HEART SURGERY CATHETERIZATION PROCEDURES
Category: Cardiovascular Surgery
Abstract : Catheterization procedures Balloon atrial septostomy and balloon valvuloplasty are cardiac catheterization procedures. Cardiac catheterization procedures can save the lives of critically ill neonates and, in some cases, eliminate or delay more invasive surgical procedures. It is expected that catheterization procedures will continue to replace more types of surgery for congenital heart
Catheterization procedures
Balloon atrial septostomy and balloon valvuloplasty are cardiac catheterization procedures. Cardiac catheterization procedures can save the lives of critically ill neonates and, in some cases, eliminate or delay more invasive surgical procedures.
It is expected that catheterization procedures will continue to replace more types of surgery for congenital heart defects in the future.
A thin tube called a catheter is inserted into an artery or vein in the leg, groin, or arm and threaded into the area of the heart that needs repair. The patient receives a local anesthetic at the insertion site. General anesthetic or sedation may be used.
BALLOON ATRIAL SEPTOSTOMY. Balloon atrial septostomy is the standard procedure for correcting transposition of the great arteries; it is sometimes used in patients with mitral, pulmonary, or tricuspid atresia. (Atresia is lack of or poor development of a structure.) Balloon atrial septostomy enlarges the atrial septal opening, which normally closes in the days following birth. A special balloon-tipped catheter is inserted into the right atrium and passed into the left atrium. The balloon is inflated in the left atrium and pulled back across the septum to create a larger opening in the atrial septum.
BALLOON VALVULOPLASTY. Balloon valvuloplasty uses a balloon-tipped catheter to open a stenotic (narrowed) heart valve, improving the flow of blood through the valve. It is the procedure of choice in pulmonary stenosis and is sometimes used in aortic and mitral stenosis. A balloon is placed beyond the valve, inflated, and pulled backward across the valve.
Surgical procedures
These procedures are performed under general anesthesia. Some require the use of a heart-lung machine, which takes over for the heart and lungs during the procedure, providing cardiopulmonary bypass. The heartlung machine can cool the body to reduce the need for oxygen, allowing deep hypothermic circulatory arrest (DHCA) to be performed. DHCA benefits the surgeon by creating a bloodless surgical field.
ARTERIAL SWITCH. Arterial switch is performed to correct transposition of the great vessels, where the position of the pulmonary artery and the aorta are reversed. The procedure involves connecting the aorta to the left ventricle and the pulmonary artery to the right ventricle.
DAMUS-KAYE-STANSEL PROCEDURE. Transposition of the great vessels can also be corrected by the Damus- Kaye-Stansel procedure, in which the pulmonary artery is cut in two and connected to the ascending aorta and right ventricle.
VENOUS SWITCH. For transposition of the great vessels, venous switch creates a tunnel inside the atria to redirect oxygen-rich blood to the right ventricle and aorta and venous blood to the left ventricle and pulmonary artery. This procedure differs from the arterial switch and Damus-Kaye-Stansel procedures in that blood flow is redirected through the heart.
FONTAN PROCEDURE. For tricuspid atresia and pulmonary atresia, the Fontan procedure connects the right atrium to the pulmonary artery directly or with a conduit, and the atrial septal defect is closed.
PULMONARY ARTERY BANDING. Pulmonary artery banding is narrowing the pulmonary artery with a band to reduce blood flow and pressure in the lungs. It is used for temporary repair of ventricular septal defect, atrioventricular canal defect, and tricuspid atresia. Later, the band can be removed and the defect corrected with a complete repair once the patient has grown.
ROSS PROCEDURE. To correct aortic stenosis, the Ross procedure grafts the pulmonary artery to the aorta. SHUNT PROCEDURE. For tetralogy of Fallot, tricuspid atresia, or pulmonary atresia, the shunt procedure creates a passage between blood vessels, directing blood flow into the pulmonary or systemic circulations.
OTHER TYPES OF SURGERY. Surgical procedures are also used to treat common congenital heart defects. To close a medium to large ventricular or atrial septal defect, it is recommended that it be sutured or covered with a Dacron patch. For patent ductus arteriosus, surgery consists of dividing the ductus into two and tying off the ends. If performed within the childs first few years, there is practically no risk associated with this operation.
Surgery for coarctation of the aorta involves opening the chest wall, removing the defect, and reconnecting the ends of the aorta. If the defect is too long to be reconnected, a Dacron graft is used to replace the missing piece.
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