Congenital heart diasease
From Radipedia
Contents
Cyanotic
- Decreased Flow
- Normal Heart Size - Tetrology of Fallot
- Cardiomegaly
- Ebstein Anomaly
- Pulmonary atresia with intact ventricular septum
- Increased Flow
- Variable flow
Non-cyanotic
- Increased pulomary arterial flow - Left to right shunt (VSD, ASD, AVC, PDA)
- Increased pulmonary venous flow - Congestive heart failure
- Normal pulmonary flow
- Obstructive lesions
- Post surgical
Palliative Procedures prior to Complete Repair
Modified Blalock Taussig Shunt
- Graft between subclavian artery and ipsilateral pulmonary artery
- Provides pulmonary blood flow to lungs in cyanotic CHD (single ventricle)
- Complications include thrombosis and post operative seroma
Waterston Shunt - anastomosis between ascending aorta and right PA (not currently used)
Potts Shunt - anastomosis between descending aorta and left PA (not currently used)
PA Banding
- Restricts pulmonary blood flow and increases systemic flow in VSD
- Protects lungs from lasting effects of pHTN
- Can also be used before repair of TGA to "train" the left ventricle for systemic pressures
Bidirectional Glenn
- SVC anastamosed to right PA with flow into both PA
- Used in patients 3-9 months old (after pulmonary pressure drops) as bridge to Fontan at age 2-4 years
Complex Repairs
Fontan
- Completes the BDG by directing flow from IVC into PA
- Initially for tricuspid atresia, now used for many single ventricle CHD
Norwood
- Primarily for hypoplastic left heart syndrome (often a majority of systemic supply via PDA due to aortic coarctation)
- Stage 1 - within first few days of life
- Connect RV with systemic arterial circulation using main PA to reconstruct often stenotic aorta
- Atrial septectomy to allow venous return to RV
- Ligate PDA
- BT (subclavian artery to PA) or Sano (RV to PA) shunt
- Stage 2 - eliminate BT shunt and perform BDG (SVC anastamosed to right PA)
- Stage 3 - Fontan
Repair of Dextro TGA (Ventriculoarterial discordance)
- Initially a atrial septostomy to allow mixing of parallel circulations
- Mustard or Senning procedures rerouted blood at atrial level with conduit to correct ventricle (not currently performed)
- Jantene arterial switch can now be perfomred within first 2 weeks of life
Repair of Levo TGA (Atrioventricular and Ventriculoarterial discordance aka Congenitally corrected TGA)
- Systemic blood enters RA, morphologic LV, then PA
- PV to LA, morphologic RV, then aorta
- Circulation is "correct" but RV and tricuspid valve (valve always concordant with ventricle) is systemic valve
