Endocardial cushion defect repair surgery

Endocardial pad defect is a rare and complex congenital heart disease. The lesion is partially missing in the atrioventricular ring, in the lower atrium, and ventricular septal tissue, and may be associated with varying degrees of atrioventricular valve malformation. Treating diseases: congenital heart disease Indication Endometrial pad defect. Preoperative preparation Antibiotics are routinely used before surgery. Surgical procedure Partial endocardial defect repair: After the establishment of extracorporeal circulation, the right atrium was opened and the lesion was revealed. The injection of physiological saline from the left ventricular cannula was helpful to observe the atrioventricular valve alignment. The mitral anterior leaflet lobes were sutured with 4-0 sutures. Generally, only 3 to 4 needles were placed. Care should be taken to avoid excessive tissue tension at the suture to cause deformation of the leaflets and aggravation of insufficiency. The crimped edge curler can be sutured and sutured to reduce tension. In a small number of cases, due to short or abnormal papillary muscles, the flaps of the flaps may be partially cut to improve the fit of the papillary muscles. The atrial septal defect can be sutured according to the operation method described in the previous paragraph, or a larger pericardial piece can be sutured and fixed on the base of the tricuspid valve leaflet corresponding to the top of the anterior leaflet fissure, and then the pericardium is covered with the atrial septal defect. And the atrioventricular nodal triangle, along the base of the tricuspid valve leaflet, the superficial tissue of the superior sinus opening or the base of the sinus sinus, the superficial tissue of the superior sinus opening or the lower edge of the coronary sinus opening and The upper edge of the room is divided into seams. Complete atrial septal defect repair: The complete endocardial cushion defect has various forms. After incision of the right atrium, the lesions of the atrioventricular valve and ventricular septum must be identified in detail. In patients with common anterior leaflet lobes, attention should be paid to the commissure of the mitral valve leaflets and the attachment of the anterior mitral valvular lobes to the mitral nucleus, and then pass through the tip of the mitral anterior leaflet lobes. Needle stitching. In cases where the anterior mitral valve leaflet and the tricuspid valve leaflet merge with each other, the mitral valve and the tricuspid valve leaflet joint of the common anterior leaflet are cut over the ventricular septal ridge to reveal the ventricular septal defect. Prepare the polyester patch according to the area of the ventricular septal defect, suture the patch continuously or intermittently with the 5-0 suture on the right side of the ventricular septal ridge, and leave the tricuspid chordae in the right ventricle of the patch. On the lateral side, the mitral chordae are placed on the left ventricular side of the patch. If a small number of chords prevent the suture of the woven piece, it can be removed. Then the anterior leaflet of the mitral valve on both sides of the rib is pulled up to tighten the chordae, and then the base of the leaflet is sutured to the edge of the patch. It must be noted that the leaflets on both sides of the lobes are well aligned and not deformed. Then suture the base of the tricuspid valve leaflet with the patch and note that the bilateral atrioventricular rings are at an appropriate height. Suture the anterior valve leaflet of the mitral valve, and the tricuspid valve does not need suture if it has a fissure. The saline was injected into the left ventricle cannula to observe the opening and closing function of the atrioventricular valve. About half of the cases after surgery are still mitral regurgitation but less than before surgery. If there is still severe mitral regurgitation, mitral valve replacement may be considered. Mild regurgitation of the tricuspid valve has little effect on cardiac function, but if the tricuspid annulus is too large and causes severe regurgitation, the annuloplasty can be performed at the junction of the leaflet and the posterior leaflet. Trim the pericardial patch or woven piece according to the shape and size of the atrial septal defect, through the continuous sacral suture through the base of the anterior leaflet of the mitral valve, the polyester patch, the base of the tricuspid valve leaflet and the pericardial patch or woven piece For suturing, the first atrial atrial septal defect was sutured as described above.