Post OP Congenitral Heart Disease Flashcards
What does this image represent?
This shows how the closure device looks like fresh vs when it sits in a patient halter a long time
What does this image represent?
A septal patch
What does this image represent?
Jatene switch
What does this image represent?
D-TGA atrial switch AKA: Senning/ Mustard
What does this image represent?
Post senning/ Mustard
What are ASD and VSD closure devices used for?
Occluding larger ASD (~8mm - 40mm) or hemodynamically significant VSD
What are the 4 types of ASD?
- Primum
- Secundum
- Sinus venosus
- Coronary sinus
What is an amplatzer?
These guys have a disc on each side of the waist which is around 5-7 mm >hole
Can an ASDs/ VSD within 5-7 mm of be closed with a amplatzer device?
No, It is contraindicated
Which ASD/VSD would not work with amplatzer?
- Primum
- Membranous
What are indications for septal patches?
ASDs/ VSDs that are not suitable for amplatzer device, such as
- Too close to valve
- Too large >40mm
What are the materials that are in a septal patch?2
- Autologous pericardium
- Synthetic materials
What are some things we see with an evaluation of a septal patch?3
- Residual leaks
- Endocarditis
- Thrombus
How can we find residual leaks with septal patches?
Use low color doppler to asses for flow at the edges of the patch or around the sutures
Why is endocarditis a risk of septal patch?
Endocarditis loves foreign objects to attach to
Why may thrombus form with a septal patch?2
- May form on the surface of the patch in early stages, before the patch “endotheliazes”
- Once the endocardium grows over the patch, it is incorporated into the wall (6 weeks)
How easy is it to evaluate the patch from the heart?
Eventually it will be hard to discern
What is D-TGA- arterial switch?
Newer and preferred surgical repair for D-TGA
What is another name for Arterial switch?
Jatene procedure
What does Arterial switch involve?
Switching the aorta and PA to their normal positions
When performing arterial switch, and moving the coronary arteries to a new aorta, what must we do first?
Check for RWMA from coronary abnormalities
When is arterial switch performed?
Within the first weeks of life
What is something that is noticeable after arterial switch?
The PA is now anterior to the AO
What do we evaluate for if we have a patient that has undergone arterial switch?4
- Scarring at the suture lines on Aorta or PA
- Wall motion abnormalities
- Valvular regurgitation/ stenosis
- Residual shunts
What is atrial switch also known as?
Senning/ mustard method
What is the atrial switch?
Switches the atria using baffles (conduits) to line up the appropriate ventricle
What is the process of flow for the Atrial switch?
- SVC/IVC flow is redirected through the baffle to the MV/LV which now becomes the pulmonary ventricle
- PVs flow redirected behind the other baffle to bring LA flow to the RV which now becomes the systemic ventricle
Which is the more common D-TGA switch method?
Arterial switch
With Atrial switch O2 rich pulmonary venous return is directed where?
TV
With atrial switch O2 Poor SVR blood is directed where?
MV
What does the Morphologic LV do with atrial switch?
Lungs
What does the morphologic RV do with Atrial switch?
Pumps aorta
What is the post procedure flow similar to in terms of atrial switch?
ccTGA
What are some complications of senning/mustard method?5
- Baffle leaks + obstructions
- RV systolic dysfunctions
- PS
- Valvular regurgitation
- Arrythmias
Do baffles grow in with patients?
no
What does this image represent?
Fontan procedure - conduit
What does this image represent?
Rastelli procedure
What does this image represent?
Blalock taussig shunt
What does this image represent? What does the numbers represent?
Surgical repair of Tetralogy of flow
- Open PV
- Close VSD
- Transannular RVOT
- +/- Rastelli procedure (pulmonary atresia)
What does this image represent?
Coarctation repair
What does this image represent?
Subclavian Flap aortoplasty
What does this image represent?
Prosthetic patch aortoplasty
What does this image represent?
Percutaneous balloon angioplasty
What does this image represent?
Coarctation of the aorta (CoA)
What does this image represent?
Mitral commissurotomy
What does these images represent?
Left: old school method for Mitral commissurotmy
Right: New school balloon (Percutaneous method)
What are these three repairs?
- Blalock- Taussig
- Rastelli
- Fontan
What are these types of repairs?
- Jatene
- Senning- mustard
Name the congenital abnormalities
1.Hypoplastic left heart
2. Total anomalous pulmonary venous return
3. D-TGA
4. Tetralogy of fallot
Name the congenital abnormalities
- Double outlet RV
- Pulmonary atresia
- Coarctation of the aorta
- Tricuspid atresia
What valves form from the Endocardial/ Lateral cushions?
AV valves (MV/TV)
What valves form from the truncus arteriosus?
Semilunar valves (AV/PV)
What is the best description of perimembranous VSD?
A defect which runs between the LVOT and the Right ventricle, seen only in the A5C or PSAX view
What is the best description of Gerbode VSD?
A shunt directed from the left ventricle to the right atrium
What is the best description of outlet VSD?
A defect between the LVOT and the RVOT
What is the best description of trabecular VSD?
A defect surrounded by the myocardium various locations and multiple defects possible
What is the best description of inlet VSD?
A ventricular defect adjacent to the mitral and tricuspid valves, seen well in the A4C view; caused by absent or deficient AV septum
What type of valve is a Hall Medtronic?
Single tilting disc
What type of valve is a St. Jude?
Bileaflet tilting disk
What type of valve is a starr-edwards?
Ball cage
What type of valve is a carbomedics?
Homograft
What type of valve is a Bjhorks- shiley
Single tilting disk
What type of graft is a hancock?
Xenograft
What type of graft is a carpentier edwards?
Xenograft
