Surgery Notes

This severely mutilated soldiers allowed the surgeons for total war new problems, which then not owned solutions. The restoration of the face made a return of the soldier to the trench or the civil society possible again. Without a recovery even this is not possible anymore. For this reason, this form of reparative or restorative surgery as a “social surgery” mentioned. Behind the front lines was desperately looking for a solution to this complicated facial mutilations. The combination of general surgical knowledge with dental or ear, nose and throat experience proved of great utility, since usually upper and lower jaw, nose, eye sockets and sinuses were involved in the accident.

Thus, specialists opt for the lower right armpit as new access road to the heart, or the incision under the right breast, choice used in teenage girls.

Only in very selected patients with heart disease and simple, they have carried out these innovative techniques in children and adolescents, having made 19 interventions. Since 2007, they have spoken to 10 teens, and since 2009 has been operated to 9 children over three years.

The cardiovascular surgical interventions are multidisciplinary working paradigm and in the case of a participating extracorporeal cardiovascular surgeons, perfusionists that control lung machine, anesthesiologists, cardiologists, and nursing staff, as well as intensivist or neonatologist if the patient is a newborn.

In 2009, they have conducted a total of 152 cardiovascular surgical interventions in children, of whom 57% were extracorporeal. 22% of the interventions were neonates. In the past three years, there has been a prominent increase in infant heart surgery, increasing by 41% the number of operations since 2007.

The complexity in this type of surgery is enhanced with increasing in recent years of interventions in patients at younger ages. The increasingly early diagnosis of congenital malformations and increased preterm births and therefore most vulnerable, increase the difficulty of interventions.

Congenital heart disease are varied. The most frequent that require surgical treatment with cardiopulmonary bypass are septal defects (holes in the walls within the heart) and tetralogy of Fallot (four heart abnormalities that cause blood to flow without sufficient oxygen).
On the other hand, coarctation, or narrowing of the aorta and the ‘persistent ductus’ (persistence, after birth, communication between the pulmonary arterial system and the aorta, necessary during fetal life) are the most common heart disease among interventions without cardiopulmonary bypass.

The Section of Pediatric Cardiovascular Surgery performed different lines of research as well as that relating to the creation of artificial pulmonary valve made of synthetic material for the treatment of complex heart disease, or who studies the use of temporary pacemaker in extracorporeal interventions to ensure heart rate at end of surgery.

These actions are framed within the objectives which includes the Comprehensive Plan of Care for Heart of Andalucia, and respond to the expectations of patients and their families, being a chance in the sense of improving quality of life of patients with heart , matching the supply of services to people’s needs effectively and efficiently