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 – Wikipedia
The patient will continue to fast cirygia 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. 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.
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.
These statistics, combined with advances in microvascular surgery, created a renewed interest in Mustard’s original concept of an arterial switch procedure.
The aortic clamp is temporarily removed while small sections of the neo-aorta are cut away to accommodate the coronary ostia, and a continuous absorbable suture is then used to anastomose each coronary “button” into the prepared space.
Eber was the first to recount a small series of successful arterial switch procedures, and the first large cirjgia series was reported by Guatemalan surgeon Aldo R.
In the event of sepsis cirugoa 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. This would have effectively reduced early mortality rates, particularly in cases with no concomitant shunts, but is unlikely to have reduced late mortality rates.
Arterial switch operation
Use of the arterial switch is historically preceded by firugia atrial switch methods: When the septal defects have been repaired and the atrial incision is closed, the previously removed cannula are replaced and the HLM is restarted. Coronary arteries are examined closely, and the ostia and proximal arterial course are identified, as are any infundibular branches, if they exist.
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.
The heart is accessed via median sternotomyand the patient is given heparin to prevent the blood from clotting.
Views Read Edit View history. As the patient is anesthetized, they may receive the following drugswhich continue as necessary throughout the procedure:. The previously harvested pericardium is then used to patch the coronary explantation 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 the aortic commissure has not previously been marked, the excised coronary arteries will be used to determine the implantation position of the aorta. Due to the technical complexity of the Senning procedure, others could not duplicate his success rate; in response, Mustard developed a simpler alternative method the Mustard procedure inwhich involved constructing a baffle from autologous pericardium or synthetic material, such as Dacron.
Anestesia en la operación de Jatene, experiencia en el Cardiocentro del Hospital “William Soler”
This procedure yielded early and late mortality rates comparable to the Senning procedure; however, a late morbidity rate was eventually discovered in relation to the use of synthetic graft material, which does not grow with the recipient and eventually causes obstruction.
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. If the aortic commissure has not yet been marked, it may be done at this point, using the same method as would be used prior to bypass; however, there is a third opportunity for this still later in the procedure.
At the time of the operation on February 6,he weighed just over 1. In most cases, though, the patient receives a donation from a blood bank. The cardiopulmonary bypass is then initiated by inserting a cannula into the ascending aorta as distally from the aortic root as possible while still supplying all arterial branches, another cannula is inserted into the right atriumand a vent is created for the left ventricle via catheterization of the right superior pulmonary vein.
Rollins Hanlon introduced the Blalock-Hanlon atrial septectomywhich was then routinely used to palliate patients. InAmerican surgeons William Rashkind and William Miller transformed the palliation of d-TGA patients with the innovative Rashkind balloon atrial septostomywhich, unlike the thoracotomy required by a septectomy, is performed through the minimally invasive surgical technique of cardiac catheterization.
As with any procedure requiring general anaesthesia, arterial switch recipients will need to fast for several hours prior to the surgery to avoid the risk of aspiration of vomitus during the induction of anesthesia.
Infundibular branches are sometimes ciurgia to be spared, but this is a very rare occurrence. Mustard first conceived of, and attempted, the anatomical repair arterial switch for d-TGA in the early s. 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 coronary arteries are carefully mapped out in order to avoid unexpected intra-operative complications in transferring them from the native aorta to the neo-aorta. While the patient is cooling, the ductus arteriosus is ligated at both the aortic and pulmonary ostiathen transected at its center; the left pulmonary branchincluding the first branches in the hilum of the left lung, is separated from the supportive tissue; and the aorta is marked at the site it will be transected, which is just below the pulmonary bifurcationproximal to where the pulmonary artery will be transected.
If there is a VSD which has not yet been repaired, this is performed via the atrial incision and tricuspid valvecjrugia sutures for a small defect or a patch for a large defect. The jateme is fitted with chest tubestemporary pacemaker leads, and ventilated before weaning from the HLM is begun. This surgery may be used in combination with other procedures for treatment of jafene cases of double outlet right ventricle DORV in which the great arteries are dextro – transposed.
From Wikipedia, the free encyclopedia. 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. Although the atrial switch procedures dramatically reduced both early and late mortality rates, these statistics remained high, partly due to the wait time jahene between birth and surgery pre-operative mortality: Pericardium Pericardiocentesis Pericardial window Jatdne 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.
An 8 day old right after the Jatene procedure. Jatene procedure An 8 day old right after the Jatene procedure. Impedance cardiography Ballistocardiography Cardiotocography. InAmerican surgeons Alfred Blalock and C. The patient will require a number of imaging procedures in order to determine the individual anatomy of the great arteries and, most importantly, the coronary arteries.
His few attempts were unsuccessful due to technical difficulties posed by the translocation of the coronary arteries, and the idea was abandoned.