Cardiac Defects and Corrective Procedures Flashcards
1
Q
Atrial Septal Defect (ASD) ANATOMY
- most common?
- least common?
A
- Most common= defects in septum primum w/in the fossa ovalis (secundum ASD’s)
- Less common= defect involving septum secundum near the SVC (sinus venosus ASD’s), or the coronary sinus.
2
Q
Atrial Septal Defect (ASD) PATHOPHYSIOLOGY
- Type of shunt?
- What does it cause?
- What can large shunts cause?
A
The LEFT to RIGHT shunt over time results in right A+V dilatation.
- -RA fibrosis can occur and then act as a substrate for late occurring atrial arrhythmia’s.
- -RV dilatation can cause tricuspid annular dilation which results in tricuspid insufficiency
- -Large shunts cause pulmonary congestion, which can (less commonly) cause pulmonary HTN which can cause right to left shunting and cyanosis to occur [risk for emboli and stoke]
3
Q
Atrial Septal Defect (ASD) SURGICAL CORRECTION
A
Surgical closure (direct suture anastamosis or patch using autologous pericardium or synthetic material) --majority of secundum ASD's use a transcatheter device
4
Q
Ventricular Septal Defect (VSD) ANATOMY
- Location and number?
- Small vs Large?
- What is special about supracristal VSD’s?
A
- May occur in multiple locations in ventricular septum (inlet, muscular, perimembranous, or supracristal)
- May be single or multiple
- Small defects usually close in the 1st few yrs of life
- Large defects have a significant LEFT to RIGHT shunt (with dilation of the PA and left A+V), systemic RV pressures, and a diameter similar to the aortic annulus
- Supracristal VSD’s can spontaneously close and cause prolapse of the right coronary cusp of the aortic valve which can cause aortic insufficiency
5
Q
Ventricular Septal Defect (VSD) PATHOPHYSIOLOGY
- Type of shunt and what it causes?
- Type of murmur heard and its location?
- Large shunts effects?
A
- A large LEFT to RIGHT shunt can cause excessive pulmonary blood flow which causes pulmonary edema and tachypnea. The increased pulmonary VR results in left A+V enlargement.
- A holistic murmur is heard at the lower left sternal border from the turbulent flow crossing the defect. Small shunts have a high pitch.
- Large shunts may interfere with a child’s feeding and growth and cause rapid breathing, irritability, excessive sweating, poor weight gain, irreversible pulmonary HTN, pulmonary vascular obstructive disease and a resultant RIGHT to LEFT shunting (Eisenmengers Syndrome).
6
Q
Ventricular Septal Defect (VSD) SURGICAL CORRECTION
- Describe infant care?
- How are they closed?
- What are the special considerations for muscular VSD’s?
A
- Infants w/ CHF from volume overload use diuretics. As their metabolic requirements increase, high calorie formulas are given. If impaired growth persists then surgery is indicated to close the VSD.
- Closed with a patch repair
- Small VSD’s may only need suturing of the edge
- Muscular VSD’s can be difficult if obscured by the trabeculations of the RV
7
Q
Patent Ductus Arteriosus (PDA) ANATOMY
- What does it connect and why?
- When does it close normally?
- When is a PDA common?
A
Connects the main PA to the descending aorta. In the fetus, it is open to shunt blood from the PA to the descending aorta to bypass the nonaerated lungs. It normally closes hours after birth leaving the fiber like ligamentum arteriosum.
-PDA is common in premature infants.
8
Q
Patent Ductus Arteriosus (PDA) PATHOPHYSIOLOGY
- Type of shunt created?
- Large vs Small?
- What type of murmur is heard and its location?
- Describe ductal dependent lesions
A
After birth, PVR is lower in the lungs which can cause the PDA to make a LEFT to RIGHT shunt from the aorta to the PA.
- Large PDA can cause HF from pulmonary over circulation and pulmonary HTN.
- Small PDA can be insignificant w/ only endocarditis as a risk.
- PDA’s are heard as a continuous murmur at the upper sternal border.
- Ductal Dependant Lesions= PDA’s may be necessary after birth to provide pulmonary or systemic BF for patients w/ Pulmonary Atresia or Hypoplastic Left Heart Syndrome.
9
Q
Patent Ductus Arteriosus (PDA) SURGICAL CORRECTION
Premature Infants vs. Older Infants/Children
A
Premature Infant= pharmacological treatment w/ indomethacin or ibuprofin. If that fails, surgical intervention is needed.
Older infants/children= the PDA is closed in the cardiac catheterization lab by coil embolization.
10
Q
Double Outlet Right Ventricle (DORV) ANATOMY
-two descriptions
A
Both the aorta and PA arise from the RV.
- Described as the presence of muscular conal tissue under the aorta and PA w/ fibrous discontinuity btwn the aortic and mitral valves.
- Described as a VSD (can be sub-aortic, sub-pulmonary, doubly-committed, or in a remote location). The great vessels may be normally related or transposed. Rarely there can be hypoplasia of the mitral valve and LV
11
Q
Double Outlet Right Ventricle (DORV) PATHOPHYSIOLOGY
- What does it depend on?
- What can be seen in infants?
A
Depends on position of VSD and degree of pulmonary stenosis.
Infants= may show spectrum from pulmonary over circulation to transposition like physiology (occurs w/ inadequate circulatory mixing due to streaming of oxygenated blood across the VSD from the LV back to the PA [Taussig-Bing Anomaly]).
12
Q
Double Outlet Right Ventricle (DORV) SURGICAL CORRECTION
-Describe the 3 different cases
A
- Normally related great vessels and sub-aortic VSD= patching the VSD to the aorta
- If aorta is remote from VSD= Rastelli-like procedure is performed to baffle the LV output to the aorta and a conduit is placed to route systemic venous blood from the RV to the PA.
- Hypoplasia of the left heart= single ventricular surgical palliation
13
Q
A-P Window ANATOMY
-Describe what it is and what it may occur with
A
There is a connection btwn the aorta and the main or right PA. Can occur as an isolated defect or in association with an interrupted aortic arch
14
Q
A-P Window PATHOPHYSIOLOGY
- What type of shunt is created?
- What may be present with a large defect?
A
results in a LEFT to RIGHT shunt w/ pulmonary over circulation and left heart dilatation. With large defect, pulmonary HTN mat be present.
15
Q
A-P Window SURGICAL CORRECTION
-What type of treatment and when must it be performed and why?
A
Surgery- must be performed early to prevent irreversible pulmonary HTN
16
Q
Tetrology of Fallot (TOF) ANATOMY
-Describe the 4 anomalies
A
- Large anteriorly malaligned VSD of the conal septum
- Stenosis of the RV outflow tract (infundibular stenosis) w/ associated pulmonary valve stenosis
- Aorta is enlarged and displaced to the right such that it overrides the VSD
- RV Hypertrophy
17
Q
Tetrology of Fallot (TOF) PATHOPHYSIOLOGY
- What is cyanosis dependent on?
- Describe effects on minimal stenosis in infants
- Describe effects of severe RV outflow tract stenosis in infants
- Describe Hypercyanotic
- Describe micro deletion of chromosome 22
A
- Degree of cyanosis is dependent on the degree of obstruction to pulmonary blood flow.
- Infants with minimal stenosis may have a large LEFT to RIGHT shunt across the VSD w/ little to no cyanosis (pink Tetralogy)
- Infants w/ severe RV outflow tract stenosis will be severely cyanotic w/ ductal dependent pulmonary blood flow.
- Hypercyanotic episodes may be fatal (leads to increased RIGHT to LEFT shunting)
- Micro deletion of 22q11 is associated with cono-truncal congential heart defects
18
Q
Tetrology of Fallot (TOF) SURGICAL CORRECTION
- What do they do for severely cyanotic infants?
- What is used in selected cases?
- When is TOF repaired?
A
- Severly cyanotic infants= Prostaglandin E1 infusion to maintain ductal patency and pulmonary perfusion
- Selected cases= modified Blalock-Taussig shunt-provides adequate pulmonary BF to the lungs
- Depending on anatomy- they might repair the defect successfully in neonatal period but is usually repaired btwn 4-6 months or as cyanosis progresses
19
Q
Transposition of the Great Arteries (TGA) ANATOMY
D Type vs L Type
A
D Type= Aorta is anterior and to the right relative to the PA and arises from the RV. The PA arises from the LV
L Type= Right A+V are connected by the mitral valve and the Left A+V are connected by the tricuspid valve
20
Q
Transposition of the Great Arteries (TGA) PATHOPHYSIOLOGY
D Type vs L Type
A
D Type= Aorta returns deoxygenated blood to systemic circulation while the PA returns oxygenated blood to the pulmonary circulation
L Type= May be asymptomatic. May have significant tricuspid insufficiency and systemic ventricular dysfunction
21
Q
Transposition of the Great Arteries (TGA) SURGICAL CORRECTION
D Type vs L Type
A
D Type= Initially given prostaglandin E1 to maintain patency- if foramen ovale is restrictive then it must be enlarged by a Balloon Septostomy. Surgery then occurs in the 1st week via a Arterial Switch Operation
L Type= Tricuspid valve replacement for those with tricuspid insufficiency and systemic ventricular dysfunction. Some may have a double switch (Senning procedure w/ an arterial switch procedure)
22
Q
Truncus Arteriosus (TA) ANATOMY
A
Aorta and PA leave the heart as a common trunk. There is a large VSD that the Truncus Arteriosus overrides. The PA arise from the Truncus Arteriosus as either confluent or (more commonly) separate origins.
23
Q
Truncus Arteriosus (TA) PATHOPHYSIOLOGY
A
Complete intracardiac mixing of the systemic and pulmonary VR causes systemic desaturation. As PVR goes lower than SVR, pulmonary over circulation and CHF occurs.
24
Q
Truncus Arteriosus (TA) SURGICAL CORRECTION
A
Closure of the VSD w/ detachment of the PA from the common trunk and incorporating them into a RV to PA conduit
25
Total Anomolous Pulmonary Venous Return (TAPVR) ANATOMY
All pulmonary veins are abnormal in how they connect to the heart. Oxygenated blood from the lungs are carried by the pulmonary veins back to the right side of the heart rather than the LA. Therefore, systemic BF requires RIGHT to LEFT shunting across an ASD.
26
Total Anomolous Pulmonary Venous Return (TAPVR) PATHOPHYSIOLOGY
-Obstruction vs no obstruction
Children show varying degrees of cyanosis.
- If there is no obstruction to BF, infants/children have obligate mixing of saturated and desaturated blood in the RA ans RIGHT to LEFT shunting of partially deoxygenated blood across the ASD
- If there is an obstruction to pulmonary VR, there may be severe cyanosis w/ rapid development of acidosis
27
Total Anomolous Pulmonary Venous Return (TAPVR) SURGICAL CORRECTION
Surgery. An anastamosis is made btwn the pulmonary venous confluence and the LA. The anomalous connection (vertical vein or infracardiac vein) should then be ligated to prevent LEFT to RIGHT shunting, and the ASD is closed.
28
Partial Anomolous Pulmonary Venous Return (PAPVR) ANATOMY
At least 1, but not all, pulmonary veins connect anomalously to the right heart. Frequently, the right pulmonary veins drain into the right heart via the SVC. This defect can occur with an ASD and lung abnormalities
29
Partial Anomolous Pulmonary Venous Return (PAPVR) PATHOPHYSIOLOGY
usually asymptomatic and may be identified serendipitously. The draining into the RA presents the same as an ASD (volume overload and chamber dilation).
-The greater the # of veins draining= a larger shunt=significant right A+V dilation.
30
Partial Anomolous Pulmonary Venous Return (PAPVR) SURGICAL CORRECTION
Surgery. The anomalous pulmonary veins are redirected to the LA
31
Ebstein’s Anomoly ANATOMY
- Descripton
- What kind of shunt can form
The tricuspid valve is abnormally formed and more apically displaced which creates atrailization of a portion of the RV. If significant it can be regurgitant, leading to further dilation of the RA.
-In the presence of an atrial communication, RIGHT to LEFT shunting can occur and cause cyanosis
32
Ebstein’s Anomoly PATHOPHYSIOLOGY
- Mild cases
- Severe cases
- Severe tricuspid valve insufficiency
Mild cases= asymptomatic
Severe cases= infants present at birth w/ severe cardiomegaly and cyanosis
Severe tricuspid valve insufficiency= the RV is unable to generate antegrade flow to open the pulmonary valve- leading to functional atresia and ductal dependency.
33
Ebstein’s Anomoly SURGICAL CORRECTION
| Infants vs Older patients
Infants= Blalock-Taussig shunt to ensure adequate pulmonary BF
Older patients= reparative procedures on the tricuspid valve or full replacement
34
Aortic Stenosis (AS) ANATOMY
Aortic valve leaflets are thickened. There can be associated defects such as PDA, sub-aortic stenosis, mital stenosis, or coarchtation of the aorta.
-Mild stenosis- compensatory LV hypertrophy is present
35
Aortic Stenosis (AS) PATHOPHYSIOLOGY
Evolves slowly and causes increased afterload on the LV- resultant hypertrophy, increased myocardial O2 demand and subendocardial ischemia.
36
Aortic Stenosis (AS) SURGICAL CORRECTION
Severe cases (>70mmHg or >50mmHg w/ symptoms)= balloon vavuloplasty or valve replacement (biologic/mechanical valve replacement or Ross procedure).
37
Pulmonary Stenosis ANATOMY
| Describe the 3 types
Pulmonary valve opening from the RV is restricted
1. Supraventricular stenosis= PA lumen above the valve opening is narrowed
2. Valvular pulmonary stenosis= The leaflets of the pulmonary valve are abnormally thickened and fused at their edges so the valve does not open fully
3. Subvalvular or infundibular stenosis= Outflow tract of RV below pulmonary valve is dynamically obstructed by muscular tisssue
38
Pulmonary Stenosis PATHOPHYSIOLOGY
- Moderate vs Severe
- Where is the murmur located
- Often well tolerated and asymptomatic
- Severe stenosis= right sided heart failure.
- With an ASD= stiff hypertrophied RV leads to decreased compliance and RIGHT to LEFT shunting and cyanosis.
- Moderate stenosis= increases RV pressure which causes hypertrophy of the RV
- Can be heard via a murmur at the left mid to upper sternal border. Higher the pitch=greater stenosis
39
Pulmonary Stenosis SURGICAL CORRECTION
| -Mild vs Severe
Mild stenosis= may require no intervention
| Severe stenosis= balloon valvuloplasty, angioplasty, stent insertion, or surgical repair
40
Coarctation of the Aorta ANATOMY
Narrowing of the lumen of the aorta. May consist of a posterior shelf life obstruction in the juxtaductal region or complete tubular hypoplasia of the aorta.
41
Coarctation of the Aorta PATHOPHYSIOLOGY
| Main 2 effects and what they cause
Causes increased afterload to the LV, higher BP proximal to the obstruction and lower BP distal.
- The increased afterload after ductal closure can cause LV failure and pulmonary HTN
- The differences in BP can cause a limb systolic BP discrepancy or the distal organ perfusion can be compromised.
42
Coarctation of the Aorta SURGICAL CORRECTION
| Infants vs adults
Infants= Initially give prostaglandins to open/maintain ductal patency. Then surgical repair- extended end to end anastomosis
Adults- Same surgical repair, transcatheter, balloon angioplasty
43
Interrupted Aortic Arch ANATOMY
| Describe the 3 types
Discontinuity btwn the ascending and descending aorta
Type A= interruption of aorta distal to the left subclavian artery
Type B= interruption of aorta btwn the left carotid and left subclavian arteries
Type C= interruption of aorta btwn the innominate and left carotid arteries
44
Interrupted Aortic Arch PATHOPHYSIOLOGY
Infants= prior to ductal closure, saturated blood perfuses the upper body and deoxygenated blood perfused the lower body (differential cyanosis). Closure of the ductus arteriousus results in CHF and inadequate perfusion of the lower body.
45
Interrupted Aortic Arch SURGICAL CORRECTION
Prostaglandin E1 is given to maintain ductal patency until surgical intervention. Surgery involves excision of ductal tissue and re-anastomosis of the interrupted portions of the arch.
46
Hypoplastic Left Heart Syndrome (HLHS) ANATOMY
| Name the 6 possible characteristics
Hypoplasia or atresia of the mitral valve
hypoplasia of the LV
aortic stenosis or atresia
hypoplasia of the ascending aorta
coarctation
ASD located superiorly on the atrial septum.
47
Hypoplastic Left Heart Syndrome (HLHS) PATHOPHYSIOLOGY
- describe the effects and what they cause
- describe what will happen to infants with a restrictive or intact atrial septum
- Systemic and pulmonary blood mixes in the RA
- PVR will be less than SVR which results in pulmonary over circulation, limiting the degree of cyanosis.
- With significant pulmonary over circulation- CHF, systemic hypoperfusion and acidosis may occur
- Infants with a restrictive or intact atrial septum will be both cyanotic and acidotic
48
Hypoplastic Left Heart Syndrome (HLHS) SURGICAL CORRECTION
- What is initially done after birth?
- What are the surgical procedures used?
- Initially prostaglandins are given for ductal patency and induction of pulmonary HTN by careful hypo-ventilation and occasionally sub-ambient O2 delivery w/ nitrogen to maintain systemic circulation.
- 1st stage surgical palliation is the Norwood Procedure, or the Sano Modification of the Norwood, followed by the Glenn or Hemi-Fontan procedures
49
Single Ventricle/ Hypoplastic Right Heart Syndrome (HRHS) ANATOMY
Name the 5 characteristics
- Pulmonary valve atresia is absent
- Very small (hypoplastic) right ventricle
- Small tricuspid valve
- A small (hypoplastic) PA
- The blood flow into the coronary arteries may be abnormal causing damage to the heart muscle
50
Single Ventricle/ Hypoplastic Right Heart Syndrome (HRHS) PATHOPHYSIOLOGY
The RV's muscle structure is poor. The proper amount of blood pumped from the RA is not sufficient which causes the blood to not be pumped efficiently to the lungs.
51
Single Ventricle/ Hypoplastic Right Heart Syndrome (HRHS) SURGICAL CORRECTION
- What is initially done at birth?
- What surgical procedures follow?
Surgery within the first days of life using the Blalock-Taussig Shunt procedure and prostaglandin E1 is given to keep the ductus open. To repair the small RV, The Fontan procedure is split into two procedures, the Glenn shunt and the Fontan completion
52
Pulmonary Atresia ANATOMY
| Intact Ventricular Septum vs With a VSD
Intact Ventricular Septum= Pulmonary valve fails to form properly so the RV and tricuspud valve are hypoplastic
With VSD= (aka Tetralogy of Fallot with pulmonary atresia). No significant RV outflow tract or main PA develops. Branch PA's may be confluent, fed by a ductus or hypoplastic/discontinuous
53
Pulmonary Atresia PATHOPHYSIOLOGY
| Intact Ventricular Septum vs With a VSD
Intact Ventricular Septum= Pulmonary BF is dependent on a patent ductus arteriosus (LEFT to RIGHT shunt) and the ASD forms a RIGHT to LEFT shunt causing cyanosis
With VSD= the VSD causes intracardiac mixing which results in systemic desaturation.
54
Pulmonary Atresia SURGICAL CORRECTION
| Intact Ventricular Septum vs With a VSD
Intact Ventricular Septum= Prostaglandin E1 is given to maintain patency of the ductus. A balloon atrial septostomy may be used to produce a large ASD and compress the RA.
With VSD= Placement of an RV-PA conduit and VSD closure .
55
Cor Triatriatum ANATOMY
A fibromuscular membrane divides the atrium in two.
-In its most common form, cor triatriatum sinister, the left atrium is divided into an upper chamber that receives the pulmonary veins and a lower chamber that is related to the left atrial appendage and the mitral valve orifice.
56
Cor Triatriatum PATHOPHYSIOLOGY
Failure of the dorsal outgrowth to join the PV's results in total anomalous pulmonary venous drainage (TAPVD). An abnormal connection between the common pulmonary vein and the atria results in any of the variants of cor triatriatum. The critical anatomic feature of cor triatriatum is a diaphragm that divides the left atrium into 2 chambers
57
Cor Triatriatum SURGICAL CORRECTION
Open correction is currently preferred over closed (percutaneous) procedures. The procedure is performed on CPB through an atrial incision with complete resection of the diaphragm
58
Anomolous Left Coronary Artery ANATOMY
| description and 3 possible origins?
The left coronary artery is abnormal in either origin or course. Can arise from the PA, right aortic sinus, or as a separate ostia for the anterior descending and circumflex branches.
59
Anomolous Left Coronary Artery PATHOPHYSIOLOGY
| PA origin vs Right Aortic Sinus origin
1. PA origin= the LV myocardium is inadequately perfused w/ deoxygenated PA blood at a lower driving pressure- leading to ischemia and a dilated cardiomyopathy.
2. Right Aortic Sinus origin= the anomalous vessel may course btwn the aorta and PA- and dynamic compression may occur (exercise induced pain or arrest)
60
Anomolous Left Coronary Artery SURGICAL CORRECTION
| PA origin
PA origin= surgical ligation at the pulmonary side, reimplantation or tunneling of the LCA to the aorta is performed
61
AV Canal ANATOMY
A large hole in the center of the heart. It's located where the septum btwn the atria joins the septum btwn the ventricles. This septal defect involves both upper and lower chambers and the tricuspid and mitral valves. Instead, a single large valve forms that crosses the defect in the septum btwn the two sides of the heart.
62
AV Canal PATHOPHYSIOLOGY
It's a very common type of heart defect in children with a chromosome problem, Trisomy 21 (Down syndrome). High pressure may occur in the blood vessels in the lungs which can cause permanent damage to the lung blood vessels.
63
AV Canal SURGICAL CORRECTION
Surgery- closed the with one or two patches and they divide the single valve between the heart's upper and lower chambers and makes two separate valves
64
Double Aortic Arch ANATOMY
| general description and descriptions of each type
The ascending aorta splits into 2 "arches" which pass to the right and left of the trachea and esophagus. The two arches rejoin behind the esophagus to form the descending aorta. There are two types:
Type 1=both arches open and functioning (common
Type 2=both arches intact but one is very narrow, usually the left.
65
Double Aortic Arch PATHOPHYSIOLOGY
Vascular rings are formed when this process of regression and persistence does not occur normally, and the resulting vascular anatomy completely encircles the trachea and esophagus.
66
Double Aortic Arch SURGICAL CORRECTION
surgery separates off the smaller branch of the double aortic arch to relieve pressure on the esophagus and trachea. The surgeon ties off the smaller branch and separates it from the larger branch. Then the surgeon closes the ends of the aorta with stitches.
67
Vascular Ring ANATOMY
| give description and name the 2 types
some of the arches and vessels that should have changed into arteries or disappeared are still present when the baby is born. These arches form a ring of blood vessels, which encircles and presses down on the trachea and esophagus.
Type 1= Double Aortic Arch
Type 2= Right Aortic Arch w/ Left Ligamentum Arteriosum
68
Vascular Ring PATHOPHYSIOLOGY
Symptoms are those associated w/ a compressed trachea and esophagus (airway restriction/dysphagia)
69
Vascular Ring SURGICAL CORRECTION
Surgery- remove the smaller portion of the double aortic arch or the division of the ligamentum arteriosum. The Kommerell's diverticulum may be removed from the left subclavian artery and closed w/ sutures.
70
Konno Procedure
| What is the procedure? What is involved in the correction?
The aortic valve is replaced with either a mechanical valve (Konno-Rastan Procedure), an aortic homograft (human aortic valve), or with the patient's own pulmonary valve. It involves the replacement of the aortic valve and the widening of the ventricular septum in the region of the valve with a patch
71
Konno Procedure
| What is the procedure used to correct?
This procedure is performed in cases of Aortic Stenosis when the left ventricular outflow tract is stenotic in addition to the aortic valve itself.
72
Valvuloplasty
| What is the procedure? What is involved in the correction?
A very small, narrow, hollow catheter is advanced from a blood vessel in the groin through the aorta into the heart. Once the catheter is placed in the valve to be opened, a large balloon at the tip of the catheter is inflated until the leaflets of the valve are opened. Once the valve has been opened, the balloon is deflated and the catheter is removed
73
Valvuloplasty
| What is the procedure used to correct?
Valvuloplasty is performed to open a stenotic heart valve.
74
Ross Procedure
| What is the procedure? What is involved in the correction?
The patient's own pulmonary valve is removed and used to replace the diseased aortic valve. The pulmonary valve is then replaced with a pulmonary homograft.
75
Ross Procedure
| What is the procedure used to correct?
Performed on patients younger than ages 40 to 50 who want to avoid taking long-term anticoagulant medications after surgery of aortic valve replacement
76
Primary Closure
| What is the procedure? What is involved in the correction?
Closure by direct vision suture
77
Primary Closure
| What is the procedure used to correct?
ASD
78
Patch Closure
| What is the procedure? What is involved in the correction?
Uses pericardial or Gore-Tex patch for closure
79
Patch Closure
| What is the procedure used to correct?
ASD
80
Blalock-Taussig Shunt
| What is the procedure? What is involved in the correction?
The surgery involves opening the chest either through a left or a right thoracotomy approach and placing a Gore-Tex tube form the innominate artery to the pulmonary artery. This is a palliative procedure, meaning that in most cases the final repair will be done at a later date.
81
Blalock-Taussig Shunt
| What is the procedure used to correct?
Common conditions are Tetralogy of Fallot, Pulmonary Atresia, Tricuspid Atresia
82
Glenn Shunt
| What is the procedure? What is involved in the correction?
the superior vena cava is connected to the right PA
83
Glenn Shunt
| What is the procedure used to correct?
hypoplastic left heart syndrome
84
Central Shunt
| What is the procedure? What is involved in the correction?
An anastomosis between the ascending aorta and the main pulmonary artery, made of prosthetic or other materials. The internal mammary artery is used to create a systemic-to-pulmonary artery shunt after failure of a previous Blalock-Taussig's shunt
85
Central Shunt
| What is the procedure used to correct?
Common conditions are Tetralogy of Fallot, Pulmonary Atresia, Tricuspid Atresia
86
Damus-Kaye-Stansel Procedure
| What is the procedure? What is involved in the correction?
The aorta and pulmonary artery are joined using a patch
87
Damus-Kaye-Stansel Procedure
| What is the procedure used to correct?
Double Inlet Left Ventricle
88
Double Switch
| What is the procedure? What is involved in the correction?
A conduit is created to shunt the blood from one side of the heart to the other. The heart's major arteries are also detached and reconnected. This corrects the circulation so that the heart's left side serves the body and the right side serves the lungs.
89
Double Switch
| What is the procedure used to correct?
Transposition of the Great Arteries, L-Type
90
Fontan Procedure
| What is the procedure? What is involved in the correction?
It connects the IVC to the PA by creating a channel through or just outside the heart to direct blood to the PA. At this stage, all deoxygenated blood flows passively through the lungs.
91
Fontan Procedure
| What is the procedure used to correct?
Tricuspid atresia
Hypoplastic left heart syndrome
Double inlet left ventricle
Some variations of double outlet right ventricle
92
Jatene Arterial Switch
| What is the procedure? What is involved in the correction?
surgeons separate the aorta and PA from their roots and reattach them to the opposite roots. Then surgeons switch the coronary arteries from the aorta to the the PA.
93
Jatene Arterial Switch
| What is the procedure used to correct?
Transposition of the great arteries
94
Mustard Procedure
| What is the procedure? What is involved in the correction?
It restores the circulation but reverses the direction of the blood flow in the heart. Blood is pumped to the lungs via the left ventricle and disseminated throughout the body via the right ventricle
95
Mustard Procedure
| What is the procedure used to correct?
Transposition of the Great Arteries
96
Senning Procedure
| What is the procedure? What is involved in the correction?
A baffle is created within the atria that redirects the deoxygenated caval blood to the mitral valve and the oxygenated pulmonary venous blood to the tricuspid valve. The anatomic LV continues to act as the pulmonary pump and the anatomic RV acts as the systemic pump
97
Senning Procedure
| What is the procedure used to correct?
Transposition of the Great Arteries
98
Norwood Procedure
| What is the procedure? What is involved in the correction?
The neo-aorta is constructed utilizing the pulmonary root, ascending aorta, and cryopreserved homograft tissue. The ductal tissue is resected and the augmentation of the aortic arch and site of coarctation is carried out beyond the area of the aortic isthmus. Pulmonary blood flow is provided by placement of a modified Blalock-Taussig shunt.
99
Norwood Procedure
| What is the procedure used to correct?
Hypoplastic Left Heart Syndrome
100
Pulmonary Artery Banding
| What is the procedure? What is involved in the correction?
The goal of PAB is to reduce PA pressure and excess pulmonary blood flow. The band is wrapped around the main PA and fixed into place. Once inserted, the band is tightened, narrowing the diameter of the PA to reduce blood flow to the lungs and reduce PA pressure.
101
Pulmonary Artery Banding
| What is the procedure used to correct?
VSD
AVSD
A single ventricle
102
Rastelli Procedure
| What is the procedure? What is involved in the correction?
The VSD is visualized through a right ventriculotomy. Obstructive RV muscle is excised, and a large intra-ventricular baffle is sutured into place closing the VSD and redirecting LV outflow to the more anteriorly placed aortic valve. A valved homograft conduit is utilized to achieve RV to PA continuity.
103
Rastelli Procedure
| What is the procedure used to correct?
d-transposition of the great vessels with ventricular septal defect and pulmonary stenosis
104
TOF Repair
| What is the procedure? What is involved in the correction?
Involves closure of the VSD with a synthetic Dacron patch so that the blood can flow normally from the left ventricle to the aorta. The narrowing of the pulmonary valve and RV outflow tract is then augmented (enlarged) by a combination of cutting away obstructive muscle tissue in the RV and by enlarging the outflow pathway with a patch.
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TOF Repair
| What is the procedure used to correct?
VSD
Overriding aorta
Pulmonary Stenosis
Right ventricular hypertrophy
