Surgery cardiac malformations in newborns
An example of neonatal surgery: transposition of the great vessels
- Transposition of the great vessels is a congenital abnormality of the structure of the heart. Instead of from the left ventricle to distribute oxygen-rich blood to the entire body, the aorta arises from the right ventricle at. And vice versa, instead of from the right ventricle to the lungs to send venous blood low in oxygen, the pulmonary artery arises from the left ventricle. If nothing is done immediately after birth is asphyxiation and rapid death of the baby.
- Most of the time, the anomaly is detected during ultrasound monitoring of pregnancy. In this case, the pregnant mother is oriented towards a high-level technical maternity (maternity type III2) where the baby was immediately assumed at birth by a pediatric cardiologist. At first, this practice catheterization: it is an artery into an instrument with an inflatable balloon to go to the heart. There he made a hole between the right and left side if it does not already exist. In this way, the blood oxygenated in the lungs, flows to the rest of the body that normally nourishes. But this is not enough.
- If you do not operate quickly, the baby's heart will deteriorate severely. So, in the week following the birth, an attempt is usually surgery "restorative". Intervention is to relocate the aorta to the left ventricle and the pulmonary artery to the right ventricle. Is re-implanted vessels to their normal place: the most difficult being the reimplantation of the coronary arteries (1mm in diameter) on the aorta. This procedure is somewhat risky today heavy hands of teams experienced in this surgery: mortality from the procedure is less than 1%. Children who underwent transposition of the great vessels usually lead normal lives strictly in the absence of medical treatment.
- These good results are due to advances in surgical techniques, anesthesia, intensive care and pediatric necessarily material cardiopulmonary bypass (CPB), otherwise nothing would be possible (heart surgery stopped, at least for changing the space aorta and coronary arteries to reimplant being necessary).
Without technique, not miracles
Grace and cardiopulmonary bypass (CPB), it is now possible to make children more small, heart increasingly complex, with a mortality risk of less than 3% of all childhood heart disease combined.
If the roles played by anesthesia and resuscitation are known to all, the role of extracorporeal circulation is much less.
During the procedure, the circuit CEC provides cardiac function (blood flow) and pulmonary (oxygen and release carbon dioxide) allowing the surgeon to operate on a heart isolated, motionless and bloodless. Once completed, the repaired heart is filled with blood, which was emptied of air could get inside and warm. He starts to fight immediately.
More than 3,000 pediatric cardiac operations are performed each year, including more than 650 on newborns less than 1 month.
Large vessels transposition: details
It is also called "ventriculo-arterial discordance" and represents 5-7% of heart (cardiac) defects, 20 to 30 children / 100,000 live births. It preferentially affects males: 70% of cases. We must always suspect to cyanosis (purple skin) early neonatal, that is to say that is not immediately improved by ventilation with oxygen.
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