What are the steps for patent ductus arteriosus surgery?

What are the surgical procedures for patent ductus arteriosus? As modern life becomes more and more stressful and the environment becomes more and more harsh, the incidence of problems such as patent ductus arteriosus is getting higher and higher, which is very harmful to patients. Therefore, after discovery, surgical treatment will be chosen. So, what are the surgical procedures for patent ductus arteriosus?

(I) Arterial duct ligation is suitable for young children whose ductus is slender, whose wall is soft and elastic, and who have not suffered from bacterial infection.

1. Incision: Left posterior lateral chest incision. Enter the chest through the 4th or 5th intercostal space.

2. Pull the left lower lobe forward and downward to expose the ductal triangle formed by the left pulmonary artery, phrenic nerve and vagus nerve. Continuous tremor can be felt in this area.

3. Cut the mediastinal pleura longitudinally between the phrenic nerve and the vagus nerve to expose the duct between the aorta and the pulmonary artery.

4. Place blocking bands on the aorta at the upper and lower ends of the free catheter.

5. Carefully separate the front and upper and lower edges of the catheter, and then bluntly separate its back wall. Avoid damaging the left recurrent laryngeal nerve during the operation. Make sure the catheter has enough length for ligation.

6. Press the arterial catheter with your fingers or clamp it with a catheter clamp for about 10 minutes to perform a blocking test. If blood pressure drops, heart rate increases, heart rate is irregular, and pulmonary artery pressure increases, the catheter should not be closed. Otherwise, the operation can continue.

7. Under the guidance of the small right-angle clamp, two No. 10 silk threads are passed through the back wall of the catheter. After the anesthesiologist lowers the blood pressure to 8N10kPa, the aortic end of the catheter is ligated first. The ligature should be tightened gradually and slowly until the tremor at the pulmonary artery end disappears, and then slightly tightened, and then the pulmonary artery side is ligated. Another stitch can also be inserted between the two threads.

8. Suture the mediastinal pleura. Place a closed chest drainage tube. Suction sputum and expand the lungs. Suture the chest wall incision.

(ii) Arterial duct cutting and suturing is suitable for older children, those with thick and short ducts, large shunt volumes or infected ducts.

1. Incision: Left posterior lateral chest incision. Enter the chest through the 4th or 5th intercostal space.

2. Pull the left lower lobe forward and downward to expose the duct formed by the left pulmonary artery, phrenic nerve and vagus nerve: the angle area. Continuous tremor can be felt in this area.

3. Cut the mediastinal pleura longitudinally between the phrenic nerve and the vagus nerve to expose the duct between the aorta and the pulmonary artery.

4. Place blocking bands on the aorta at the upper and lower ends of the free catheter.

5. Carefully separate the front and upper and lower edges of the catheter, and then bluntly separate its posterior wall. During the operation, avoid injuring the left recurrent laryngeal nerve.

6. Place a Potts-Smith clamp on the aorta side; place two arterial clamps on the pulmonary artery side.

7. While cutting the catheter, suture the aorta side continuously back and forth.

8. Use the same method to suture the pulmonary artery side.