Surgical Repairs

Question 1

Ebstein’s surgical repairs

Answer 1

Biventricular repair :
- Tricuspid valve repair (Danielson, Cone, Carpentier)
- Tricuspid valve replacement (Bioprosthetic, Mechanical)
Single ventricle repair
- Starnes procedure: Single ventricle repair
- Singe ventricle repairs are performed in patients that have inadequate right cardiac output
- Goals—- exclude and decompress the right ventricle, unrestrictive atrial communication, reduction atrioplasty, systemic to pulmonary shunt
- Procedure— MPA ligation, pericardial patch with fenestration to close the tricuspid orifice, Plication of the RA and RV wall, systemic to pulmonary shunt

Question 2

Surgical procedure for HLHS (list stages)

Answer 2

Fontan Procedure

1) Norwood procedure (The native pulmonary artery is connected to aortic arch and PDA closed, a BT shunt connects from innominate artery to RPA, and DKS to incorporate coronaries) usually in first 2 weeks of life

2) Glenn Procedure (BT shunt take down, the SVC is connected to the RPA)

3) Completed Fontan (**The IVC is detached from RA (intracardiac or extracarfiac Fontan)

4) Cardiac transplant

Question 3

DTGA Surgical repairs

Answer 3

Arterial or atrial switch

1) Jatene procedure = arterial switch
2) LeCompte maneuver often with arterial switch—- has PA’s straddling ascending aorta
3) Mustard or Senning = atrial switch (Mustard uses synthetic material like Dacron to create baffle, Senning uses patient’s own tissue)

Question 4

LTGA surgical repairs

Answer 4

1) “Double switch”/biventricular repair—- an arterial and atrial switch
2) Often VSD closures or pulmonary valve ballooning/repair

Question 5

4 Types of biventricular repairs and pathologies that use them **NEED TO FINISH PATHOLOLOGIES

Answer 5

1) Double switch—- Corrects CCTGA (arterial and atrial switch)
2) 1.5 ventricle repair— Diverts some blood into the lung to reduce the hearts workload
3) Biventricular conversion— converts patients who were previously single ventricle palliations into two ventricle arrangement
4) Ventricular recruitment— A staged procedure that makes a borderline small ventricle grow until a 2-ventricle repair is an option