DE LA PARTE PEREZ, Lincoln. ANESTHESIA IN JATENE’S SURGERY, AN EXPERIENCE AT THE CARDIOLOGY CENTER OF “WILLIAM SOLER” HOSPITAL. Recursos Materiales y Humanos del Servicio de Cirugia cardiovascular 7. Organización para la corrección anatómica u Operación de Jatene siempre que. Cirugía de switch arterial: una historia de grandes esperanzas. mArsHALL L. JAcoBs1. Forty years ago, when Adib Jatene, in Sao Paulo, Bra- zil performed the.

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The Jatene procedure is ideally performed during the second week of life, before the left ventricle adjusts to the lower pulmonary pressure and is therefore unable to support the systemic circulation. In most cases, the coronary implantation sites will be at left and right anterior positions at the base of the neo-aorta; however, if the circumflex coronary artery branches from the right coronary arterythe circumflex coronary artery will be distorted if the pair are not implanted higher than normal on the neo-aorta, and in some cases they may need to be implanted above the aortic commissure, on the native aorta itself.

Scottish pathologist Matthew Baillie first described TGA inpresumably as a posthumous diagnosis. Rollins Hanlon introduced the Blalock-Hanlon atrial septectomywhich was then routinely used jatenee palliate patients.

Arterial switch operation

The coronary ostia and a large “button” of surrounding aortic wall are then excised from the aorta, well into the sinus of Cirrugia ; and the proximal sections jatnee the coronary arteries are separated from the surface of the heart, which prevents tension or distortion after anastomosis to the neo-aorta.

An 8 day old right after the Jatene procedure. If the aortic commissure has not previously been marked, the excised coronary arteries will be used to determine the implantation position of the aorta.

The Jatene procedurearterial switch operation or arterial switchis an open heart surgical procedure used to correct dextro-transposition of the great arteries d-TGA ; its development was pioneered by Canadian cardiac surgeon William Mustard and it was named for Brazilian cardiac surgeon Adib Jatenewho was the first to use it successfully.

When the patient is fully cooled, the ascending aorta is clamped as close as possible below the HLM cannula, and cryocardioplegia is achieved by delivering cold blood to the heart via the ascending aorta below the cross clamp.

The circumflex coronary artery may originate from the same coronary sinus as, rather than directly from, the right coronary artery, in which case they may still be excised on the same “button” and transplanted similarly to if they had a shared ostium, unless one or both have intramural communication with another coronary vessel.

A generous section of pericardium is harvestedthen disinfected and sterilized with a weak solution of glutaraldehyde ; and the coronary and jahene artery anatomy are examined.

Jateen the time of the operation on February 6,he weighed just over 1. The patient will continue to fast for up to a few days, and breastmilk or infant formula can then be gradually introduced via nasogastric tube NG tube ; the primary goal after a successful arterial switch, and before hospital discharge, is for the infant to gain back the weight they have lost and continue to gain weight at a normal or near-normal rate.

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Impedance cardiography Ballistocardiography Cardiotocography. In the event of sepsis or delayed diagnosisa combination of pulmonary artery banding PAB and shunt construction may be used hatene increase the left ventricular mass sufficiently to make an arterial switch possible later in infancy.

The great arteries are usually arranged using the LeCompte maneuverwith the aortic cross clamp positioned to hold the pulmonary artery anterior to ed ascending aorta; though with some congenital arrangements of the great arteries, such as side-by-side, this is not possible and the arteries will be transplanted in the non-anatomic ‘anterior aorta’ arrangement.

However, in cases ccirugia the individual has been diagnosed but surgery must be delayed, maternal or even autologousin certain cases blood donation may be possible, as long as the mother has a compatible blood type. This procedure yielded early and late mortality rates dirugia to the Senning procedure; however, a late morbidity rate was eventually discovered in relation to the use of synthetic graft material, which does not jateme with the recipient and eventually causes obstruction.

Silk marking sutures may be placed in the pulmonary trunk at this time, to indicate the commissure of the aorta to the neo-aorta ; alternatively, this may be done later in the procedure. The patient is fitted with chest tubestemporary pacemaker leads, and ventilated before weaning from the HLM is begun. His few attempts were unsuccessful due to technical difficulties posed by the translocation of the coronary arteries, and the idea was abandoned.

Heart valves and septa Valve repair Valvulotomy Mitral valve repair Valvuloplasty aortic mitral Valve replacement Aortic valve repair Aortic valve replacement Ross procedure Percutaneous aortic valve replacement Mitral valve replacement production of septal defect in heart enlargement of existing septal defect Atrial septostomy Balloon septostomy creation of septal defect in heart Blalock—Hanlon procedure shunt from heart chamber to blood vessel atrium to pulmonary artery Fontan procedure left ventricle to aorta Rastelli procedure right ventricle to pulmonary artery Sano shunt compound procedures for transposition of great vessels Arterial switch operation Mustard procedure Senning procedure for univentricular defect Norwood procedure Kawashima procedure shunt from blood vessel to blood vessel systemic circulation to pulmonary artery shunt Blalock—Taussig shunt SVC to the right PA Glenn procedure.

This would have effectively reduced early mortality rates, particularly in cases with no concomitant shunts, but is unlikely to have reduced late mortality rates.

If the aortic commissure has not yet been marked, it may be done at this point, using the same method as would be used prior to bypass; however, there is a third opportunity for this still later in the procedure. InAmerican surgeons William Rashkind fe William Miller transformed the palliation of d-TGA patients with the innovative Rashkind balloon atrial septostomywhich, corugia the thoracotomy required by a septectomy, is performed through the minimally invasive surgical technique of cardiac catheterization.

Retrieved from ” https: Sometimes, one or more coronary ostia are located very close to the valvular opening and a small portion of ciugia native aortic valve must be removed when the coronary artery is excised, which causes a generally mild, and usually well- toleratedneo-pulmonary valve regurgitation. These statistics, combined with advances in microvascular surgery, created cirugla renewed interest in Mustard’s original concept of an arterial switch procedure.


The coronary arteries are carefully mapped out in order to avoid unexpected intra-operative complications in transferring them from the native aorta to the neo-aorta.

The patient will require a number of imaging procedures in order to determine the individual anatomy of the great arteries and, most importantly, the coronary arteries.

This surgery may be used in combination with other procedures for treatment of certain cases of double outlet right ventricle DORV in which the great arteries are dextro – transposed. Jatene procedure An 8 day old right after the Jatene procedure. Coronary arteries are examined closely, and the ostia and proximal arterial course are identified, as are ve infundibular branches, if they exist. While the patient is cooling, the ductus arteriosus is ligated at both the aortic and pulmonary ostiathen transected at its center; the left pulmonary branchincluding the first branches in the hilum of the left lung, is separated from the supportive tissue; and the aorta is marked at the site it will be transected, which is just below cirugiia pulmonary bifurcationproximal to where the pulmonary artery will be transected.

If a ventricular septal defect VSD is present, it may be repaired, at this point via dd the aortic or pulmonary valve ; it may alternatively be repaired later in the procedure. The aorta is then transplanted onto the cigugia root, using either absorbable or permanent continuous suture. The world’s smallest infant to survive an arterial switch was Jerrick De Leon, born 13 weeks premature. Pericardium Pericardiocentesis Pericardial window Pericardiectomy Myocardium Cardiomyoplasty Dor procedure Septal myectomy Ventricular reduction Alcohol septal ablation Conduction cjrugia Maze procedure Cox maze and minimaze Catheter ablation Cryoablation Radiofrequency ablation Pacemaker insertion Left atrial appendage occlusion Cardiotomy Heart transplantation.

Egyptian ckrugia surgeon Magdi Yacoub was subsequently successful in treating TGA with intact septum when preceded by pulmonary artery banding and systemic-to-pulmonary shunt palliation.

Arterial switch operation – Wikipedia

By using this site, you agree to the Terms of Use and Privacy Policy. Mustard first conceived of, and attempted, the anatomical repair arterial switch for d-TGA in the early s. The vessels are again examined, and the pulmonary root is inspected for left ventricular jateene tract obstruction LVOTO. The success of this procedure is largely dependent on the facilities available, the skill and experience of the surgeon, and the general health jaten the patient.

Views Read Edit View history. This page was last edited on 4 Decemberat The ductus arteriosus and right pulmonary branchup to and including the first branches in the dee of the right lungare separated from the surrounding supportive tissue to allow mobility of the vessels.

The aortic clamp is temporarily removed while small sections of the neo-aorta are cut away to accommodate the coronary ostia, and a continuous absorbable suture is then used to anastomose each coronary “button” into the prepared space.