tailieunhanh - SURGICAL OPTIONS FOR THE TREATMENT OF HEART FAILURE - PART 4

Hình 44 cho thấy những nguyên nhân phổ biến nhất gây tử vong sau khi cấy ghép phổi (cả người lớn và trẻ em) tại ba điểm thời gian difterent. Harly sau khi ghép, ghép thất bại không đặc hiệu và nhiễm trùng chiếm vị thế chủ đạo. | 54 . Semeihaga and . Keen. Figure X Endavenlriẹtilạr Oftearysm repair narrow cavity. Further if the septum is involved a. paradoxical area will add to these 1 Incorporating the concepts of Daggett et al . Jatene developed a technique to address these issues 35 36 Following resection of the aneurysm leaving a rim. of scar for Suturing the orifice of the aneurysm is reduced concentrically with Ư shaped stitches externally anchored on Teflon pledgets. An LinsiCteiiable Dacron patch whose shape .duplicates that of the original infarctcd area is fixed over the reduced To determine the- size- and- shape of the Dacron patch to be used one or two purse-string sutures are placed at the. transition zone between normal and fibrous tissue and the purse-string sutures are carefully pulled to rebuild the left ventricular cavity. Tò address septal distension Jatcne recommended the use of two or three mattress stitehes with pledgets placed posterior to anterior to reduce elongation of the septal wall and prevent septal distension - Endoven tricìiỉạrRepair of Dor Eigure 3 In 1984 almost simultaneous with he work of Jatene Dor developed the technique of endoventricular circular patch plasty E VCPP .37 After opening the aneurysm through Left Ventricular Aneurysm Repair for Management Left Ventricular Dysfunction 55 Figure J. circular patch plasty EVI PPỊ ofijor the apex the junction between the endocardial scar and normal nryocardioum is identified throughout the entire circumference of the aneurysm. A continuous 2-0 monofilament suture is placed around the entire circumference of the base of thè aneurysm at the junction of sear and normal myocardium. The degree of tightening of this suture will determine the final size of the remaining opening in the ventricle and the size of the endocardial patch to be used. The patch is usually 2-3 cm 111 diameter and can be Dacron or pericardium. The patch is sutured at the level of .