心脏外科 CARDIAC SURGERY.pptVIP

PDA Left-to-right shunt, pulmonary vascular congestion, PA hypertension, lung infection, right heart failure Symptoms and signs: infants have poor feeding, respiratory distress, frequent respiratory infection, heart failure; older patients are often asymptomatic or have continuous murmur over pulmonary area Treatment Premature infants: medical therapy with indomethacin (50%success) Full-term infants or children: surgical obliteration by ligation, clipping, or division Larger infants and children: Video assisted thoracoscopy * * Choice of conduit Vascular Conduits for CAD can be either venous or arterial 1- Long Saphenous Vein is easy to harvest by a second surgeon and allows multiple grafts to be fashioned Patency rate 50 % at 10 years 2- Left internal mammary artery (LIMA) as been used to graft the left anterior descending Patency rate 90% at 10 years * What are the other conduit options?  1- Radial artery. RA 2- Gastroepiploic artery. GEA 3- Inferior epigastric artery. IEA What is the risk of using both internal mammary arteries as conduits? Sternal necrosis * Obtaining vein graft: The left internal mammary artery is dissected free from the anterior chest wall proximally up to the level of the subclavian vein and distally to its bifurcation. If a leg vein graft is required, an incision is made from the groin to the midcalf to carefully excise and dissect free the long saphenous vein with ligation and division of any branches. * * Surgery Chest is entered via a median sternotomy Left internal mammary artery is dissected Long saphenous vein can be harvested and prepared by second surgeon Rt.Atrium is cannulated and patient is placed on cardiopulmonary bypass (CPB) Aorta is cross clamped MYOCARDIAL PROTECTION by cardioplegic solutions Cardioplegia can be either warm (37 degrees) or cold (15-20 degrees) to induce a hypothermic, cardioplegic arrest. * * Recent advances include 1- Off-pump coronary artery surgery