This is normally performed within a few days of birth or diagnosis of Hypoplastic Left Heart Syndrome, whilst the Ductus Arteriosus is being kept open with Prostaglandin therapy.
Modified Norwood Procedure
The aims of the first operation are:
(a) To improve the flow of red blood (oxygenated blood) around the body by attaching the base (Trunk) of the lung artery (Pulmonary Artery) to the body artery (Aorta). It may be necessary to enlarge the body artery with a patch.
(b) To provide a blood flow to the lungs through a passage (Shunt), creating a link between the lung artery (Pulmonary Artery) and the body artery (Aorta). The passage is made out of soft plastic (Gore-Tex).
(c) To create a permanent passage (septectomy) between the collecting chambers (Left and Right Atrium) ensuring that a mix of red (oxygenated) blood and blue (deoxygenated) blood is flowing around the body.
This operation is extremely complicated and holds a high risk (chance of the baby
dying). Ask your surgeon about the risk for your child. The baby may need to be
in hospital for some weeks following this surgery to ensure that the baby’s
condition is stable before discharge home.
Batista Procedure
The Batista Operation Procedure was developed by Brazilian surgeon Dr. Randas J. V. Batista, as a treatment for heart failure. Technically called as reduction left ventriculoplasty, the Batista operation is a procedure that was primarily developed for patients with dilated left ventricles and severe heart failure.
It is an open heart operation performed with the help of a heart-lung machine in order to maintain blood circulation while the heart is stopped. The essence of the procedure is to remove a block present in the left ventricle muscle and then stitch together the two edges of the left ventricle. By doing this, the size of the left ventricle is reduced, and the ventricle is remodelled as well. The Batista procedure was an experimental open heart surgery to reverse the effects of remodelling. This operation was carried on patients who were suffering from enlarged left ventricle because of which the blood was not being pumped efficiently. In the Batista procedure, an elliptical piece of living heart tissue is removed from the left ventricle. By doing this, the heart’s chamber is made smaller and thus it can contract more effectively to pump more blood.
The image A below shows the heart before surgery
The image B shows the heart after surgery
Initially, the aorta of the hollow heart patient is clamped. Then, with the help of a heart lung machine, the heart persists to function. Then after removal of the block in the left ventricle, the surgeon again closes the heart with the help of a few stitches. This process is done by surgeons with vast experience. However, after carefully completing with the stitches, the heart lung machine is then removed. The Batista procedure is used for patients whose heart muscles have been stretched or weakened by some disease, such as infection or inflammation which has led to congestive heart failure.
The Batista's operation procedure has a high death rate of about 20 percent in the first post-operative month and 20 percent in the rest of the year making a total of about 40 percent. There were debates whether to continue the use of this procedure or not. Though, the Batista procedure seemed to show potential at first, it was later found to have little benefit and more risks which is why today, the Batista procedure is not a recommended treatment for dilated cardiomyopathy. Another reason for why this procedure is not used is that, suppose if the heart fails to respond to conventional therapy then, the patients will be at an even higher risks to suffer from severe heart failure.
Coronary Artery Bypass Grafting
Coronary artery bypass grafting (CABG) is a type of surgery that improves blood flow to the heart. It's used for people who have severe coronary heart disease (CHD), also called coronary artery disease.
CHD is a condition in which a substance called plaque (plak) builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood.
Plaque can narrow or block the coronary arteries and reduce blood flow to the heart muscle. If the blockage is severe, angina (an-JI-nuh or AN-juh-nuh), shortness of breath, and, in some cases, heart attack can occur. (Angina is chest pain or discomfort.)
CABG is one treatment for CHD. During CABG, a healthy artery or vein from the body is connected, or grafted, to the blocked coronary artery. The grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery.
This creates a new passage, and oxygen-rich blood is routed around the blockage to the heart muscle.
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