Cardiovascular Surgery Coarctation Aorta correction

Coarctation of Aorta (Pediatric)

Objective

In case of narrowing of the distal segment of the aortic arch:

•   To open chest  

•   To expose the site of narrowing 

•   Relieving obstruction to blood flow in the descending aorta. 

Position

•   Right lateral position with left arm stretched above the head. 

Anesthesia

General, endotracheal.

Procedure

   1.  Cleaning and draping. 

   2.  Operation for left thoracotomy. 

   3.  BP handle No. 3 with No. 10 skin blade attached to it. 

   4.  Finochietto chest retraction with small sized (No. 2) blades attached to it. 

   5.  Pleural stay - 3-0 on 4-0 atro silk. 

   6.  Straight Mosquito’s clamp to be given for stay suture. 

   7.  Small aortic (angled) clamps to be given. If infant use Castaneda clamps for the aorta.

   8.  Clamps to be placed above and below the coarctation. 

   9.  Operation of coarctation of aorta usually is done by direct end to end anastomosis by resecting the narrow area of the aorta. 

10.  Occasionally a tubular dacron prosthesis or similar graft is required to bridge the gap. 

11.  Pleura to be sutured with 3-0 or 4-0 atro silk loaded on a Sarrot NH. 

12.  Sponge, gauze pieces and instruments count. 

13.  Insertion of chest tube in the pleural cavity. 

14.  Chest closure. 

Instruments

•   Cleaning tray 

•   Cardiac set 

•   Pediatric set 

•   Water seal set 

•   PDA set (above 5 years)

•   Castaneda vascular clamps 

•   Gemini right angle clamp

•   Castroviejo needle holders.

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Cardiovascular Surgery ligation PDA

PDA Ligation

Objective

•   Open chest

•   Suture ligation of patent ductus arteriosus.

Position

Right lateral (Left side up).

Anesthesia

General, endotracheal.

Procedure

   1.  Skin incision No. 3 BP handle with No. 10 blade.

   2.  Separation of muscle, Zerney’s retractor and Morris retractor.

   3.  Rib separation with cautery.

   4.  Finechietto retractor with small blade.

   5.  Exposure of ductus.

   6.  Right angle and silk-2, to tie the ductus.

   7.  Pleural closing 4.0 Atrosilk.

   8.  Chest drainage tube.

   9.  Pericostal and closure 0-catgut on round body needle.

10.  Muscle closing 3.0 Vicryl or 3.0 Dexron.

11.  Dressing with betadine.

Instruments

•   Cardiac set as in pericardiectomy.

•   Bailey Glovers PDA clamps, 2 set     

•   DeBakey angled clamp small, 1 set  In case PDA to be

•   DeBakey angled clamp curved, 1 set       sutured.

•   Cooley clamp, 1 set                            

•   Harken clamp, 1 set

•   Ligature carrier, 1 set

•   Scissors Metzenbaum, 1 set

•   Scissors Pott’s 7", 1 set

•   Debakey needle holder 7", 1 set

•   Bailey needle holder 8", 1 set

•   Retractor, malleable, small, 1 set

•   Debakey dissecting forceps 7", 3 set

•   Morse Andrews suction tip big, 1 set

•   Morse Andrews suction tip small, 1 set

•           Gemini right angle clamp, 1 set.

Any questions be sent to drmmkapur@gmail.com

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Cardiovascular Surgery repair ASD

Atrial Septal Defect Closure (ASD)

Objective

•   To open chest

•   To close a defect (hole) in the atrial septum.

Position

•   Left semilateral/supine.

Anesthesia

General, endotracheal.

Procedure

   1.  Catheterization: Cleaning and draping.

   2.  Skin incision with No. 4 BP handle with No. 20 blade.

   3.  Saw and cable for sternotomy.

   4.  Pericardiotomy: Stay suture 2/0 At. silk.

   5.  Loop the SVC and IVC.

   6.  Keep ready for venous tubing, aortic tubing and cardio­plegia tubing.

   7.  Aortic purse string 3.0 T3 single arm suture (2) cannulated.

   8.  IVC purse string and cannulation.

   9.  SVC purse string and cannulation.

10.  Aortic cannulation No. 11 knife for hole in the aorta. Insert cannula, silk tie. Connect the venous and arterial line in SVC and IVC.

11.  Cardioplegia stitch 4.0 T3 single arm, arterial line, scissors, snugger medium snap, cardioplegia cannula, silk tie.

12.  Scissors for opening the RA.

13.  Direct closure 4.0 T3 stitch or Dacron patch 4/0 Surgilene.

14.  RA closure 5/0 Prolene.

15.  Decannulation, Pacing wire.

16.  Drainage tube.

17.  Sponge and instruments count.

18.  Sternum closure—muscle and subcutaneous.

Instruments

•   Cleaning tray

•   Catheterization set

•   Cardiac set

•   Open heart vascular set

•   Open heart special set

•           Open heart water seal.

Any questions be sent to drmmkapur@gmail.com

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Cardiovascular Surgery Sternotomy procedure instruments

Sternotomy

Objective

To open the chest and to expose the heart and mediastinum.

Position

Supine.

Anesthesia

General, endotracheal.

Procedure

1.  Incision from suprasternal notch to xiphoid process.

2.  Deepen incision to periosteum.

3.  Retract skin at the upper end with Rake retractor with scissors and a right angled clamp clear the upper sternal edge.

4.  Divide interclavicular ligament.

5.  Use sternal saw to cut along the line from above downwards.

6.  Pericardium is incised.

Instruments

•   Cleaning tray

•   Sternotomy set.

Any questions be sent to drmmkapur@gmail.com

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Cardio-vascular Surgery Pericardectomy

Pericardiectomy

Objective

•   To open chest

•   To excise pericardium

•   To relieve constriction of the heart.

Anesthesia

General, endotracheal.

Position

•   Supine or right semilateral

Procedure

   1.  Cleaning and draping.

   2.  Incision midsternotomy or thoracotomy.

   3.  Skin incision with knife, sponge and cutting cautery.

   4.  Separation of the pericardium with Rt. angle and cautery (cutting) and gauze piece.

   5.  Excise the pericardium.

   6.  Chest drainage tube.

   7.  Pericostal closure sponge and instruments count.

   8.  Muscle closure with 1-0 Vicryl or Dexron.

            9.         Subcutaneous 2-0 Vicryl or Dexron.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archive for accessand reiew

Thosewho follow may post contributions to the site,please writo tp address above.

To create consumer/provider enagement visit www.surginstruatlas.blogspot.com

www.drmmkapur.blogspot.com                 www.surgseminar.blogspot.com

Also available now on android & smartphones same internet address