Repair Of Truncus Arteriosus

REPAIR OF TRUNCUS ARTERIOSUS REASON FOR VISIT: • • • • •

Truncus arteriosus Diaphoresis Tachypnea Cyanosis Congestive heart failure

RISK ASSESSMENT • • •

Low birth weight Premature baby Kidney diseases

PREPARATION OF THE PATIENT: • • • • • • • • • •

Angiography Blood tests Urine tests Chest X-ray ECG 2D-Echo CTscan MRI Multiplane transesophageal echocardiography (TEE) Two-dimensional transthoracic echocardiography (TTE) • Cardiac catheterization • Nothing is taken by mouth 6hrs before surgery • Antibiotics were given • PGE1 was discontinued. POSITION OF THE PATIENT: Supine position ANESTHESIA: General THE PROCEDURE PREPARATION

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The room was cooled as much as possible to start surface cooling. The patient was kept on minimal oxygen (usually room air) and maintained on relative hypoventilation. Aprotinin, solumedrol (30 mg/kg), Regitine (0.1 mg/kg), and prophylactic antibiotics were administered. Standard median sternotomy, harvesting of pericardium and fixation in glutaraldehyde, and heparinization were performed. The right pulmonary artery was dissected free on the right side of the aorta, and a silk snare placed around it. The aorta was cannulated high, well above the bifurcation of the truncus The venous cannula was placed through the right atrial appendage. Cardiopulmonary bypass was started, and the patient cooled to 18 - 20 C over a period of 20 minutes. The left and right pulmonary arteries were completely mobilized past the takeoff of their first branches, and were snared and occluded. After aortic cross clamping and administration of cardioplegia, the pulmonary artery snares were removed.

REPAIR • • •

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The pulmonary arteries were excised from the truncal root. This was performed under circulatory arrest / about half-flow cardiopulmonary bypass. Great attention was given to the location and origin of the coronary arteries so as to not injure them during excision of the pulmonary arteries. The branch pulmonary arteries originate quite separately from each other, the truncal root was transected proximally and distally to the take-off of the branch pulmonary arteries. . The defect in the truncal root was closed. Careful attention to the truncal valve and the coronary ostia was critical to this phase of the operation. The removed truncal tissue was adjusted with a patch of pericardium. Truncal transection, was present a primary end-to-end anastomosis of the truncal root to the ascending aorta is performed. The ventricular septal defect was closed.

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A longitudinal incision was made into the right ventricle, beginning just below the truncal valve annulus. The ventricular septal defect was exposed The incision was extended into the right ventricle just far enough to expose the defect and create a right ventricular opening of appropriate size for the conduit. The outlet septum was absent The superior aspect of the defect was closed by applying the patch to the cut edge of the right ventriculotomy just below the truncal valve. The atrial septal defect was closed. The atrial septum was retrograde through the tricuspid valve / through a small right atriotomy. A patent foramen ovale was present, it was left alone. A large secundum atrial septal defect was present; it was partially closed by overlapping the septum primum to the left side of the limbus, thus creating a small defect (2 to 3 mm) in the form of a patent foramen ovale. The atriotomy was closed Cardiopulmonary bypass and core rewarming begun. A valved allograft was then used to construct a right ventricular outflow tract. The distal anastomosis was constructed first using running 6-0 polypropylene suture. The proximal end of the allograft was then sutured to the edge of the right ventriculotomy, often incorporating ventricular muscle and the superior rim of the patch on the ventricular septal defect. A pericardial hood was used to complete the reconstruction of the right ventricular outflow tract; The hood was attached to the remaining circumference of the allograft and to the remainder of the ventriculotomy incision Pericardium was closed with absorbable sutures Chest tubes were fixed chest was closed

DURATION _____________hrs

AFTER PROCEDURE •

Patient was shifted to the I.C.U

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Patient was on ventilation • Heart sounds, oxygenation, and the ECG were monitored. • Chest tubes are checked to ensure that they're draining properly and there is no hemorrhage. POSTOPERATIVE CARE • • •

Take antibiotic medicine as prescribed Take pain medication Start chest exercises and chest physical therapy

COMPLICATIONS • • • • • • • • • • •

Infection Endocarditis Congestive heart failure Lack of oxygen Too much carbon dioxide in the blood Irregular heartbeat Stroke Kidney damage Lung blood clot Hemorrhage Cardiac arrest