Features preoperative preparation in children

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If you are a visitor of this website: Please try again in a few minutes. Please forward this error screen to 93. Due to major advances in both diagnosis and treatment of congenital heart disease in children, many are living into adulthood. There are almost one million such patients this year. The cyanotic ones in which the oxygen level in the blood is low enough for the lips and skin to show varying degrees of bluish discoloration. The cyanosis is due to the shunting of systemic venous blood to the arterial circulation causing arterial blood desaturation of oxygen. The size of the shunt determines the degree of desaturation.

In adults the most common causes of cyanotic congenital heart disease are tetralogy of Fallot and Eisenmenger’s syndrome. Symptoms in adults include shortness of breath and limited exercise tolerance. Color Doppler can visualize the VSD. Heart catherterization can confirm the diagnosis. Surgical repair is recommended to relieve symptoms and to improve survival. VSD and relief of RV outflow obstruction is performed currently when patients are very young. Patients are at risk for heart infections and should thus receive prevention with antibiotics before dental or elective surgical procedures.

Patient with repaired tetralogy are at risk for other chronic complications. Pulmonary regutgitation may develop as a consequence of surgical repair of the right ventricular outflow tract. Alternatively, patients may have residual or recurrent obstruction of the right ventricular outflow tract, requiring repeated surgery. Approximately 10 to 20 percent of patients with repaired tetralogy of Fallot have residual ventricular septal defects, and such patients may require repeated sirgery if the defects are of sufficient size. Late survival is excellent, even in patients who underwent repair during the very early years of open heart surgery. Surgery can not be considered curative,since survival,even in excelllent series is slightly but significantly worse than for a matched control population.

The late functional outcome is excellent for the mayority of patients. Most live normal lives, but the results appear to be better in those undergoing surgery at a younger age. Pulmonary valve replacement can be accomplished with low risk. Exercise performance is usually impaired when surgery is undertaken in adolescence or adulthood.

This valve often allows blood to regurgitate from the small RV back into the large RA. Eighty percent of these patients have ASD’s through which right-to-left shunting of blood may occur with cyanosis. There is usually a heart murmur. An echocardiogram can define the abnormalities, and a color Doppler imaging study can determine the presence and size of interatrial shunting.

Management involves prevention of complications, such as heart infection, prevented with antibiotic prophylaxis. Repair or replacement of TV in conjunction with closure of the interatrial communication is recommended in older patients with severe symptoms despite medical therapy and heart enlargement. Findings include cyanosis and heart murmur. Chest X ray shows heart enlargement. Cardiopulmonary bypass can be conducted in a number of ways, depending on the surgeon’s preference or the time required to accomplish complete repair, particularly in the presence of a ventricular septal defect or other anomalies such as coarctation of the aorta or a hypoplastic or interrupted aortic arch. The sternum is opened, the patient heparinized, and a large segment of pericardium is harvested and prepared with 0.

The coronary arteries and great vessels are inspected. The arterial duct is dissected free, as are the left and right pulmonary arteries, including the first pulmonary artery branches in the hilum of each lung. The right pulmonary artery can be dissected prior to bypass, and the left dissected while on bypass. The ascending aorta is cannulated as far distally as possible to allow adequate length for the aortic anastomosis. A single venous cannula is placed within the right atrium.

The left ventricle is vented with a catheter placed in the right superior pulmonary vein. The arterial duct is doubly ligated and divided, and the branch pulmonary arteries are completely mobilized. The site of aortic transection is marked before the cross clamp is applied. This is just distal to the pulmonary artery bifurcation, as best judged by the take-off of the left pulmonary artery. C rectal temperature, the distal ascending aorta is clamped, and cold blood cardioplegia is delivered into the proximal ascending aorta. The aorta is divided at the previously marked site, and the main pulmonary artery is divided just proximal to its bifurcation. The aortic and pulmonary valves are careftilly inspected, as is the presence of left ventricular outflow tract obstruction.