Palliative surgeries and their classification.. Pulmonary artery cerclage. Rashkind or percutaneous atrioseptostomy

Palliative surgeries and their classification:

1- Pulmonary artery cerclage:

It consists of passing a tape around the pulmonary artery to tighten it and limit the flow through it.

The intention is to reduce the excessive amount of blood that goes to the lungs and thus balance the systemic (blood that supplies the body) and pulmonary (blood that supplies the lungs) circulations.

For example, children with a very large VSD who.
cannot have corrective surgery.

transposition of the great arteries:

In the specific case of children with transposition of the great arteries (the arteries leaving the heart are connected in an inverted way with the ventricles:
pulmonary leaving the left ventricle and the aorta from the right ventricle) who cannot undergo corrective surgery Initially, pulmonary artery cerclage is also used to increase the muscle mass of a ventricle that has lost a large part of its muscle to perform its function (deconditioned), by squeezing the artery, an obstruction is generated to the passage of blood flow and the ventricle.

you have to do more force to be able to push the blood; making this effort, the ventricle manages to strengthen and condition itself and in this way prepare itself to support the definitive surgery in a second time.

2- Rashkind or percutaneous atrioseptostomy:

Normally the circulation is a series circuit, which means that the blood that arrives without oxygen (venous blood) to the right side of the heart must be pumped to the lungs to be oxygenated (red) and from there it returns again to the left side of the heart.

heart to be pumped throughout the body (carrying oxygen to cells).
There are malformations where this circuit does not work in series, but in parallel, which means that oxygenated blood does not pass to the left side to be carried to the cells and deoxygenated blood does not pass to the lungs to be oxygenated. Patients with this type of circulation require the creation of an orifice that allows blood to mix, which is an emergency procedure to save life.

foramen ovale:

All children are born with a hole between the two atria (foramen ovale), but in these children it is not large enough to allow proper mixing.

An efficient way to achieve mixing circulations is to enlarge it.
This procedure can be accomplished without surgery, by passing a special wire (catheter) through a vein in the groin to the heart.

This catheter has a balloon at the tip that, once it passes from the right atrium to the left atrium through the foramen ovale, is inflated and pulled to break the interatrial septum, enlarging the original foramen ovale.