1. Cardiac p37-39 (Cardiac surgeries) Flashcards
Palliative surgery for hypoplastic left heart - trivia (4)
Not curative.
Done in 3 stages to protect lungs and avoid right heart overload.
Norwood or Sano - within days of birth
Glenn - 3-6 months
Fontan - 1.5-5 years
Norwood procedure - anatomy (5)
Aims to create unobstructed outflow tract from the systemic ventricle.
Tiny native aorta is anastamosed to pulmonary trunk, and arch augmented by graft.
ASD enlarged to create non-restriced atrial flow.
Blalock-taussig shunt between right subclavian and right PA.
Ductus removed to prevent overshunting to the lungs.
Sano procedure - anatomy (2)
Same as norwood, but Blalock-taussig shunt replaced with conduit connected right ventricle to pulmonary artery.
Classic Glenn procedure - anatomy (2)
End-end shunt between SVC and right PA.
Proximal end of right PA closed to reduce right ventricular work, so all venous return is directed straight to lung.
Bi-directional Glenn - anatomy (3)
end-to-side shunt between SVC and RPA.
RPA left open, allowing blood flow to both lungs.
If done as part of left hyperplasia treatment, blalock-Taussig shunt will be removed.
Fontan operation - anatomy (5)
Used for hypoplastic heart
Closure of ASD,
Glenn shunt,
Shunt between right atrium and left PA.
Aim to let blood flow passively, no pump, from systemic veins to lungs.
Then turn the right ventricle into a functional left ventricle.
Blalock-Taussig shunt (3)
Originally for use with TOF.
Subclavian artery to pulmonary artery.
On opposite side to arch.
Modified Blalock Taussig shunt
Performed on the SAME side as the arch. technically easier to do.
Pulmonary artery banding (3)
Done to reduce pulmonary artery pressure (aim 1/3 of systemic).
Common indication is CHF in infancy with expected delayed repair
Single ventricle is commonest lesion requiring banding
Atrial switch - purpose (3)
Used to correct transposition, by creating a baffle within the atria to switch back blood flow at the level of in-flow.
Right ventricle becomes systemic, left pumps to lungs.
Usually done in first year of life.
Rastelli operation - purpose (3)
Most commonly used operation for
- transposition
- pulmonary outflow obstruction
- VSD
Rastelli operation - anatomy (4)
Placement of baffle within the RV, diverting flow from the VSD to the aorta (using the VSD as part of the LVOT).
Pulmonary valve is oversewn, conduit inserted between RV and PA.
Left ventricle becomes the systemic ventricle.
Conduit wears out, committing the child to multiple future surgeries.
Jatene procedure - anatomy (2)
Arterial switch, transection of the aorta and pulmonary arteries about the valve sinuses, including removal of coronaries.
Great arteries switched, coronaries sewn onto new aorta (formerly PA).
Atrial switch - types (2)
Mustard and Senning procedures:
Senning: Baffle created from right atrial wall and septum WITHOUT extrinsic material
Mustard: Involves resection of atrial septum and creation of baffle using pericardium or extrinsic material
Ross procedure - anatomy (3)
Done to repair diseased aortic valves in children.
Replaces aortic valve with patient’s pulmonary valve.
Replaces pulmonary valve with cryopreserved pulmonary valve homograft.
