Cardiovascular Diseases / / August 12, 2017
operations on the pericardium and heart
(method of operation)
1. Access. anterolateral thoracotomy in the fourth intercostal space on the left.Reveal the pleural cavity.Haemostasis by electrocoagulation.Skin isolated napkins.If necessary, cross or resected 1-2 adjacent ribs.For soft-tissue dissection surgeon should apply tight little cotton swab on the terminals Mikulic.One of the assistants tongs for gripping light takes him aside, the other - large, soft cotton swab dries operational regiment.
2. pericardiotomy. pericardium dissected long scissors in front of and parallel to the phrenic nerve.The edges of the dissected pericardium sewn with thin and strong silk ligatures №4 length of 40 cm, at the ends of which is applied Billroth clips.With the help of assistants clamps hold the pericardium and bred in the part of its cut edges.
3. Preparation of the left atrial appendage. left atrial appendage, if it spikes spliced to the pulmonary artery and ventricle, emit litt
4. Intracardiac stage (commissurotomy). Clipping tab tops producing scissors after the preliminary preparation and mobilization of attention of the whole team.It begins the most crucial stage of intracardiac surgery.Exempted from clots ear cavity.The surgeon inserts the opening index finger, first assistant holds the turnstile or seams-taped, the second assistant holds the ready ear clip heart, the third assistant aspirates from pericardial blood, and my sister is closely monitoring the progress of the operation, ready to carry out any instructions of the surgeon.Before the introduction of the finger into the cavity of the heart surgeon usually removes the glove.This facilitates handling and improves tactile sensitivity, giving a more complete picture of the disease.Sister surgeon should give abundant alcohol moistened cloth for further treatment of his right hand.Thereafter, the arm was treated with iodine.It is very important to do, since the time of the intracardiac phase of the operation in a glove can accumulate a certain amount of moisture from the sweat glands of the brush, which increases the likelihood of wound infection.During this period, various complications are possible, the most formidable of which - the gap atrial wall and embolism of cerebral vessels.If the finger is not possible to break the commissure, one of dilators used.After intracardiac phase of the operation of the heart's eye is sutured obvivnym silk suture №4.The wound was sutured pericardium individual rare catgut sutures (catgut №3).
5. Washing and revision of the pleural cavity. pericardial and pleural cavity thoroughly freed of clots and liquid blood.If significant blood loss, blood is collected in a jar, a solution of sodium citrate (sodium citrate) and poured into a vein of the patient.
6. Drainage of the pleural cavity.
7. stitching thoracotomy wound.
8. straightened light.