Triple ligation for patent ductus arteriosus (PDA) is a closed heart surgery which used to be done for the closure of patent ductus arteriosus. Left side of the chest is opened from the back and the PDA is identified between the aorta and pulmonary artery. Three ligatures (ties) are placed, one near the pulmonary artery, one near the aorta and one in between. Now a days this surgery is seldom done as most PDA closures are done in the cathlab with either a coil or device closure, thus avoiding an open surgery.
Category Archives: Heart Surgery
Closed heart surgery for mitral stenosis (closed mitral valvotomy)
Closed mitral valvotomy (CMV) was the closed heart procedure being done to open up a narrowed mitral valve (mitral stenosis) in the yester years. The scar is seen on the left lower part of chest in those who have undergone this surgery decades back. Now it is seldom done and most cases of mitral stenosis are treated with balloon mitral valvotomy. In closed mitral valvotomy the surgeon opens the left side of the chest and then the left atrium. He feels the mitral valve and then introduce a Tubbs mitral valve dilator through the apex of the left ventricle. Tip of the dilator is positioned across the narrowed mitral valve, guided by the finger in the left atrium. The device is opened using its handle outside the left ventricle to enlarge the opening of the mitral valve. The finger in the left atrium checks for any mitral regurgitation and the efficacy of the dilatation. Serial dilatations are given if the results are not satisfactory.
Can the scar of open heart surgery become prominent after a few months?
A scar takes about six months to become stable. It can enlarge in size in certain prone individuals up to about six months. In very occasional persons it can become quite large and form a keloid. In most persons the scar becomes less prominent as years go by. In some elderly persons and in children, the scar may be hardly appreciable after several years. But in most adults, it will remain quite visible. If the wound gets infected, the scar is likely to be more prominent and broader.
Jatene’s procedure
Jatene’s procedure is arterial switch operation, a corrective surgery for d-transposition of great arteries (d-TGA). d-TGA is a condition in which aorta arises from the right ventricle and pulmonary artery arises from the left ventricle. It is a congenital heart disease with cyanosis. A septal defect or patent ductus arteriosus is associated with d-TGA as survival is impossible with out that. In Jatene’s procedure, aorta is connected back to the left ventricle and pulmonary artery to the right ventricle, thus normalizing the circulation. The procedure has to be done quite early after birth, as early as two to three weeks.
Is it necessary to open the whole of the heart to repair an ASD?
An atrial septal defect (ASD) can be repaired even without surgery by a catheter based device which can occlude the defect with a clam shell like ASD device. Even when the defect is not suitable for a device closure due to absence of good rim all around for the device to hold, ASD surgery does not need opening up the whole heart. Even opening up of the sternum is not needed for closing an ASD. A surgery on the right side of the chest, below the breast can give access to an ASD, which can be closed by opening up the right atrium alone. Hospital stay is also short in this case, about four days.