Ventricular septum perforation suture

After ventricular septal perforation, myocardial tissue of ischemic necrosis can complete the fibrotic healing process after 6-8 weeks. At this time, the operation is stable because of the disease, and the fibrotic myocardial tissue around the broken hole is firmer. Stronger, the success rate of surgery is higher. However, most cases did not survive until 2 months after onset. Therefore, surgery should be performed as early as possible. However, early surgery after onset, the operative mortality rate is higher. Treatment of diseases: renal failure, cardiogenic shock Indication The operative mortality rate decreased after 3 weeks of ventricular septal perforation. Only 20% of those who survived for more than one month after onset. The choice of operation time needs to weigh the pros and cons, and there are many controversies. After the onset of hemodynamics, the circulatory system changes rapidly, and the symptoms of cardiogenic shock, elevated pulmonary venous pressure, renal dysfunction, and imbalance of body fluid balance must be performed as soon as possible. Contraindications When the disease progresses to a severe shock, affecting the central nervous system, kidney or other visceral failure, it should be classified as a contraindication for surgical treatment. Preoperative preparation A full-scale examination is required to assess the patient's physical condition. Surgical procedure The midline of the chest is incision, the sternum is cut longitudinally, the happy bag is cut, the heart is revealed, and the myocardial and ventricular septal infarction sites are determined. After systemic heparinization, a blood-sucking catheter is placed in the right atrium or in the superior and inferior vena cava, a blood catheter is inserted into the ascending aorta, and the artificial heart-lung machine is connected to start extracorporeal circulation. The ice was used for local deep cooling of the heart, and a blocking forceps was placed in the ascending aorta. The cold heart cardioplegia was injected into the proximal aorta of the forceps to perform intracardiac operation. The left ventricular incision should be used for ventricular septal perforation after suturing myocardial infarction, and the right ventricular incision approach for suturing congenital ventricular septal defect should not be used. Because the right ventricular incision is not only unsatisfied with the ventricular septal area, the abnormal activity caused by left ventricular myocardial infarction, or the ventricular aneurysm of the cake, and the right ventricular incision damage the normal right ventricular myocardium, cut off from the right The collateral circulation of the coronary branch further impairs left ventricular myocardial blood supply. Brandt et al. and David et al reported cases of ventricular septal perforation through right ventricular incision, and left to right shunt recurrence after 38 to 41% of ventricular levels. The ventricular septal rupture site is most common in the anterior ventricular septum near the apical region, followed by the ventricular septum, and can also be confined to the apical region. The ventricular septal perforation site is confined to the apical region. Because of the small myocardial infarction area, the technique of suturing is simple and the surgical effect is the best. The technique of suturing the posterior perforation of the ventricular septum is the most difficult. Pericardial ventricular septal perforation: the incision into the left ventricular cavity through the left ventricular apex myocardial infarction, revealing the ventricular septal perforation, resecting the necrotic myocardium in the ventricular septal lesion and myocardial tissue in the left and right ventricular apical infarction . The left ventricular surface is sewed with a polyester woven piece under the ventricular septum to fill the broken area. The suture should be placed at a normal ventricular septal tissue far from the perforated area, and a small piece of woven piece is placed on the right ventricular surface, and the left and right ventricular apical incisions are sutured. Polyester woven sheet, or woven with a woven piece to fill the apex incision. The suture of the sutured apical incision should be passed through the lower portion of the sutured ventricular septum. Ventricular septal anterior perforation: a left ventricular incision parallel to the anterior descending artery in the middle part of the left ventricular anterior wall myocardial infarction, revealing the ventricular septal rupture site, excising the ventricular septal and ventricular wall necrosis of myocardial tissue, and then pressing the ventricle The size of the gap is used for direct suture or woven suture. If the rupture is smaller, the posterior edge of the ventricular septum can be directly sutured with the anterior wall of the left and right ventricles with the intermittent suture suture with a gasket. The needle should be slightly farther from the rupture and penetrate the healthy myocardial tissue. . The rupture is large. If the suture tension is too large after suturing directly, it is necessary to use a polyester woven suture to fill the ventricular septum and then suture the left ventricle incision. Perforation of the posterior ventricular septum: the perforation of the posterior ventricle is more difficult and difficult to operate. After the heart is lifted out from the pericardial cavity and raised, the myocardial infarction area of the posterior wall of the left ventricle is incised, and the ventricular septal perforation area is revealed. If the ventricular septal break is small, the necrotic myocardium at the ventricular septum and ventricular wall is removed. After the tissue, the posterior edge of the breach and the right ventricular wall of the face were sutured intermittently with a sputum suture, and the left ventricular incision was sutured. If the rupture is larger, the ventricular septum should be sewed with polyester woven pieces, the woven piece covering the left ventricle side of the rupture, and another woven piece should be used to fill the left ventricular incision. In the same period, patients undergoing coronary artery bypass grafting took a spare saphenous vein before starting extracorporeal circulation. After the completion of ventricular septal repair, the saphenous vein-coronary artery end-to-side anastomosis was performed. After the aortic occlusion forceps were removed and the extracorporeal circulation was stopped, the aortic wall was partially clamped for ascending aorta-saphenous vein anastomosis. complication About 10 to 25% of patients with follow-up after surgery still have residual left-to-right shunt or ventricular septal fissure and then split again. Those with more flow should be operated again.