Procedures Seth had
during his surgery in 2009
Nikaidoh Procedure
Children’s
Hospitals and Clinics of MN,
2525 Chicago
Avenue S,
Minneapolis, MN
55404
2012 The
Children’s Heart Clinic
The
Nikaidoh procedure is a surgery that can be used to correct congenital heart
defects such as double outlet right ventricle (DORV) or transposition of the
great arteries (TGA) with narrowing of the pulmonary valve (stenosis). This
surgery involves “translocation” of the transposed aorta over the correct,
left, ventricle. The outflow of the right ventricle is then reconstructed with
either a right ventricle to pulmonary artery (RV-PA) conduit or patch made of
bovine (cow) pericardium (sac surrounding the heart). There are many types of
materials used for RV-PA conduits. Depending on the surgical plan and patient’s
anatomy, conduits made of Gore-Tex® (Gore), homograft (cadaver valved tissue),
Contegra® (Medtronic) conduits (valved bovine jugular vein), or Hancock® (Medtronic)
conduits (Dacron tube graft containing a porcine (pig) valve) can be used.
During surgery, a median sternotomy
(incision through the middle of the chest) is done through the patient’s prior
incision, if present. The patient is placed on cardiopulmonary bypass (heart – lung
machine). The aortic root and valve is removed as one piece from its location
over the right ventricle. When removing the aortic root, a cuff of muscle is
left surrounding the aortic valve to preserve the leaflets and the coronary
arteries are keep in their original positions. The pulmonary valve is excised
and removed. The excised aortic root is then slid back so that it is sitting
over the left ventricle. The cuff of muscle in the aortic root is then sewn to
the muscle of the left ventricle. Often, a longer flap of muscle is left on the
front of the aortic root, so that it can be used to fill the space where the
ventricular septal defect (VSD) is. If the VSD is very large, occasionally a
Dacron patch can be used to close the space of the VSD. Once the neo-aorta is
sewn over the left ventricle, the outflow tract of the right ventricle must be
reconstructed. If a RV-PA conduit is used, an appropriate sized prosthesis is
selected. One end of the conduit is sewn onto the incision on the pulmonary
artery and the other end is sewn onto the incision on the right ventricle. If
the right ventricle outflow tract is planned to be reconstructed, a patch of
bovine pericardium is cut to the appropriate size. The patch is sutured to the
pulmonary artery and right ventricle to create a “baffle” or “tunnel” for blood
to travel to the lungs in. The patch is often sutured to the aorta & heart
muscle, which creates the back wall of the new outflow tract. After completion
of the Nikaidoh procedure, “blue,” deoxygenated blood can travel from the right
ventricle to the lungs and “red,” oxygenated blood can travel from the left
ventricle to the body, similarly to a normal heart’s circulation.
Typical
Post-Operative Course:
Surgery Length : 6 hours
·Typical Lines:
Most patients will return to the Cardiovascular Care Center after surgery with a breathing tube, an arterial
line to monitor blood pressure, a central venous line (for giving IV medicines
and drawing labs), a peripheral IV, chest tubes to drain fluid, and a foley
catheter to drain urine.
·Typical Post-Operative Recovery: The breathing tube is generally removed within
24-48 hours after surgery. The
arterial line is usually removed within a few days, once most IV medicines are
stopped. The central venous line is removed once most IV medicines are stopped
and labs no longer need to be drawn. Chest tubes are usually removed 24 - 48
hours following surgery, once the output of fluid is minimal.
Depending on the type of conduit
placed and surgical plan, the patient may be placed on aspirin for a period of
time after surgery.
·Typical Length of Stay:
A patient usually stays in the hospital for 8 days following a Nikaidoh
procedure.
Typical
Home Medications: Children will require one or more
medications at home following a Nikaidoh procedure such as:
·Diuretics (Lasix) to control fluid
·Anticoagulation (aspirin) to prevent clotting
·Afterload reducing agent (Enalapril, Captopril)
© 2012 The
Children’s Heart Clinic
Lecompte
Procedure
For complete transposition of the great
arteries with ventricular septal defect and pulmonary stenosis.
D-Transposition
of the great vessels is a congenital cardiac anomaly in which the aorta arises
from the right ventricle, and the pulmonary artery arises from the left
ventricle. Desaturated venous blood returning from the peripheral tissue is
pumped back to the systemic circulation while oxygen rich pulmonary venous
blood is pumped back to the pulmonary artery. Patients present with cyanosis.
Patients with transposition of the great vessels must have a communication
between the systemic circulation and the pulmonary circulation to be consistent
with life. Ideally, these patients will have a patent ductus arteriosus and an
atrial septal defect. These work together to allow blood to shunt from the left
atrium to the right atrium allowing oxygenated blood to enter the systemic
circulation. Intravenous infusion of prostaglandin E1 will usually open the
ductus arteriosus and a bedside balloon atrial septostomy is performed to
create a communication between the atria.
Warden
Procedure
Partial anomalous pulmonary venous
connection (PAPVC) is a rare congenital cardiac defect. As the name suggests,
in PAPVC, the blood flow from a few of the pulmonary veins return to the right
atrium instead of the left atrium. Usually, a single pulmonary vein is
anomalous. Rarely, all the veins from one lung are anomalous. Thus, some of the
pulmonary venous flow enters the systemic venous circulation.
PAPVC from the right lung is twice as
common as PAPVC from the left lung. The most common form of PAPVC is one in
which a right upper pulmonary vein connects to the right atrium or the superior
vena cava. This form is almost always associated with a sinus venosus
type of atrial septal defect (ASD).
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