Moderate
Left anterior thoracotomy
Isolated pulmonary artery banding (PAB)
Left lateral thoracotomy
PAB (when coarctation or aortic arch repair also required)
Right lateral thoracotomy
Blalock-Hanlon atrial septectomy
Each of these procedures is performed through an incision between the ribs and visualized by echocardiogram; these are far less common than heart cath procedures. Pulmonary artery banding is used in a small number of cases of d-TGA, usually when the corrective surgery needs to be delayed, to create an artificial stenosis in order to control pulmonary blood pressure; PAB involves placing a band around the pulmonary trunk, this band can then be quickly and easily adjusted when necessary. An atrial septectomy is the surgical removal of the atrial septum; this is performed when a patent foramen ovale (PFO), or atrial septal defect (ASD) are not present and additional shunting is required to raise the oxygen saturation of the blood flowing eventually into the aorta. Major
Median sternotomy
PAB (when intracardiac procedures also required)
Concomitant atrial septectomy
In recent years, it is quite rare for palliative procedures to be done via median sternotomy. However, if a sternotomy is required for a different procedure, in most cases all procedures that are immediately required will be performed at the same time. Monitoring and maintenance
Nasogastric tube (NG tube or simply NG)
Intubation, oxygen mask, or nasal cannula
Intravenous drip (IV)
Arterial line
Central venous catheter
Fingerprick
Sphygmomanometer
Pulse oximeter
EKG
An NG tube is used to deliver nourishment, and occasionally medication, to the patient. Since the tube extends right into the stomach, it can also be used to monitor how well the patient is digesting their "food".
Riedels thyroiditis, is a chronic form of thyroiditis. It is now believed that Riedels thyroiditis is one manifestation of a systemic disease that can affect many organ systems called IgG4-related disease. It is often a multi-organ disease affecting pancreas, liver, kidney, salivary and orbital tissues and retroperitoneum. The hallmarks of the disease are fibrosis and infiltration by IgG4 secreting plasma cells. Signs and symptoms
Pathophysiology
Riedels thyroiditis is characterized by a replacement of the normal thyroid parenchyma by a dense fibrosis that invades adjacent structures of the neck and extends beyond the thyroid capsule. This makes the thyroid gland stone-hard (woody) and fixed to adjacent structures. The inflammatory process infiltrates muscles and causes symptoms of tracheal compression. Surgical treatment is required to relieve tracheal or esophageal obstruction. Diagnosis
It typically present as a painless, hard anterior neck mass, which progresses over weeks to years to produce symptoms of compression, including dysphagia, dyspnea choking and hoarseness. Patients may present with symptoms of hypothyroidism and hypoparathyroidism as the gland is replaced by Fibrous tissues .physical examination reveals a hard,"woody" thyroid gland with fixation to surrounding tissue. The diagnosis needs to be confirmed by open thyroid biopsy because the firm and Fibrous nature of the gland renders FNAB inadequate

Treatment
Therapy usually consists of prednisolone, nonetheless some cases may require surgery. Tamoxifen has been proposed as part of a treatment plan.Treatment is directed to surgical relief of compressive symptoms. Tamoxifen may also be beneficial.The type of surgery which is indicated here is isthmectomy. Prevalence
Riedels thyroiditis is classified as rare.