REPAIR SINUS OF VALSALVA FISTULA

REASON FOR VISIT:

• Acute chest / right upper quadrant pain

• Subacute dyspnea on exertion / at rest
• Progressive cough, peripheral edema
• Syphilis
• Marfan syndrome
• Blunt / penetrating chest injury
• Infective endocarditis

RISK ASSESSMENT

• Old age
• Prior heart surgeries
• Hyper tension
• Diabetes
• Kidney diseases

PREPARATION OF THE PATIENT:

• Blood tests
• Urine tests
• Chest X-ray
• ECG
• 2D-Echo
• Angiography
• CT scan
• MRI
• Multiplane transesophageal echocardiography (TEE)
• Two-dimensional transthoracic echocardiography (TTE)
• Cardiac catheterization
• Nothing is taken by mouth 6hrs before surgery
• Antibiotics were given
 • PGE1 was discontinued.

POSITION OF THE PATIENT:

Supine

ANESTHESIA:
General

THE PROCEDURE

• The patient was received midazolam before line placement (PIV,

arterial line, and CVP)
• Anesthesia was given
• Orotracheal intubation was performed
• The TEE probe was passed
• Invasive arterial blood pressure was monitored by radial artery
cannulation
• Arterial saturation, CVP pressure was monitored by right IJ
cannulation, ETCO2, temperature and urine output was
monitored.
• A right/left common femoral artery vein was then exposed
through a longitudinal incision in the right/left groin and
prepared for cardiopulmonary bypass.
• The pericardium was then exposed through a median sternotomy
• The patient was fully heparinized
• Purse strings were placed in the ascending aorta for aortic
cannulation and antegrade cardioplegia was instilled with _____
• Purse strings were placed in the Superior vena cava and Inferior
vena cava for venous cannulation
• Purse strings were placed in the right atrium for the retrograde
cardioplegia was instilled with ______
• Purse strings were placed in the right superior pulmonary vein
for LV vent insertion.
• Aprotonin infusion was started.
• Cardiopulmonary bypass was instituted, aortic cross clamp was
placed with the pump flow down
• The aorta was Atransected just above the sinotubular junction.
• Right ventriculostomy was performed and the vegetation was
excised.
• The fistula was closed via aortic and right ventricular approach
using a pericardial patch.
• Pericardium was closed with ______absorbable sutures
• Chest tubes were inserted into the mediastinum
• Chest was closed with ____ sutures

DURATION
_____________hrs

AFTER PROCEDURE

• Patient was shifted to the I.C.U

• Patient was on ventilation
• Heart sounds, oxygenation, and the ECG were monitored.
• Chest tubes are checked to ensure that they're draining
properly and there is no hemorrhage.

POSTOPERATIVE CARE

• Take antibiotic medicine as prescribed

• Take pain medication
• Start chest exercises and chest physical therapy

COMPLICATIONS

• Infection
• Endocarditis
• Congestive heart failure
• Irregular heartbeat
• Stroke
• Kidney damage
• Lung blood clot
• Hemorrhage
• Cardiac arrest