PAULlSTA*, Adib D. JATENE*, Luiz Carlos Bento de SOUZA* RESUMO: A cirurgia de Gleen bidirecional tem sido empregada como uma opção ao tratamento Missing: cirugia | Must include: cirugia. c Servicio de Cirugía Cardiovascular, Hospital Universitario Virgen del Rocío, Anatomic repair, according to the technique described by Jatene et al1 with the. Introducción: La cirugía de switch arterial es el procedimiento de con cirugía de Jatene en nuestra institución con un seguimiento de 7,6.
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Yet unfavorable coronary artery anatomy has not been considered a risk factor.
We have also compared the most significant findings of the present study with those obtained in a preceding study conducted between and in a population of 21 children with TGA and small or no VSD, given that the present study was a continuation of this previous one. Of these, 48 children In all cases, the diagnostic cirugia de jatene treatment protocols described below were followed.
These protocols covered the preoperative, perioperative, and postoperative periods. The variables analyzed were age and weight at the time of surgery, coronary artery anatomy, whether or not the VSD was closed, need for total circulatory arrest and its duration, duration of extracorporeal circulation and myocardial anoxia, time on mechanical ventilation, and length of stay in the ICU Table cirugia de jatene.
Age and weight were recorded at the time of surgery.
Risk Factors Associated With Arterial Switch Operation for Transposition of the Great Arteries
Variables related to the surgical procedure were obtained from cirugia de jatene information and from the log sheet filled out by the surgeon, while variables related to the postoperative period were taken from the monitoring done in the ICU.
A database was set up using the SPSS program version We then performed a Rashkind atrioseptostomy cirugia de jatene all patients in the catheterization laboratory or in the ICU under echocardiographic control if the patient was in such a poor condition that he or she could not be moved.
If the child was still hypoxemic after these measures, pulmonary hypertension was suspected and, if confirmed, treated with inhaled nitric oxide.
Surgery in patients with TGA but without VSD was preferably cirugia de jatene at around the first week of life and we tried to avoid procedures once the baby was more than 2 weeks old. Patients with Cirugia de jatene and VSD associated with significant shunting could undergo the operation when they were older and heavier, though surgery was not delayed excessively because of the risk that the patient might develop irreversible pulmonary hypertension.
Surgical Technique The cirugia de jatene technique used was first described by Jatene with the Lecompte maneuver to transpose the pulmonary artery to an anterior position.
Circulation was arrested on closure of the VSD or when we implanted a single cannula in the right atrium. Both venae cavae could be cannulated with small cannulas in older and heavier children with a larger right atrium, leaving the cirugia de jatene free so that we could close the septal defects with greater ease, and without the need for circulatory arrest.
This was possible more often in children with TGA and large VSD because, as we mentioned earlier, these children underwent the operation when they were older. Once repair was complete, and after extracorporeal circulation had been finalized, a controlled ultrafiltration was done with two aims: If this measure proved insufficient and edema cirugia de jatene severe and associated with hemodynamic instability, we opted to defer closure of the sternotomy until the patient was in the ICU.
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We also inserted a peritoneal dialysis cirugia de jatene to allow appropriate management of fluids in cirugia de jatene postoperative period. Postoperative Management Postoperative management was based on treatment of left ventricular failure.
We maintained sedation and analgesia with midazolam and fentanyl for the first night after the operation, and only resorted to neuromuscular paralysis when the patient had difficulty adapting to the ventilator. We started the process of weaning from the ventilator the following day by reducing the dose of sedative and analgesic, and we used pressure-support ventilation, which facilitates spontaneous breathing and digestive tolerance.
The same day, we started transpyloric enteral nutrition, preferably with breast milk or hydrolyzed proteins, and we avoided parenteral nutrition as far as possible.
Arterial switch operation - Wikipedia
Analytical monitoring included both arterial and venous blood-gas analysis on admission and every 6 hours, and whenever indicated by the clinical state of the patient. Cirugia de jatene measured oxygen saturation SaO2 noninvasively by pulse oximetry and exhaled carbon dioxide CO2 by capnography.
We also monitored heart rate, the electrocardiographic trace, blood pressure, central venous pressure, and diuresis. The patients underwent echocardiography immediately after the operation to assess left ventricular function. The echocardiographic findings also indicated whether closure of the VSD was satisfactory and whether supravalvar aortic or cirugia de jatene stenosis and mitral, tricuspid, aortic, or pulmonary cirugia de jatene regurgitation were present.
Statistical Analysis Qualitative variables were analyzed descriptively with absolute and relative frequencies. Quantitative variables were not normally distributed Kolmogorov-Smirnov testand so they were described with the median interquartile range.
Association between cirugia de jatene variables was determined using the Spearman rank coefficient. All analyses were done with the SPSS program, version The child cirugia de jatene the Taussig-Bing anomaly was also included in this second group.