Tetralogy of Fallot| Extending The Patch With Patient's Own Pericardium скачать в хорошем качестве

Tetralogy of Fallot| Extending The Patch With Patient's Own Pericardium

This patient has Tetralogy of Fallot requiring surgical repair. The pericardial stays are cut and a large rectangle of autologous pericardium is harvested. The autologuos pericardium is then positioned and its bottom corner is anchored first. Then the right side suture line of the right ventricular outflow tract augmentation patch, together with a unicuspid pulmonic valve made of GoreTex membrane is carried headwards as a forehand, continuous over and over suture. Where it meets the suture on the equine pericardium, the two lengths are tied together. This process is repeated on the other side. The autologous pericardium is trimmed to fit. The final suture line unites the equine pericardium above with the autologous pericardium below. Here the suture lines are extended from the left to the right and from right to left. Where the sutures from the two sides meet in the middle they are tied together. The suture line is inspected and probed for gaps. Then it is reinforced with a second suture line. The right ventricular outflow tract is plumbed with Hegar dilators of varying diameters to ensure that it is of the correct size. Then the small atrial septostomy made for the pericardial sucker is closed. With pump flows momentarily reduced, the crossclamp is released. Freshly oxygenated blood coming from the cardiopulmonary bypass pump flows down the coronary arteries, allowing the heart to start to beat again. The right atriotomy closure suture is anchored in the bottom corner. The right atrium is closed from below upwards with a continuous over and over suture line. At the top corner of the atriotomy, the suture is tied to itself. Then it is reinforced from below upwards with another continuous over and over suture line. At the top, both ends of the suture are tied together, completing the closure. The long continuous suture lines of the augmentation patches are reinforced along their entire length with figure of eight sutures. These help to redistribute suture tension and ensure water tightness. This is especially important in the area of the unicuspid pulmonic valve, where the GoreTex membrane is interposed between the tissues of the patient and the pericardial patches.