DE LA PARTE PEREZ, Lincoln. ANESTHESIA IN JATENE’S SURGERY, AN EXPERIENCE AT THE CARDIOLOGY CENTER OF “WILLIAM SOLER” HOSPITAL. Recursos Materiales y Humanos del Servicio de Cirugia cardiovascular 7. Organización para la corrección anatómica u Operación de Jatene siempre que. Cirugía de switch arterial: una historia de grandes esperanzas. mArsHALL L. JAcoBs1. Forty years ago, when Adib Jatene, in Sao Paulo, Bra- zil performed the.
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Arterial switch operation
Scottish pathologist Matthew Baillie first described TGA inpresumably as a posthumous diagnosis. The aorta is then transected at the marked spot, and the pulmonary artery is transected a few millimetres below the bifurcation. Due to the technical complexity of the Senning procedure, others could not duplicate his success rate; jarene response, Mustard developed a simpler alternative method the Mustard procedure inwhich involved constructing a baffle from autologous pericardium or synthetic material, such as Dacron.
Jatene procedure An 8 day old right after the Jatene procedure.
InAmerican surgeons Alfred Blalock and C. When jatee patient is fully cooled, the curugia aorta is clamped as close as possible below the HLM cannula, and cryocardioplegia is achieved by delivering cold blood to the heart via the ascending aorta below the cross clamp.
Views Read Edit View history. The great arteries are usually arranged using the LeCompte maneuverwith the aortic cross clamp positioned jstene hold the pulmonary artery anterior to the ascending aorta; though criugia some congenital arrangements of the great arteries, such as side-by-side, this is not cifugia and the arteries will be transplanted in the non-anatomic ‘anterior aorta’ arrangement.
It was the first method of d-TGA repair to be attempted, but the last to be put into regular use because of technological limitations at the time of its conception. The patient’s mother is normally unable to donate blood for the transfusion, as she will not be able to donate blood during pregnancy due to the needs of the fetus or for a few weeks after giving birth due to blood lossand the process of collecting a ciruugia amount of blood may take several weeks to a few months.
The previously harvested pericardium is then used to patch the coronary xe sites, and to extend – and widen, if necessary – the neo-pulmonary root, which allows the pulmonary artery to be anastamosed without residual tension; the pulmonary artery is then transplanted to the neo-pulmonary root. If a ventricular septal defect VSD is present, it may be repaired, at this point via either the aortic or pulmonary valve ; it may alternatively be repaired later in the procedure.
The patient will continue to fast for up to a few days, and breastmilk or infant formula can then be gradually introduced via nasogastric tube NG tube ; the primary goal after a successful arterial switch, and before hospital discharge, is for the infant to gain back the weight they have lost and continue to gain weight at a normal or near-normal rate.
Arterial switch operation – Wikipedia
Impedance cardiography Ballistocardiography Cardiotocography. The vessels are again examined, and the pulmonary root is inspected for left ventricular outflow tract obstruction LVOTO. Use of the cirugja switch is historically preceded by two atrial switch methods: InAmerican surgeons William Rashkind and William Miller transformed the palliation of d-TGA patients with the innovative Rashkind balloon atrial septostomy dr, which, unlike the thoracotomy required by a septectomy, is performed through the minimally invasive surgical technique of cardiac catheterization.
The patient is fitted with chest tubestemporary pacemaker leads, and ventilated before weaning from the HLM is begun. The jarene arteries are carefully mapped out in order to avoid unexpected intra-operative complications in transferring them from the native aorta to the neo-aorta.
The HLM is turned off and the aortic and atrial cannula are removed, then an incision is made in the right atrium, through which the congenital or palliative atrial septal defect ASD is repaired; where a Rashkind balloon atrial septostomy was used, the ASD should be able to be closed with sutures, but cases involving large ciurgia ASDs or Blalock-Hanlon atrial septectomy ds, a pericardial, xenograftor Dacron patch may be necessary.
A generous section of pericardium is harvestedthen disinfected and sterilized with a weak solution of glutaraldehyde ; and the coronary and great artery anatomy are examined. The left ventricle is then vented and the cross clamp removed from the virugia, enabling full-flow to be re-established and rewarming to begin; at this point the patient will receive an additional dose of Regitine to keep blood pressure under control.
Eber was the first to recount a small series of successful arterial switch procedures, and the first large successful series was reported by Guatemalan surgeon Aldo R.
The heart is accessed via median sternotomyand the patient is given heparin to prevent the blood from clotting. An 8 day old right after the Jatene procedure. If there is a VSD which has not yet been repaired, this is performed via the atrial incision and tricuspid valveusing sutures for a small defect or a patch for a large defect.
Although the atrial switch procedures dramatically reduced both early and late mortality rates, these statistics remained high, partly due to the wait time required between birth and cirrugia pre-operative mortality: Bythe arterial switch had become the procedure of choice, and remains the standard modern procedure for d-TGA repair. Silk marking sutures may be placed in the pulmonary trunk at this time, to indicate the commissure of the aorta to the neo-aorta ; alternatively, this may be done later in the procedure.
Egyptian cardiac surgeon Magdi Yacoub was subsequently successful in treating TGA with intact septum when preceded by pulmonary artery banding and systemic-to-pulmonary shunt palliation. The rib cage is relaxed and the external surgical wound is bandaged, but the sternum and chest incision are left open to provide extra room in the pleural cavityallowing the heart room to swell and preventing pressure caused by pleural effusion. If the procedure is anticipated far enough in advance with prenatal diagnosis, for exampleand the individual’s blood type is known, a family member with a compatible blood type may donate some or all of the blood needed for transfusion during the use of a heart-lung machine HLM.
The circumflex coronary artery may originate from the same coronary sinus as, rather than directly from, the right coronary artery, in which case they may still be excised on the same “button” and transplanted similarly to if they had a shared ostium, unless one or both have intramural communication with another coronary vessel. A blood transfusion is necessary for the arterial switch because the HLM needs its “circulation” filled with blood and an infant does not have enough blood on their own to do this in most cases, an adult would not require blood transfusion.
In the event of sepsis or delayed diagnosisa combination of pulmonary artery banding PAB and shunt construction may be used to increase the left ventricular mass sufficiently to make an arterial switch possible later in infancy. If the aortic commissure has not previously been marked, the excised coronary arteries will be used to determine the implantation position of the aorta.
Anestesia en la operación de Jatene, experiencia en el Cardiocentro del Hospital “William Soler”
As the patient is anesthetized, they may receive the following drugswhich continue as necessary throughout the procedure:. This page was last edited on 4 Decemberat This would have effectively reduced early mortality rates, particularly in cases with no concomitant shunts, but is unlikely to have reduced late mortality rates. Pericardium Pericardiocentesis Pericardial window Pericardiectomy Myocardium Cardiomyoplasty Dor procedure Septal myectomy Ventricular reduction Alcohol septal ablation Conduction system Maze procedure Cox maze and minimaze Catheter ablation Cryoablation Radiofrequency ablation Pacemaker insertion Left atrial appendage occlusion Cardiotomy Heart transplantation.
The sternum and chest can usually be closed within a few days; however, the chest tubes, pacemaker, ventilator, and drugs may still be required after this time. The Jatene procedurearterial switch operation or arterial switchis an open heart surgical procedure used to correct dextro-transposition of the great arteries d-TGA ; its development was pioneered by Canadian cardiac surgeon William Mustard and it was named for Brazilian cardiac surgeon Adib Jatenewho was the first to use it successfully.
From Wikipedia, the free encyclopedia. Rollins Hanlon introduced the Blalock-Hanlon atrial septectomyfe was then routinely used to palliate patients. The Jatene procedure is ideally performed during the second week of life, before the left ventricle adjusts to the lower pulmonary pressure and is therefore unable to support the systemic circulation.