At each operation should remember the following. Correction of hemodynamic disorders should be performed radically surgeon. Unacceptable partially eliminate stenosis in tetralogy of Fallot, the valve prosthesis while leaving the defect (stenosis or insufficiency) of the other valve openings: incomplete revaskulyarizovat infarction in patients with coronary heart disease.
Must take into account complications arising during surgery. Complications are listed in our classification, are observed in all the clinics around the world with the most diverse frequency. Great importance to have a contingent of the operated patients and the severity of the initial states.
Calcification of the valve, especially with the transition to the wall of the atrium or the aorta, atrial thrombosis, severe heart failure, rheumatic heart disease greatly complicate the operation, increase the complication rate and thus the danger of death.
Surgical treatment of congenital heart defects in infants in relation to the particular difficulties constitute a separate section of cardiac surgery. We are moving here, unfortunately, slow.
Particularly noteworthy are also risk factors for surgery for coronary heart disease. That surgeon, first and foremost being the main person responsible for the outcome of the operation, should exercise caution and thoroughness:
- when handling hazardous areas of the heart;
- under the most critical and difficult stages of the operation;
- with respect to the myocardium.
The correction of congenital heart defects are the most dangerous zone passing the coronary arteries of the heart and the location of the conduction system.
Coronary artery is usually visible, but is so loose their type, especially in tetralogy of Fallot, which must either abandon the radical correction, or use an artificial trunk of pulmonary artery to avoid injury to major blood vessels.
Incision in the ventricle should be performed, backing not less than 1 -1.5 cm from the coronary artery. On the site incision muscle contracts, and then sew up the incision can be difficult without damaging or pulling the coronary artery. Coronary artery is easy to damage in prosthetic mitral valve, capturing it in the seam or pulling the surrounding tissue near the root of the aorta.