Corrective surgeries

Question 1

Goals of shunting surgeries

Answer 1

Shunts developed to ↑ pulmonary flow and decompress RV

Question 2

Shunt procedures

Answer 2

• Pott’s shunt
• Waterson-Cooley’s shunt
• Blalock-Taussig

Question 3

Pott’s shunt procedure and indications

Answer 3

o Procedure: side-to-side anastomosis from LPA → descending Ao
o Indications: refractory PH

Question 4

Pott’s advantages

Answer 4

 Immediate ↓ RV afterload
 Absence of upper body cyanosis

Question 5

Pott’s disadvantages

Answer 5

many complications
 Distorsion of PA, CHF, PH

Question 6

Waterson-Cooley’s shunt: procedure and indications

Answer 6

o Procedure: side-to-side anastomosis from ascending Ao → RPA
 Waterson: extrapericardial
 Cooley: intrapericardial
o Indication: Tetralogy of Fallot

Question 7

Waterson-Cooley’s shunt disadvantages

Answer 7

 High complication rate:
* Preferential distribution of shunt to R lung
* RPA narrowing at anastomose site
* ↑ stenosis/atresia in RVOT
* LPA hypoplasia
* Shunt obstruction
 Difficult to close at moment of complete repair

Question 8

Blalock-Taussig procedure: classic vs procedure

Answer 8

o Procedure:
 Classic: end-to-side anastomosis of subclavian/innominate artery → PAs
* On the side opposite to Ao arch to minimize kinking of subclavian artery
 Modified: PTFE (gore-tex) graft btw subclavian artery→ PA
* Prevent sacrificing subclavian artery

Question 9

Blalock-Taussig indications

Answer 9

o Modified procedure with PTFE graft is procedure of choice
 ↓ pulmonary overcirculation
 Minimal LV dysfct/pulmonary vascular dz

Question 10

Blalock-Taussig classic procedure disadvantages

Answer 10

difficult to maintain patency post op

Question 11

Hybrid operation

Answer 11

combine sx repair + interventional (KT based) procedure

Question 12

Fontan physiology

Answer 12

single ventricle

Question 13

Fontan procedure

Answer 13

redirection of venous blood from inferior/superior VC → pulmonary arteries
 Bypass the heart: allow oxygenation of blood by pulmonary circulation before returning to heart
 Aim is to separate systemic and pulmonic circulation

Question 14

Fontan indications

Answer 14

single ventricle physiology
TV atresia
D outlet or inlet RV
D outlet or inlet LV
Hypoplastic L heart
PA atresia and RV hypoplasia
Severe Ebstein w/ inadequate RV
Unbalanced AV canal w/ non viable LV or RV

Question 15

Fontan disadvantages

Answer 15

multiple complications (PLE, liver dysfct, arrhythmias, CHF)
 Single ventricle remains: risks for ventricular dysfct particularly if single RV
 Single ventricle compliance is determinant for pulmonary circulation (no forward pulmonary thrust)

Question 16

Glenn procedure

Answer 16

o Procedure: redirection of venous blood from superior VC → PA
 Blood from upper body flow goes into lungs, bypass heart
 Variant of Fontan procedure
 Goal: reduce workload of single ventricle + improve blood O2
o Usually performed 2nd, then complete Fontan
 1st procedure is Norwood (creates new Ao to RV)