Ventricular Septal Defect (VSD)
Objective
• To open chest
• To close a defect (hole) in the ventricular septum.
Position
• Supine
Anesthesia
General, endotracheal.
Procedure
1. Catheterization.
2. Cleaning and draping.
3. Skin knife No. 3 or 4 BP handle with No. 10 to open the skin, cutting cautery sponge.
4. Saw and cable for opening the sternum.
5. Pericardial; Pericostal stay suture.
6. Loop the SVC and IVC.
7. Aortic purse string IVC and SVC purse string.
8. 5.0 Prolene 13 mm or 16 mm double arm, 3/0 T3 or 4/0 T3 sutures snugger, 4/0 T3 suture snugger.
9. Aortic cannulation, scissors and No. 11 knife insert cannula, exhaust with arterial line.
10. SVC cannulation, scissors; open SVC, pass the SVC cannula, connect the cannula to venous tubing.
11. IVC cannulation clamp, No. 11 knife and scissors.
12. Open the IVC, put the IVC cannula, connect the cannula to venous line.
13. Cardioplegia purse string and cannulation.
14. 4/0 T3 single arm Tevdek suture.
15. RA stay 4.0 T3 - VSD retractors; VSD suture, 6 to 8 pledget sutures with VSD Decron patch. RA closure 5/0 Prolene.
16. Pacing wire.
17. Open the PA. See PV, PA closure.
18. PA closed 6/0 prolene.
19. Remove the cardioplegia cannula.
20. Decannulation.
21. Close the SVC, IVC with 5-0 prolene pieces.
22. Remove the aortic cannula; stitch 4.0 T3.
23. Drainage tube sponge and instruments count.
24. Sternum closure after all counts.
25. No. 2 ethibond.
26. Muscle closure No. 3/0 Vicryl.
27. Skin 4.0 surgilene.
Instruments
• Cardiac set
• Open heart special set
• Open heart vascular set
• Open heart water seal
• Pediatric set.
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