A narrow surgery of lung artery treats _'s treatment

A narrow surgery of lung artery treats _'s treatment
Slight lung narrow to have symptom at the clinical patient in petal in artery, can grow normally, and meet normal viability, does not need surgery to treat; Medium-sized degrees of the intersection of lung and the intersection of artery and petals of narrow patient, appear palpitation, out of breath state 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; Often present obvious symptom to a 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 ( 1) The patient although symptom, electrocardiogram have not obviously unusually changed, the right heart conduit checks and shows the systolic pressure of right room in 8.0kPa(60mmHg) The above, or step the steps bad> 5.3kPa(40mmHg) of a pressure ,Or pursue to check and show a hole in 1.0- 1.5cm, belong to intermediately and narrowly and should consider the operation in interesting supersound. ( 2) 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. ( 3) There are symptom electrocardiogram and X-ray that have persons who unusually change, age of operation is by implementing preschoolly for being good. ( 4) 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 methodLung artery one narrow at intermediate low-temperature generally in the past ' 30- 32 ) ,Implement ocular to depend on membrane juncture cut skill, low-temperature method simple and convenient, until physiological disorder of function less in the body, recover smoothly while being postoperative, but because the low temperature can only be offered and circulated and blocked time limit 6- 8m i n 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. In recent years, extracorporal circulatory system becoming better and approaching perfection day by day, 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) Cut the skill in a petal of direct-view of lung artery at low temperature
Suitable for getting simple artery petal narrow lung only, and condition relatively light, have, continue person who send funnel a narrow and other companions take place the deformity in the heart.
Method: 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 hook, lead, turn on the intersection of lung and artery, cut-out, appear 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, cut-out with fine rule, treat, relax lower vena cava, block, bring behind the 30s, operation finish all 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 skillSuitable for a narrow treatment of artery of all kinds of lungs.
Method: 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, flow out line expand, mend slice come on.
Funnel part is plump it excise muscle should include not separating bunch, among bunch and ridge dirt muscles plump 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, answer flowing out on dishes of diameter adult after dredging> 1.7cm,answer children> 1.4cm about, otherwise, employ pericardium slice not to be cut out to last slice in order to be expanded and be flowed out by lining as one of shuttleless loom shapes, 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 and spend postoperative critical days safely in order to avoid producing the serious lung artery one, 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 4.5cm vein of per kilogram of weight.
Postoperative complications and operation results: Postoperative complication, mainly there are two points except looking complication which may cause in the heart in operation straight in general extracorporal circulatory system: First, after it is removed that the intersection of lung and the intersection of artery and mouth is narrow, the blood capacity of circulation of lung obviously increases, so, should fill the blood capacity appropriately according to arterial pressure and central venous pressure, in order to prevent postoperative low heart from arrange the intersection of blood and disease, vein instil dopamine and the west inside strong heart such as being blue step up medicine if necessary, in order to strengthen myocardium contractile force, the transition is steady to dynamics of blood flow; Second, one is too narrow to remove completely such as flowing out, the right room is still tall in pressure, it is postoperative apt to cause the right room to cut-out and bleed, and apt to produce the right heart depletedly.
The operation mortality of this disease is relatively low, generally
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