Lecture 1 / Coarctation of Aorta, Semilunar valvular stenosis,

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

4 Repair Options for Coarction of the Aorta.

Answer 2

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

Question 3

How would you diagnose aortic coarctation?

Answer 3

Elevated pressures in the upper versus lower extremities.

Question 4

Describe the left subclavian patch angioplasty proceure.

Answer 4

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

Question 5

Advantages of a left subclavian patch angioplasty

Answer 5

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

Question 6

Disadvantages of a left subclavian patch angioplasty

Answer 6

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

Question 7

Describe the End to end anastomosis proceure.

Answer 7

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

Question 8

Describe the subclavian translocation angioplasty proceure.

Answer 8

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 9

Ductus Arteriosus definition

Answer 9

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 10

What are the 3 fetal shunts?

Answer 10

Ductus ArteriosusDuctus VenosusForamen Ovale

Question 11

Ductus Venosus definition

Answer 11

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 12

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 12

FORAMEN OVALEDUCTUS ARTERIOSIShttps://www.youtube.com/watch?v=CWwkC5g-vnY

Question 13

2 Semilunar valves ?

Answer 13

Aortic Pulmonary

Question 14

Physical signs of Preductal Coarctation of the aorta.

Answer 14

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

Question 15

Physical signs of Postductal Coarctation of the aorta.

Answer 15

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

Question 16

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

Answer 16

Ligamentum arteriosum

Question 17

Name of the ductus arteriosis if it never closes.

Answer 17

Patent ductus arteriosis.

Question 18

Supravalvular Aortic Stenosis

Answer 18

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 19

When is surgical intervention recommended for Supravalvular Aortic Stenosis?

Answer 19

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

Question 20

Describe the surgical repair forSupravalvular Aortic Stenosis.Books procedure

Answer 20

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 21

Valvular Aortic Stenosis

Answer 21

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 22

Supra-valvular stenosis

Answer 22

Narrowing of the aorta superior to the valve.

Question 23

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

Answer 23

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

Question 24

6 Options for Correction ofAortic Stenosis

Answer 24

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

Question 25

Konno-Rastan procedureslide 27

Answer 25

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 26

Definition of hypoplastic or hypoplasia ?

Answer 26

Underdeveloped or Very small

Question 27

59:03Slide 28

Answer 27

Pulmonary