CVPR 326 Pediatric Perfusion / Lecture 1 / Coarctation of Aorta, Semilunar valvular stenosis,

Question 0

4 Repair Options for Coarction of the Aorta.

Answer 0

– subclavian patch angioplasty
– End to end anastomosis
– subclavian translocation
– Tube graft

Question 1

Coarction of the Aorta

Answer 1

Narrowing of the aorta, distal to the left subclavian opposite of the ductus arteriosus.
- Presence of a patent ductus arteriosus will allow adequate lower body perfusion.
- Presentation:
Infant: acute decompensation at the time of ducal closure.
Older child or Adult: Upper extremity hypertension
-Identification:
Elevated pressures in the upper versus lower extremities.

Question 2

How would you diagnose aortic coarctation?

Answer 2

Elevated pressures in the upper versus lower extremities.

Question 3

Describe the left subclavian patch angioplasty proceure.

Answer 3

The left subclavian is sacraficed and divided distally, and then longitudinally to create a flap that will be sutured onto the aorta.

Question 4

Advantages of a left subclavian patch angioplasty

Answer 4

• Patients own tissue
• Low recurrence rate
• Excellent relief of the
  obstruction
• Simple

Question 5

Disadvantages of a left subclavian patch angioplasty

Answer 5

• Subclavian artery is sacrificed
• Decreased perfusion to the
  left upper extremity.

Question 6

Describe the End to end anastomosis proceure.

Answer 6

Distal aortic arch and the descending aorta are dissected thereby removing the aortic coarctation. They are then sutured together.

Question 7

Describe the subclavian translocation angioplasty proceure.

Answer 7

The subcalvian artery is isolated and transected at its origin. A flap is then created and anastomosed back to the aorta replacing the coarctation.

Question 8

Ductus Arteriosus definition

Answer 8

In the developing fetus, the ductus arteriosus (DA), is a blood vessel connecting the pulmonary artery to the proximal descending aorta.

It allows most of the blood from the right ventricle to bypass the fetus’s fluid-filled non-functioning lungs.

Upon closure at birth, it becomes the ligamentum arteriosum.

Question 9

What are the 3 fetal shunts?

Answer 9

Ductus Arteriosus
Ductus Venosus
Foramen Ovale

Question 10

Ductus Venosus definition

Answer 10

Oxygenated blood from the placenta is carried via the umbilical vein. As it travels towards the underdeveloped liver of the fetus, the blood is shunted or re-directed past the liver via the DUCTUS VENOSUS.

Question 11

Fetal lungs are not yet fully functional, they are filled with fluid, therefore creating a high resistance (Pressure). This leads to high pressures in the Pulmonary trunk, RV, and RA. High pressures in the RA causes blood to travel from the RV to LV through the ____ _____. In the event that some blood makes it past the tricuspid valve and into the pulmonary trunk it can be shunted via the ____ _____.

Answer 11

FORAMEN OVALE
DUCTUS ARTERIOSIS

https://www.youtube.com/watch?v=CWwkC5g-vnY

Question 12

2 Semilunar valves ?

Answer 12

Aortic

Pulmonary

Question 13

Physical signs of Preductal Coarctation of the aorta.

Answer 13

Poor perfusion of the upper body, but great perfusion of the lower body.

Question 14

Physical signs of Postductal Coarctation of the aorta.

Answer 14

Poor perfusion to the lower body, but great perfusion to the upper body.

Question 15

The name of the ductus arteriosis after its no longer a blood vessel, meaning after it has closed after birth.

Answer 15

Ligamentum arteriosum

Question 16

Name of the ductus arteriosis if it never closes.

Answer 16

Patent ductus arteriosis.

Question 17

Supravalvular Aortic Stenosis

Answer 17

Narrowing of the junction between the the aortic valve and the ascending aorta.

- Encountered with pts with 
  Williams Syndrome.
- Obstruction leads to LV 
  hypertrophy.
- LV Hypertrophy leads to LV 
  dysfunction, ischemia, and 
  risk of sudden death.

Question 18

When is surgical intervention recommended for Supravalvular Aortic Stenosis?

Answer 18

When the pressure gradient across the area of the narrowing is significant.

Question 19

Describe the surgical repair for
Supravalvular Aortic Stenosis.

Books procedure

Answer 19

Short to moderate CPB & cross-clamp time required.

1. ) Counter-inscisions are made in the aorta above the stenotic segment and also below the stenotic segment just above the sinus of valsalva.
2. ) Both segments are interdigitated and anastomosed using monofilament suture.
3. ) Compare LV and peripheral artery pressures following weaning from bypass.

Question 20

Valvular Aortic Stenosis

Answer 20

Does not open wide enough because the 3 leaflets a fused together. Surgically repaired by simply re-cutting the leaflets (Commissurotomy).

If fibrosis and calcification make reconstruction impossible, the valve is removed and replaced with a prosthetic.

Question 21

Supra-valvular stenosis

Answer 21

Narrowing of the aorta superior to the valve.

Question 22

LV that has become hypertrophied would cause what to left ventricular outflow tract (LVOT)?

Answer 22

Make it too small, it would be considered a sub-valvular aortic stenosis.

Question 23

6 Options for Correction of

Aortic Stenosis

Answer 23

• Balloon Dilatation
• Commissurotomy
• Valvuloplasty
• Valvectomy
• Resections of Obstruction
• Konno-Rastan

Question 24

Konno-Rastan procedure

slide 27

Answer 24

Used for severe aortic stenosis and hypoplastic aortic annulus.

- Prosthetic Aortic Valve 
  implanted.
- Left Ventricular Outlfow Tract 
  enlargement with trans-
  annular patch that looks like a 
  football.

Question 25

Definition of hypoplastic or hypoplasia ?

Answer 25

Underdeveloped or Very small

Question 26

59:03

Slide 28

Answer 26

Pulmonary