Selected Cardiac Surgery Procedures

1. The Glenn procedure involves cutting the right pulmonary artery at the bifurcation of the pulmonary trunk, suturing the proximal end closed, and anastomosing the distal end to the superior vena cava. The procedure is more effective and has the advantage of not increasing the load on the left ventricle or producing pulmonary vascular lesions. However, the operative mortality rate is higher in cases under 6 months of age, and the surgery causes continuous interruption of the left and right pulmonary arteries. 2. Fontan surgery is a procedure used to treat tricuspid atresia. It is a palliative procedure based on the two-way Glenn procedure, in which venous blood from the body circulation is directed into the pulmonary artery without passing through the right ventricle, thus separating the body and pulmonary circulation and reducing the load on the left ventricle. Currently, the best option is extracardiac total vena cava-pulmonary artery anastomosis. Feng Tianying, Department of Ultrasound Medicine, People’s Hospital of Inner Mongolia Autonomous Region 3. Norwood procedure As the first palliative procedure in the staged treatment of hypoplastic left heart syndrome, it is increasingly used and has achieved some success. The atrial septum is excised to enlarge the interatrial traffic, and the main pulmonary artery is transected at the right and left pulmonary arteries and the distal end is repaired with a homogeneous vascular piece. The arterial duct is dissected, its pulmonary side dissection end is sutured, and the aortic side dissection end is cut and enlarged. The descending aortic arch was shaped with the homologous pulmonary artery, and a body-pulmonary shunt was made with an artificial vessel at the junction of the aortic arch and the right and left pulmonary arteries. The descending main pulmonary artery is anastomosed to the formed ascending aorta.4. Ross procedure In children or prepubertal patients with various aortic valve diseases, most patients face valve replacement again after several years if valve replacement is performed because they are not fully developed, and postoperative anticoagulation in children still has a high complication rate. The present procedure better addresses this problem. An autologous pulmonary valve is transplanted into the aortic valve position, and the right ventricular outflow tract is then reconstructed using the same pulmonary valve. The pulmonary valve transplanted into the aortic valve position has the potential and possibility of continued growth because it is autologous tissue, has ideal hemodynamic results, solves the problem of the fixation of the prosthetic annulus limiting the development of the aortic root, and has ideal long-term results.5. Rastelli procedure For patients with transposition of the great arteries combined with ventricular septal defect, left ventricular outflow tract stenosis, or pulmonary valve stenosis. The procedure is performed through a ventricular incision, and the ventricular defect is repaired with artificial vessel pieces or polyester fabric to reconstruct the intracardiac passage. The main pulmonary artery is dissected and the proximal opening of the pulmonary artery is sutured closed, and an extravalvular conduit connection is used between the right ventricle and the pulmonary artery, with autologous pulmonary arteries and artificial vessels as the preferred materials. The distal end is anastomosed first, followed by the proximal end, or the proximal end can be anastomosed first and then the distal end.6. Switch procedure It is an anatomic correction for congenital heart diseases such as double outlet of the right ventricle and complete transposition of the great arteries. Under general anesthesia, extracorporeal circulation is established, the aorta is cut at the root and the main pulmonary artery is cut before bifurcation, and then the right and left coronary arteries and the nearby aortic wall are cut off and anastomosed at the root of the pulmonary artery. The distal pulmonary artery is then anastomosed to the proximal aorta to form a “new” aorta. The distal aorta is then anastomosed to the proximal pulmonary artery to form a “new” pulmonary artery. This procedure is very effective. The main complications are cardiac insufficiency and bleeding. Long-term follow-up found that children who underwent Switch surgery for complete transposition of the aorta were physically and psychologically indistinguishable from the normal population, and those who recovered poorly from the surgery were slightly worse than normal.7. Mustard surgery is a surgical procedure to repair atrial septal defects during the treatment of complete transposition of the great arteries. After blocking the ascending aorta, the septum is resected and the septum is reconstructed with an autologous pericardium cut into a spindle shape. The approach is to start the sutures above the left pulmonary vein opening, with one line along the top of the coronary sinus and below the right and left inferior pulmonary veins, and the other along the top of the pulmonary veins and the left atrial wall, around the upper and lower vena cava openings. After reconstruction, the interatrial septum isolates oxygenated pulmonary venous blood into the right ventricle into the body circulation, and body venous blood returns to the left ventricle into the pulmonary circulation.9. Senning procedure This procedure is used to treat complete transposition of the great arteries. The right atrium is incised in front of the sinus node, and the left atrium is incised longitudinally behind the border crest. The coronary sinus and the septum are incised to form the posterior wall of the corporal venous channel with the autologous pericardium in front of the opening of the pulmonary veins, and the anterior wall of the corporal venous channel is formed by connecting the anterior wall of the right atrium to the left edge of the septum, so that blood from the corporal circulation enters the left ventricle through the mitral valve and enters the pulmonary artery. The right edge of the right atrium near the border crest incision is then connected to the anterior wall of the right atrium via the root of the superior and inferior vena cava, allowing pulmonary venous blood to enter the right ventricle through this channel via the tricuspid valve and enter the body circulation, thus achieving functional correction.10. The subclavian artery is anastomosed to the pulmonary artery to allow for the passage of blood from the body to the pulmonary circulation. A Gore-Tex bypass can also be used.