The way tricuspid valve plasty for the correction of ventricular septal defect

 

(57) Abstract:

The invention relates to methods of surgical treatment of heart diseases. The purpose of the prevention of residual shunt at the closure of the ventricular septal defect patch covered by a fold of tricuspid valve. The method is carried out by dissection of the partition sash tricuspid valve from the free edge in the direction of the annulus, and the direction, angle and shape of the incision is determined by the localization of ventricular septal defect. The fullest edges of the defect separation of the cleaved fragments of the leaf in hand. Implanted patch, sewing the individual U-shaped seams around the perimeter. Plastic sash double row of continuous atraumatic suture.

The invention relates to medicine, namely to surgery, and may find application in the correction of heart defects.

Radical correction over the ventricular septal defect (VSD) in a significant number of cases associated with plastic surgery on the tricuspid valve. The known method tricuspid valve plasty in the correction of VSD, warning tricuspid nedostatochna edges of the bulkhead and the front wings (Wakalaka Ya Century and Lacis, A. T. Surgical treatment of ventricular septal defect, Riga, 1978).

The disadvantages of this method is that it is used only at the location of the VSD at the front comissary tricuspid valve, the deformation of the annulus and adjacent segments cusps of tricuspid valve, forming a textile conglomerate, with subsequent calcification in the long term.

The known method tricuspid valve plasty in the correction of VSD, which is based on the method of dissection of the bulkhead doors from the free edge perpendicular to the fibrous ring. To avoid damage to the chords on either side of the proposed cut on the free edge of the leaf impose one taped atraumatic thread AKKA 15-1. After the closure of the VSD restore the integrity of the sash single interrupted sutures (N. Amosov.M. Zinkovsky M. F. et al. Raspredsetey access for correction of VSD. Surgery, 1984, No. 5, 102-105).

However, in the case of fixing the edges of the bulkhead fold many chords and the adhesion of the leaf with the edge of the defect cannot expose the edges of the defect and securely close it with the patch, therefore, remains a possibility of residual shunt. Cu is 2">

The aim of the invention is the prevention of residual shunt and preventing the eruption of the seams.

To do this, hold the cut partition sash tricuspid valve from the free edge to the fibrous ring. The direction, angle and shape of the incision is determined on the basis of localization of ventricular septal defect. Maximum open defect implanted synthetic patch, be bound on all edges of the defect. Plastic shutters perform two-row continuous atraumatic suture.

The method is as follows.

Radical correction of VSD perform in conditions of deep hypothermic protection. After pharmachological cardiac arrest under conditions of occlusion hollow veins and Horta from fritanga access inspect the interventricular septum, identify the anatomical localization of the defect. At the location of the VSD under the flap of tricuspid valve, impose handles atraumatic thread N 5.00-6.00 for the free edge of the leaf above and below the proposed cut. Incision with a scalpel or scissors hold the free edge of the leaf in the direction of the annulus of tricuspid valve and along it. The angle and shape of the cut (l is jeludockovy partition as well as the availability of the fixing edge of the leaf to the defect. Throw the flaps fold in the sides, the maximum opening of the defect. Close the ventricular septal defect with a synthetic patch, and a separate U-shaped seams hold for visually controlled edges of the defect around the perimeter, thereby providing a reliable fixation of the patch, excluding residual shunt. Plastic shutters perform two-row continuous atraumatic suture 5.00-6.00 with an atraumatic needle AKKA-10. The first seam continuous blanket, the second continuous seam blanket emotionally draining. The first step seam impose for free edge of the cut segments of the leaf, some distance from the edge of 1-2 mm, continue the seam in the direction of the annulus of tricuspid valve. This same thread in the opposite direction to apply a continuous blanket stitch emotionally draining. Then you should check valves tricuspid valve, the evaluation of its switching function. Restoration of cardiac activity. Control intracavitary hemodynamics.

P R I m m e R. Patient C. E. 3 g, 9 months, past medical history N 3298. He enrolled in the Department of pediatric cardiac surgery with symptoms of heart failure, delay, weight, and physical development. 3 months pring covers. Shortness of breath, respiratory rate 30 / min, the liver is enlarged and protrudes from under the costal arch 2 cm, the growth of 97 cm, weight 14 kg auscultation of the left of the sternum heard a rough systolic murmur with epicenter 3-4 m/p, the second tone of the pulmonary artery strengthened. ECG electrical axis vertical, slight hypertrophy of the right ventricle. Radiographically the increase in both ventricles, extended arc of the pulmonary artery. ECHO-cardioscope lazerette high ventricular septal defect under the flap of tricuspid valve. Data sensing. Pressure: PP-12/4, mud-84/0, LA 30/14, LV 136/8 mm RT.article Mobc-5,76 Mack 7,95 l, reset the left-right 2,19 l/min, the resistance of the IAC-372,8 dissm-5. Increasing the oxygenation level of the right ventricle 5% VSD large sizes. Clinical diagnosis of CHD. Ventricular septal defect, primary pulmonary hypertension. Hypotrophy 1 tbsp.

31.10.90 the operation closure of ventricular septal defect, plastic bulkhead sash tricuspid valve. Surgery was performed under deep hypothermic protection (T 25,5aboutC) occlusion of aorta 30 minutes From fritanga access detected ventricular septal defect dia is CSA visualization of the defect of septal flap was dissected in the direction of the annulus, cut leaf fragments were divorced in hand for pre-imposed atraumatic thread-holders. Implanted synthetic patch, stitched seven separate U-shaped seams for all exposed edges of the defect. Made of plastic bulkhead sash tricuspid valve two-row continuous atraumatic suture. The function of the tricuspid valve was found satisfactory. The operation is finished in the usual way. The postoperative period was uneventful.

The WAY TRICUSPID VALVE PLASTY for the CORRECTION of VENTRICULAR SEPTAL DEFECT, including raspredsetey access, septal dissection of the leaf tricuspid valve from the free edge to the fibrous ring of the valve, closure of ventricular septal defect with a synthetic patch, characterized in that, to reduce the number of postoperative complications by preventing residual shunt and prevent the eruption of the joints by increasing the visual control during closure of defect of interventricular septum, septal flap is dissected by changing the shape of the cut and the angle of inclination of the fibrous ring and the plastic sash tricuspid valve exercise

 

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