Surgery Notes

The patient is placed supine and the surgeon opened the chest of a longitudinal section along the sternum, which is split by a saw. Then usually be the right atrium and the aorta cannulated and the hoses connected to the HLM (depending on the procedure). To prevent the blood clots in the tube system, is administered for the duration of the surgery a blood coagulation inhibitor. monitor after connecting to the HLM of the perfusionist the pumping function of the heart and the oxygenation of the blood. The surgeon cut off the blood supply to the heart. To the energy and thus reduce the oxygen consumption of the body and this easily maintained by the HLM to, the patient for the duration of the procedure in addition actively controlled by a few degrees and cool and provides the heart with a cold, potassium-rich liquid. Now the planned operation will be carried out. Here, every second counts, because the heart is now in the so-called ischemic time and will get the circulation of the entire body through a machine upright.

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