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(DAMUS-KAYE-STANSEL PROCEDURE)
RISK ASSESSMENT
• Blood tests
• Electrolyte levels
• Baseline nutrition laboratory values
• Echocardiography
• Cardiac angiography
• Cardiac catheterization
• MRI
• Chest radiograph
• ECG
• Nothing is taken by mouth 6hrs before surgery
• Antibiotics were given
• PGE1 was discontinued.
ANESTHESIA
General
PROCEDURE
PRE-CARDIOPULMONARY BYPASS
CANNULATION:
THE DISSECTION
• The aorta was dissected completely from its root to the head
vessels
• The head vessels were completely mobilized.
• The innominate artery was dissected above the innominate vein,
and both the right subclavian and right carotid arteries were
mobilized and encircled with silk snares.
• The left carotid and subclavian arteries were completely
mobilized and encircled with silk snares.
• The pulmonary artery was completely mobilized.
• The left carotid and subclavian arteries are completely mobilized.
• The homograft patch was prepared from an appropriately sized
pulmonary homograft.
• The inlet portion and the valve itself are discarded.
• The widest portion of the homograft patch was chosen as that at
the inlet side, and was tailored to tapers with a nice curve
towards the longest of the two branch pulmonary arteries.
• The Prolene stitch was used to sew the homograft
AORTO-PULMONARY ANASTOMOSIS
• The atrium and aortic root were filled with cold normal saline,
and the aortic and venous cannulae were replaced.
• cardiopulmonary bypass was resumed
• Any air in the systemic circulation was allowed to flow down the
aorta.
• The head vessel snares are released and removed.
• The distal divided end of the pulmonary artery was patched with
GoreTex / homograft.
• The size of the shunt was _______
• The systemic arterial side of the shunt was performed first.
• The anastomosis was performed on the posterior aspect of the
innominate-subclavian artery junction in an end-to-side fashion
using polypropylene suture.
• The pulmonary side of the shunt was performed next.
• The site of the anastomosis was chosen to lie as close to the
ductus insertion site and the shunt sewn into this position.
• After completion of the shunt, a clamp was applied to the shunt
until weaning from cardiopulmonary bypass was started.
• Heart was closed
• Chest tubes were inserted
• Chest was closed with sutures
DURATION
_____________hrs
AFTER PROCEDURE
POSTOPERATIVE CARE
COMPLICATIONS
• Infection
• Endocarditis
• Congestive heart failure
• Lack of oxygen
• Too much carbon dioxide in the blood
• Irregular heartbeat
• Stroke
• Kidney damage
• Lung blood clot
• Low blood pressure
• Hemorrhage
• Cardiac arrest