A narrow treatment of lung artery explains _'s treatment

A narrow treatment of lung artery explains _'s treatment
Slight lung artery narrow to have symptom at the clinical patient, can grow and meet normal viability, need surgery to treat normally, medium-sized degrees of the intersection of lung and the intersection of artery and narrow patient, appear palpitation and out of breath symptom under activity while being about 20 years old generally, if does not adopt the surgery treatment, will inevitablely lead to the fact with the years the load of right ventricle is overweight to present depleted symptom of the right heart, thus lose life and labour capacity and often present obvious symptom to the narrow patient of extremely severe lung artery in infancy, if it can often be in the death in infancy not to treat in time.
(1) Operation indication Although the patient has no symptom, the electrocardiogram has not obviously unusually changed, the right heart conduit checks and shows the systolic pressure of right room in 8.0kPa( 60mmHg) The above, or it is greater than 5.3kPa( 40mmHg) badly to step a pressure rank ,Or supersound aroused in interest to pursue, check, show petals of hole, belong to intermediate to should consider surgery while being narrow in 1.0- 1.5cm. There is not symptom but the heart electricity illustrationally shows right ventricular hypertrophy or with straining, it has intermediate persons who increase that slice shows the heart in the X-ray. There are symptom electrocardiogram and X-ray that have persons who unusually change, age of operation is by implementing preschoolly for being good. Symptom have, faint, break out history belong to extremely getting narrow, should until baby perform a surgical operation by lightening the load of right ventricle infancy obviously.
(2) Operation method Lung artery one narrow at intermediate low-temperature generally in the past ' 30- 32 ) Implement, look the intersection of valve and juncture straight, cut skill, low-temperature method simple and convenient, until physiological disorder of function less in the body, resume smoothly while being postoperative, but because low temperature only can offer, circulate, block 6- 8 minutes such as time limit safely, must finish to operate hurriedly in the heart, and does not have abundant time to ascertain and correct and manage the deformity in the heart. Extracorporal circulatory system becoming better and approaching perfection day by day in recent years, myocardium protection and the intersection of operation and progress of skill make in the heart regarding performing the operation as safe direct, therefore lung the intersection of artery and the intersection of mouth and narrow operation adopt extracorporal circulatory system generally direct-view correct cure skill in the lower heart.
1.One is narrow to cut the skill and only suitable for the simple lung artery in a petal of direct-view of lung artery at low temperature, and condition to have, continue person who send funnel a narrow and other companions take place the deformity in the heart.
After trachea intubate anaesthetize, steep, enter patient competent body surface cool in the frozen water, wait nasopharyngeal temperature drop to at 35 surfacing, dry the body, the body temperature will continue dropping to 32- 30 .
The patient fetches and lies supine the location, the centre of brestbone cut-outs and cuts the brestbone longitudinally, cut the pericardium, carry on the palpation outside the heart, can touch systolic phase to tremble in the lung artery root, can lay one's hand on and increase and harden the valve merged thick while pressing this department, right room present obviously plump to increase, dissociate up and down vena cava and suit around blocking bringing respectively check-off, on lung in front of the artery at the wall and underpart, and both sides put draw suture by 4 stitch, pincers insert some lung wall cut the intersection of lung and wall in front of the artery longitudinally in front of the artery, after the anaesthetist walks several times and excessively takes a breath, tighten the up and down vena cava around taking separately, block the blood flow of vena cava, unlock the lung forceps artery after the heartbeat empty a of over blood of heart 6- 8 times, exhaust the intersection of lung and blood under artery, with draw the hook, involve and drive the lung artery to cut-out and expose lung artery one and a ring, see clearly the integration spine of the valve, by cutting off or the knife is cut and driven to a ring to the artery wall of Damien's lung progressively from a hole along merging the spine, using the forefinger is ascertained whether the right ventricle has plump and narrow muscles by a hole cut, mention the traction line of the lung artery wall in the heart after finishing, the open superior vena cava blocks bringing, resume, breathe, treat blood cut-out, gush out by artery by lung while being auxiliary, arrange, remain pincers insert the lung artery cut-out behind the air in the right room to the limit, sew up and cut-out with the fine rule, stay for half a minute, relax down one more of quiet and block bringing, the operation is all finished promptly. Might present, pass the intersection of and reactive hypertension while being postoperative, sew up pericardium, cut-out after returning to normal in blood pressure and heart rate, the intersection of brestbone and the intersection of trailing and porous drainage tube in the pericardium, ventricle quiver should cut behind the narrow valve making heart massage and shocking by electricity, going quiver rapidly such as take place in the skill.
2.The extracorporal circulatory system makes direct-view and corrects and manages the skill and is suitable for the narrow treatment of artery port of all kinds of lungs, patient's body posture, chest cut-out and dissect the step and look the operation straight with the heart trunk if at low temperature, until the intersection of 3mg/ kg and Heparin take, aorta insert artery in pour into, in charge of, insert up and down the intersection of vena cava and drainage tube in respectively through right auricle of heart and atrium dextrum on rise, the blood lowers the temperature at the beginning after setting up extracorporal circulatory system, according to heart function state and pathological change complexity, lower the intersection of patient and nasopharyngeal temperature, aorta hinder bring up the rear, rise aorta root fast to inject the cold heart into, park, fight liquid, pericardium pour with frozen water, heart surface lower the temperature and protect the cardiac muscle with little the intersection of ice bag and part, then block the up and down vena cava around taking, cut the intersection of lung and artery or right room, implement the intersection of lung and the intersection of artery and petals of the intersection of direct-view and lower juncture, cut skill and/or the intersection of funnel and parts of plump muscle, excise skill or flow out line expand, mend slices of skill.
Funnel part is plump excise muscle should include not separating bunch, among bunch and muscles plump of ridge in some room, the plump meat column should be excised, in order to dredge and flow out one, but need to avoid cutting off skin of neighbouring papilla, taper skin and regulating bunch in the heart, flowing out a diameter adult and should be greater than 1.7cm after dredging, children should be greater than about 1.4cm, otherwise employ the pericardium one to be cut out and mended slice in order to expand and flow out one as a shuttleless loom shape, a ring of narrow and small lung artery should also be cut until the right room flows out one, then by weave slice or pericardium slice and expanding. Step petals of ring, mend block, will produce the intersection of lung and the intersection of artery and petal, close completely, might it produces right rooms to be depleted while being postoperative. Can't close completely in order to avoid producing the serious lung artery one, spend postoperative critical days safely, can adopt and take a leaf and mend one and expand a ring of lung artery, avoid leading to the fact the lung artery one can not be closed completely because a ring is expanded. Skill finish right room and the intersection of aorta and the intersection of root and part insert needle rank angry, the open aorta blocks pincerses, shocking by electricity if necessary quiverly makes the heart reply and beat. Wait to reply warmly to 35 , the heartbeat stops the extracorporal circulatory system with blood pressure after being steady effectively, successively pulled out up and down vena cava intubate and artery to pour into and manage, instilled in order to neutralize Heparin according to fish's precise albumen 4.5mg vein of per kilogram of weight.
|