Procedures Flashcards
Palliative procedures are often associated with what CHD
- Severe Tetralogy of Fallot
- Pulmonary atresia
- Hypoplastic right/left heart syndrome
- Extreme prematurity
what are the 3 palliative systemic to pulmonary artery shunts?
Classic Blalock-Taussing (BT) shunt
Potts
Waterston
Modified (BT) shunt
What type of anastomosis is a classic BT shunt?
What vessels are involved?
-End-to-side anastomosis
-subclavian artery and branch pulmonary artery
Classic BT shunt is most commonly used in what CHD?
TOF
What type of anastomosis is the Waterston shunt?
What vessels are involved?
side-to-side anastomosis
between the ascending aorta and right pulmonary artery
no longer commonly performed
What type of anastomosis is the Potts shunt?
What vessels are involved?
side-to-side anastomosis
between descending aorta and left pulmonary artery
no longer commonly performed
modified BT shunt consist of
variation of classic BT utilizing a synthetic Gore-Tex graft connecting the subclavian artery and a branch pulmonary artery
Doppler interrogation of a BT shunt will demonstrate
High-velocity flow profile because is systemic to venous shunt
Below baseline
Best seen in SSN SAX view “above crab view” dumping into the RPA.
What type of anastomosis is a Classic Glenn shunt?
end-to-side anastomosis
end of the RPA to the side of the SVC
Only to the right RPA
Unlike systemic to pulmonary shunts the doppler for a Glenn is
low velocity slightly phasic flow, because venous to venous shunt versus a systemic to venous like BT shunts are
pulmonary artery distortion less likely to occure due to low flow
What type of anastomosis is a bidirectional Glenn shunt
End-to-side anastomosis
between the SVC and branch pulmonary arteries
allows flow to both lungs unlike the Classic glenn
What is SVC syndrome
compression/obstruction of the SVC resulting in increased venous pressure and upper edema
Can be result of Glenn
Post follow-up of a Glenn shunt should look for
- Narrowing at the anastomosis between the SVC and right pulmonary artery
- Assess for thrombus formation in the shunt
- Assess for SVC syndrome
- Eval size of the PA’s
- Doppler will be low velocity, phasic flow from the shunt to the branches.
Pulmonary artery banding is used to
to reduce excessive pulmonary blood flow due to an underlying cardiac defect in setting of large VSD, ASD, Etc.
Pulmonary banding is performed via ___ thoracotomy.
Left thoracotomy
Pulmonary banding doppler profile
similar to severe pulmonary stenosis, very high systolic jet
The intent to having a atrial septectomy is to
improve arterial saturation by encouraging mixing at the atrial level
What are the types of atrial septectomy?
Blalock-Hanlon- not common anymore, requires right thoracotomy
Rashkind balloon septostomy- most common, cath lab, seen with D-TGA, HLHS with restrictive IAS
Park blade septostomy- cath lab, used for thicker atrial septum
Surgical ASD repair
Dacron Patch- surgically closed, becoming less common due to advent device closures, can wait till pt symptomatic, discharged in 4 days
When is a VSD repair necessary?
When the patient becomes symptomatic and has signs of HF and failure to thrive. Can cause surgically created AV block.
most closed with patch material, newer technique involves closing muscular VSDs with device in Cath lab
Primary indication for AVSD repair
PHTN and HF/failure to thrive
Around what age does AVSD repair typically begin?
between 3-6months of age
AVSD surgical repair involves?
- patch closure of septal defects
- suture closure of the MV cleft
Risk factors of AVSD repairs?
- Residual MR- further repair/replacement
- Subaortic stenosis due to atrioventricular valve tissue -more common in partial AVSD repair
