By Constantine Mavroudis, Carl Lewis Backer, Rachid F. Idriss
The raison d’etre for a brand new atlas of congenital center surgical procedure relies at the fact that the uniqueness has passed through quite a few alterations within the previous couple of years leading to superior thoughts and new operations. The sheer variety of new strategies and the mandatory attendant technical abilities to effectively whole an operation has turn into a problem to grasp, in particular for citizens who're pursuing a occupation in congenital middle surgical procedure. whereas the options that we're espousing are as a rule our personal, there's a good deal of similarity among foreign facilities because of the impression of video shows, manuscript guides, and bankruptcy reports. We for that reason think that the concepts which are illustrated during this atlas usually are just like the strategies which are taught around the world to citizens and fellows. The atlas is equipped usually by means of illnesses and approaches pertaining thereto. basic sections contain cannulation options and palliative strategies, respectively. a unique part depicts tough difficulties within the type of medical vignettes which can come up in the course of cardiopulmonary pass comparable to: lowered venous go back, undiagnosed patent ductus arteriosus, and technical blunders resulting in hemodynamic problems. The reader is suggested to use measures that may bring about solution of those difficulties. we have now selected tactics, which conceal the breadth of congenital middle surgical procedure. whereas probably no longer absolutely inclusive, the reader will locate the larger majority of congenital center techniques illustrated and defined during this text.
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Unwanted cavitary entry during mediastinal dissection can cause marked hemodynamic instability, especially in patients with Fontan physiology. Any precipitous decrease in right atrial pressure owing to uncontrolled hemorrhage results in the obvious hypovolemic aberrations and unfavorably impacts the driving force (elevated central venous pressure) that controls the pulmonary circulation and cardiac output. This same set of circumstances also impacts patients who are undergoing ventricular-to-pulmonary conduit replacement, reoperations for tetralogy of Fallot, and others.
2 2 Palliation Techniques 21 Fig. 6 Fig. 4 Fig. 7 Fig. 5 Fig. 8 22 C. 1 Pulmonary Artery Band Takedown and Repair Pulmonary artery banding takedown usually requires cardiopulmonary bypass, Teflon PAB removal, and repair by either direct anastomosis or patch technique. Each technique has its advantages and disadvantages and is illustrated. Fig. 11 shows the completed dissection of a patient with PAB in preparation for the excision and direct anastomosis technique. After cardiopulmonary bypass, the PAB is removed and the surgeon is shown removing the cuff of pulmonary artery wall (dotted lines) that was involved in the PAB (Fig.
35 shows exposure through a right thoracotomy with dissection of the right pulmonary artery and ascending aorta. The distal right pulmonary artery is controlled by snuggers, and a single curved vascular clamp occludes a portion of the ascending aorta and the right pulmonary artery. The dotted lines demonstrate the incisions for the proposed anastomosis. 36 shows the side-to-side anastomosis in progress. Because this anastomosis does not involve any synthetic grafts, there is less chance of clot formation, but constructing the exact size can be challenging—either being too small or too large.
Atlas of Pediatric Cardiac Surgery by Constantine Mavroudis, Carl Lewis Backer, Rachid F. Idriss