Holes in the heart
Holes in the heart
Galen postulated the existence of pores between the two sides of the heart, persistence of holes after birth sooner or later has a deleterious effect on the circulation.
Treatment of holes
The surgical treatment of all holes in the heart is to close them by stitching the edges together when this combe done without tension or by inserting a patch of plastic material in the large ones . (48)
Patch used to repair the whole prior disorders ,Prosthetic patch was introduced by vosschuttle in 1957 ,subsequently, it has become a widely accept technique for the repair of coarctation .(58) Prosthetic patch are widely used in the surgical treatment of cnegentital heart disease,(59) especially in the tetralogy of fallot reconstruction of the right. (60) Patch material may be either autogenous or synthetic autogenous, grafts have been formed from arterial venous and peritoneal tissue. Many surgeons prefer veins for autogenous patches because they are more readily available and they expand like a vein patch.Synthetic patch material may be made of PTFE (Teflon) or dacron (polyester), patches may be flat pieces of fabric or cut from tube graft as the patch is cut to fit the arteriotomy and may be oval, rectangular or Y shaped (have a bifurcation like these used in transplantation or reimplantation)
The size of the patch is determined by the length of the arteriotomy , and the patch is made large enough to ensure that sutures can be placed in an area of the heart that is free of disease .The surgeon hold the patch in place with the index finger of the non sewing hand, this method enables the surgeon or to control the area of bleeding , the occluding finger is removed after the circumferential suture line has been completed .(63) A patch coated with silicone rubber has been to served as a partial substitute for the pericardium in reducing postoperative adhesion over the heart great vessels , patch mesh has also been used as the remain forcing fabric for the outside of a total artificial hearts , patch has been laminated on to the surface of a cardiac pumping diaphragm to maintain a totally biolized surface.(22) finally the surgical advantages include minimization of total cross – clamp time (10 minutes in infants and 12 minutes in older patients) and elimination of the need for extensive dissection for proximal and distal control , hence , this technique has minimized , the associated severe complication of coarctation repair even in emergency cases (64).