Surgical corrections Flashcards
(28 cards)
Blalock-Taussig shunt
anastomosis of subclavian artery to pulmonary artery
RSA-RPA
or
LSA-LPA
Modified Blalock-Taussig
tube connecting subclavian artery to pulmonary artery
RSA-tube-RPA
or
LSA-tube-LPA
Glenn shunt
anastomosis of SVC to RPA
Balloon atrial septostomy
Catheter:
IVC
RA
Foramen ovale
LA
balloon inflated
balloon pulled back to create hole (ASD)
Percutaneous closure device
Used to close shunts if there is enough tissue to anchor the device (cath lab with TEE)
What if there is not enough tissue to anchor a percutaneous closure device? How is the shunt fixed?
Septal patch (OHS)
usually use autologous pericardium treated with glutaraldehyde (from self)
can use synthetic materials
endothelialized over time
When is a coarctation severe enough to need surgery?
systemic arterial HTN with
upper and lower systolic PB diff > 20 mmHg
There are 4 types of coarc repairs
Resection and end-to-end anastomosis
Coarctation repair:
cut out narrow part and sew together
risk of re-stenosis at suture line
Subclavian flap aortoplasty
Coarctation repair:
LSA ligated and divided
incision through prox LSA and coarc (inside the bend is cut out)
LSA stump is turned down as patch
prosthetic patch aortoplasty
Coarctation repair:
Longitudinal incision made through coarc
area is enlarged with patch (Darcon or Gortex)
Risk of late aneurysm
Percutaneous balloon angiogplasty
Coarctation repair: only option that does not involve surgery
balloon to enlarge coarc diam by producing intimal tears
risk of aneurysm
What are the surgeries for TGA?
Jatene procedure
1980s to current
Mustard and Senning procedures
1960s to 80s
Jatene procedure
1980s to current
Switch the Ao and PA to their normal positions and move the coronaries to new Ao
risk of stenosis at suture lines
*Note: Asc Ao stays behind PA
Mustard and Senning procedures
1960s to 80s
Build a baffle to direct blood coming into heart
deO2 blood:
IVC/SVC
baffle
MV - LV - pulmonary circulation
O2 blood:
PVs
baffle
TV - RV - systemic circulation
Risk of baffle obs/leaks/clots; Right HF
What is the different between Mustard and Senning?
Same procedure, different material to make baffle
Mustard - synthetic material
Senning - patients own tissue
What is the surgery for a simple ToF (RVOT obs and PS minimal)?
ToF surgery:
widen RVOT and PA
close VSD
transannular RVOT patch
(palliative: modified Blalock-Taussig to incr flow to lungs)
What surgery is for
complicated TGA (severe PS)
complicated ToF or
Truncus Arteriosus?
Rastelli Procedure
Rastelli procedure
- cut and close off MPA
- added intraventricular patch/tunnel through VSD to connect LV to Ao
- add extracardiac conduit to connect RV to MPA
What surgery is for single ventricle conditions?
(HRHS, HLHS, DORV)
Fontan operation
What are the three stages of the Fontan operation? At what age are they performed?
stage 1. Norwood - 1st week of life
stage 2. Glenn - 3 to 6 months old
stage 3. Fontan - 1.5 to 5 yo
Norwood procedure
Stage 1 of Fontan operation
- cut PA at bifurcation and attach MPA to Ao. Add a patch to the Ao to make it bigger and stronger
- put temporary shunt btw Ao and PAs to create flow to lungs (Blalock-Taussig)
- remove IAS
*mixed O2 to body and lungs
Glenn procedure
Stage 2 of Fontan operation
- ligate SVC and attach it directly to PAs
- remove Blalock-Taussig shunt
*less mixed O2 to body (upper body deO2 goes directly to lungs)
Fontan procedure
Stage 3 of Fontan operation
- ligate IVC and attach to PAs or build a baffle through RA to guide blood from IVC to PAs *
if baffle, sometime leave a fenestration (hole) to act as a pressure release which is later closed
*O2 blood to body (SVC and IVC bypass heart and go straight to lungs)
What is the Jatene procedure for?
TGA (1980s to current)
