conleyclan
Guru
Cardiothoracic Surgery Operative Report
PREOPERATIVE DIAGNOSES:
1. Foreign body in left pulmonary artery.
2. Hypoplastic right pulmonary artery.
3. Atrial septal defect.
POSTOPERATIVE DIAGNOSES:
1. Foreign body in left pulmonary artery.
2. Hypoplastic right pulmonary artery.
3. Atrial septal defect.
PROCEDURES:
1. Resection of foreign body from left pulmonary artery.
2. Closure of atrial septal defect.
3. Patch augmentation of right and main pulmonary artery.
4. Placement of monocusp GORE-TEX valve.
ANESTHESIA: General anesthesia.
ESTIMATED BLOOD LOSS: Minimal.
IMPLANTS:
1. GORE-TEX patch of right pulmonary artery.
2. GORE-TEX patch of right ventricular outflow tract.
3. Monocusp valve of GORE-TEX.
SPECIMENS: None.
OPERATIVE INDICATIONS: I was called emergently to the catheterization
laboratory. This is a patient that was previously operated on by -----
for repair of tetralogy of Fallot. There is a hypoplastic right
pulmonary artery. The patient originally had discontinuance of pulmonary
arteries that have been reimplanted. During the stenting of the right
pulmonary artery, the stent was lost and then became lodged in the left
pulmonary artery. There was also need for patch augmentation on the right
pulmonary artery and closure of atrial septal defects as well as free
pulmonary insufficiency. We discussed this at length and elected to take
her to the operating room to repair all of these lesions with the exception
of the free pulmonary insufficiency. The decision was made by the
cardiologist to leave their catheter in place as they were afraid that the
stent would migrate back into the ventricle.
OPERATIVE PROCEDURE: After family was informed and informed
consent was obtained, she was brought emergently to the operating room and
placed on table in supine position. Anesthesia monitor attached and
general anesthesia was obtained. Her chest and abdomen prepped and draped
in usual sterile fashion. A redo incision was performed with the
oscillating saw. There were dense adhesions to the posterior table of the
mediastinum. I then carried out dissection and identified the aorta and
right atrium. I should note that the right phrenic nerve lay directly on
top of the superior vena cava, which was somewhat odd. I did free this up.
I then cannulated the aorta and right atrium after full heparinizing dose
was given. I then moved my cannulization strategy to the superior vena
cava and the inferior vena cava. I should note that there was a
retroaortic innominate vein. I carried out dissection of the aorta, and
the Cardioplegia needle was then placed into the aorta. The aorta was
cross-clamped, and Cardioplegia was administered and the heart rested
promptly. I had placed tapes around the superior vena cava and inferior
vena cava. I then opened the right atrium and closed the atrial septal
defect with 2 layers of 5-0 Prolene suture. I then closed the right atrium
with 2 layers of 5-0 Prolene suture. I then opened the main pulmonary
artery, and I was able to visualize the stent into the left pulmonary
artery, and the stent was extracted. At this point in time I removed the
catheter from the right groin, and pressure was held over the site. There
was a very tight orificial lesion of the right pulmonary artery and the
right pulmonary artery ____ distal to this. I opened the right pulmonary
artery extending my incision all the way to the first bifurcation. I cut
the 4 mm GORE-TEX graft and I sewed this in place with a running 7-0
Prolene suture to patch the right pulmonary artery all the way to the main
pulmonary artery. I had opened the outflow tract completely. I observed
for any muscle bundles. There was none. Monocusp valve was performed with
pericardial membrane. This was sewn in place with a running 6-0 Prolene
suture and then I patched the entire right ventricular outflow tract as
well as the left and right pulmonary arteries with GORE-TEX patches as
well, sewn in place with running 6-0 Prolene suture. We had given
Cardioplegia every 20 minutes with a crossclamp time. ------- was placed in
a head down position. Left ventricle was fully deaired, and the crossclamp
was removed. We had cooled to 32 degrees Celsius and began rewarming to
normothermia. Once we reached normothermia, we weaned from cardiopulmonary
bypass without difficulty. Ventricular pacing wires were placed and has
had a 15 French Blake drain. The echocardiogram demonstrated an excellent
result. A 15 French Blake drain was brought through separate stab
incision. A pericardial membrane was sewed in place of GORE-TEX for ____
entry. The sternum was closed with stainless steel wires, and the skin was
closed in 2 layers, and a Dermabond dressing was applied. -------- tolerated
the procedure very much and transported to the ICU in stable condition.
PREOPERATIVE DIAGNOSES:
1. Foreign body in left pulmonary artery.
2. Hypoplastic right pulmonary artery.
3. Atrial septal defect.
POSTOPERATIVE DIAGNOSES:
1. Foreign body in left pulmonary artery.
2. Hypoplastic right pulmonary artery.
3. Atrial septal defect.
PROCEDURES:
1. Resection of foreign body from left pulmonary artery.
2. Closure of atrial septal defect.
3. Patch augmentation of right and main pulmonary artery.
4. Placement of monocusp GORE-TEX valve.
ANESTHESIA: General anesthesia.
ESTIMATED BLOOD LOSS: Minimal.
IMPLANTS:
1. GORE-TEX patch of right pulmonary artery.
2. GORE-TEX patch of right ventricular outflow tract.
3. Monocusp valve of GORE-TEX.
SPECIMENS: None.
OPERATIVE INDICATIONS: I was called emergently to the catheterization
laboratory. This is a patient that was previously operated on by -----
for repair of tetralogy of Fallot. There is a hypoplastic right
pulmonary artery. The patient originally had discontinuance of pulmonary
arteries that have been reimplanted. During the stenting of the right
pulmonary artery, the stent was lost and then became lodged in the left
pulmonary artery. There was also need for patch augmentation on the right
pulmonary artery and closure of atrial septal defects as well as free
pulmonary insufficiency. We discussed this at length and elected to take
her to the operating room to repair all of these lesions with the exception
of the free pulmonary insufficiency. The decision was made by the
cardiologist to leave their catheter in place as they were afraid that the
stent would migrate back into the ventricle.
OPERATIVE PROCEDURE: After family was informed and informed
consent was obtained, she was brought emergently to the operating room and
placed on table in supine position. Anesthesia monitor attached and
general anesthesia was obtained. Her chest and abdomen prepped and draped
in usual sterile fashion. A redo incision was performed with the
oscillating saw. There were dense adhesions to the posterior table of the
mediastinum. I then carried out dissection and identified the aorta and
right atrium. I should note that the right phrenic nerve lay directly on
top of the superior vena cava, which was somewhat odd. I did free this up.
I then cannulated the aorta and right atrium after full heparinizing dose
was given. I then moved my cannulization strategy to the superior vena
cava and the inferior vena cava. I should note that there was a
retroaortic innominate vein. I carried out dissection of the aorta, and
the Cardioplegia needle was then placed into the aorta. The aorta was
cross-clamped, and Cardioplegia was administered and the heart rested
promptly. I had placed tapes around the superior vena cava and inferior
vena cava. I then opened the right atrium and closed the atrial septal
defect with 2 layers of 5-0 Prolene suture. I then closed the right atrium
with 2 layers of 5-0 Prolene suture. I then opened the main pulmonary
artery, and I was able to visualize the stent into the left pulmonary
artery, and the stent was extracted. At this point in time I removed the
catheter from the right groin, and pressure was held over the site. There
was a very tight orificial lesion of the right pulmonary artery and the
right pulmonary artery ____ distal to this. I opened the right pulmonary
artery extending my incision all the way to the first bifurcation. I cut
the 4 mm GORE-TEX graft and I sewed this in place with a running 7-0
Prolene suture to patch the right pulmonary artery all the way to the main
pulmonary artery. I had opened the outflow tract completely. I observed
for any muscle bundles. There was none. Monocusp valve was performed with
pericardial membrane. This was sewn in place with a running 6-0 Prolene
suture and then I patched the entire right ventricular outflow tract as
well as the left and right pulmonary arteries with GORE-TEX patches as
well, sewn in place with running 6-0 Prolene suture. We had given
Cardioplegia every 20 minutes with a crossclamp time. ------- was placed in
a head down position. Left ventricle was fully deaired, and the crossclamp
was removed. We had cooled to 32 degrees Celsius and began rewarming to
normothermia. Once we reached normothermia, we weaned from cardiopulmonary
bypass without difficulty. Ventricular pacing wires were placed and has
had a 15 French Blake drain. The echocardiogram demonstrated an excellent
result. A 15 French Blake drain was brought through separate stab
incision. A pericardial membrane was sewed in place of GORE-TEX for ____
entry. The sternum was closed with stainless steel wires, and the skin was
closed in 2 layers, and a Dermabond dressing was applied. -------- tolerated
the procedure very much and transported to the ICU in stable condition.
