purine base, no atropine. 4. Treatment of infected lesions such as dental caries and tonsillitis. Surgical procedure 1. Position, incision: right lateral position, for the left posterolateral incision, the child enters the chest through the fourth intercostal space, the fourth rib is removed by the adult, and the chest is inserted through the ribbed bed; 3 intercostal anterior lateral incision. 2. Determining the catheter site: After entering the chest, the vagus nerve located on the lateral side and the medial phrenic nerve are identified in the aortic arch, and a triangular region is formed between the two and the upper edge of the left hilum. If the tremor can be reached at the bottom of the triangle (where the catheter is located between the left pulmonary artery and the aorta), the diagnosis is correct. 3. Incision of the mediastinal pleura: longitudinally incision of the mediastinal pleura at the posterior descending aorta of the vagus nerve, and suture the traction line to pull the pleura along with the vagus nerve to the front side. 4. Separation catheter: use the tissue sharpness and bluntly separate the anterior, upper and lower edges of the catheter with a small gauze ball to expose the recurrent laryngeal nerve from the vagus nerve to the posterior side of the catheter, pay attention to protection, and prevent the clamp from being clamped. Or damage. The small gauze ball is then passed through the upper and lower edges of the catheter to separate the posterior side of the catheter, and then the right side of the catheter is used to probe the opposite side from the superior or lower edge of the catheter. If the clamp end is seen on the opposite side, the back side has been separated; if the tip of the clamp is not exposed, the left hand can be used to touch the finger; if it is found that a thick layer of tissue is still separated, the separation clamp should be withdrawn and reused. The small gauze ball is separated; if the finger feels only a thin layer of soft tissue, the small gauze ball can be used to rub the tip of the pliers, the soft tissue is separated, the plier tip is exposed, and the separation surface on the back side of the catheter is further enlarged. 5. Treatment catheter (1) Ligation catheter: Two "reins" braided with a 7-gauge thread were passed through the posterior side of the catheter and placed at the ends of the aorta and pulmonary artery, respectively. The aortic end was first ligated, and the tremor completely disappeared to moderate, and then the pulmonary artery was ligated. (2) Severing and suturing the catheter: If it is not suitable for ligation and is suitable for cutting or suturing, the two aortic forceps are used to clamp the aortic end and then the pulmonary artery end. Both pliers should be as close as possible to the ends so that there is a large distance between them to cut and suture. If the distance between the two clamps is too short (less than 0.5cm), then a pair of catheter clamps should be placed on each side of the two clamps, and then the middle two clamps should be removed to make a sufficient distance in the middle. When cutting and suturing the catheter, it is advisable to cut and sew the seam, in case the bleeding is easy to handle. The catheter can be cut halfway, sutured with 3-0~5-0 suture, the end of the aorta side is sutured, and the end of the pulmonary artery is sutured, and then suture is continued. After sewing the first track, turn back and continue to stitch the second. The second is to be closer to the catheter clamp to avoid damage to the first suture. When assisting in the use of catheter clamps, care should be taken to press the clamps against the aorta and the pulmonary artery side, respectively, to prevent the catheter forceps from slipping off, and to prevent the clamps from loosening to avoid major bleeding. Release the catheter clamp and observe for blood leaks. If there is blood leakage, it can be stopped by warm saline gauze; the larger blood leakage is interrupted by intermittent suture. 6. Close the chest: After closing the mediastinal pleura, flush the chest cavity, place the chest drainage tube, and suture the chest wall layer by layer.