Ravilya_Pediatrics_Cardiology_Congenital Heart Disease

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association

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shunts

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Transposition of great vessels with no VSD

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a. Transposition of great vessels with no VSD
Arterial switch (Jatene) is final procedure of choice. Rashkind balloon atrial septostomy is initial procedure. Mustard or Senning operation (atrial switch) has complications.

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Transposition o fgreat vessels with VSD

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Transposition o fgreat vessels with VSD
Arterial (Jatene) switch and VSD repair is final procedure of choice. Initial pulmonary artery banding can be avoided by doing Rashkind procedure and arterial switch operation

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Hypoplastic

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Hypoplastic (L) heart syndrome
Norwood operation or heart transplantation

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Aortic stenosis

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Aortic stenosis
Balloon valvuoplasty is procedure o fchoice; if fails, perform surgical therapy. Both surgical and catheter approach are used in neonates

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Aortic coarctation

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Aortic coarctation
Surgical repair

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Postsurgical recurrent aortic coarctation

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Postsurgical recurrent aortic coarctation
Balloon angioplasty

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Pulmonary stenosis

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Pulmonary stenosis
Balloon pulmonary valvuloplasty or valvotomy

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Tetralogy ofFallot

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Tetralogy ofFallot
Blalock-Taussig shunt or total repair

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Tricuspid atresia

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Tricuspid atresia
First modified Blalok-Taussig shunt, second stage is bidirectional Glenn shunt, third stage is modified Fontan procedure. Currently, a cavopulmonary isolation procedure is performed, i.e., anastomosis of inferior vena cava to pulmonary arteries via a baffle that runs along lateral wall of right atrium or via a homograft or Gore-Tex tube running outside heart,

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Ebstein anomaly

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Ebstein anomaly
Starnes procedure: surgical patch closure of tricuspid value, atrial septectomy, and placement of aortopulmonary shunt. Starnes operation is followed by a Glenn, then a Fontan procedure

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Truncus arteriosus

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Truncus arteriosus
Total repair (VSD is closed, pulmonary arteries are separated from truncus and attached to (R) ventricle with a homograft conduit).

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Single ventricle

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Single ventricle
Pulmonary artery banding in over circulation. Glenn shunt followed by a modified Fontan operation is procedure of choice

Front 15

Total anomalous pulmonary venous return

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Total anomalous pulmonary venous return
Total correction (pulmonary venous trunk is connected to left atrium, the ASD is closed, and connection to systemic venous circuit is interrupted

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Atrioventricular septal defect

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Atrioventricular septal defect
Total correction (ASD andVSD are patched; AV valves are reconstructed) .

Front 17

VSD,ASD

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VSD,ASD
Total correction

Front 18

PDA

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PDA
Ligation ofPDA

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Arterial (Iatene) switch in transposition of great arteries

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Arterial (Iatene) switch in transposition of great arteries
Divide aorta and pulmonary artery above sinuses; connect (L) ventricle with aorta and (R) ventricle to pulmonary artery. Coronary arteries are reimplanted with "neo aorta,"

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Rashkind procedure in transposition of great vessels

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Rashkind procedure in transposition of great vessels
Balloon atrial septostomy through cardiac catheterization.

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Mustard or Senning operation in transposition of great vessels

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Mustanl or Senning operation in
transposition of great vessels
Atrial baffle connecting (R) atrium to (L) ventricle and (L) atrium to (R) ventricle.

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Patch closure of VSD,

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Rastelli operation in transposition of Patch closure of VSD, ventricle prosthesis connecting (L) ventricle to aorta, great vessels with VSD (R) ventricle to pulmonary artery with valve prosthesis

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Norwood procedure in hypoplastic (L) heart

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Norwood procedure in hypoplastic (L) heart
Stage I: Anastomosis of narrow ascending aorta to proximal pulmonary artery; ligate and transect distal pulmonary artery; artrial septectomy; repair of coarcted segment.
Stage II and III: Glenn anastomosis is followed by modified Fontan operation

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Modified Fontan operation in tricuspid atresia and stage II Norwood in hypoplastic (L) heart

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Modified Fontan operation in tricuspid
atresia and stage II Norwood
hypoplastic (L) heart

Anastomosis between pulmonary artery and inferior vena cava by baffle that in runs either intra-atrial or along lateral wall of right atrium.

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Modified Blalock-Taussig shunt in tetralogy of Fallot

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Modified Blalock-Taussig shunt in tetralogy of Fallot

Gore-Tex conduit anastomosis of subclavian artery to homolateral pulmonary". artery.

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Glenn shunt in second stage repair of tricuspid atresia

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Glenn shunt in second stage repair of tricuspid atresia

Anastomosis between superior vena cava and pulmonary artery.

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Starnes procedure in Ebstein anomaly

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Starnes procedure in Ebstein anomaly Aorto pulmonary shunt, atrial septectomy and closure of tricuspid valve.

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Risk of recurrence in congenital heart disease (CHD):

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Risk of recurrence in congenital heart disease (CHD): ( Incidence in general population: 0.8%
(ii) If one parent is affected: 2%to6%
(iii) Ina2ndpregnancyafterbirthofchildwithCHD: 2%to6%
(iv) Two 1st-degree relatives have coo: 20% to30%

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Most congenital heart disease is the result of

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Most congenital heart disease is the result of:multifactorial inheritance,which has a low risk recurrence

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Heart disease is most common:

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Heart disease is most common: trisomy 18 (more than 90% of cases), most common type is VSD; trisomy 21 (50% of cases), most common type is atrioventricular septal defects; Turner syndrome (40% of cases), most common type is bicuspid aortic valve. Heart disease is common in abortuses (10-25% ofcases).

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Etiology of most congenital heart disease:

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Etiology of most congenital heart disease: unknown

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Post pericardiotomy syndrome is due to:

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Post pericardiotomy syndrome is due to: a nonspecific hypersensitivity reaction to trauma to pericardium and epicardial surface of heart; high titers ofantiheart antibodies arepresent