Cardiovascular surgery, Congenital heart disease Dr. Robin Man Karmacharya, Lecturer, Department of Surgery, Dhulikhel Hospital
Jan 02, 2016
Cardiovascular surgery, Congenital heart disease
Dr. Robin Man Karmacharya,Lecturer, Department of Surgery,
Dhulikhel Hospital
Introduction
• Cardiac anomalies since birth• 1% child at birth
Classifications
Cyanotic:• Right to left shunt with decreased pulmonary
blood flow: TOF• Parallel: TGVAcyanotic:
Left to right shunt with increased pulmonary blood flow: PDA, ASD, VSD
Tetralogy of Fallot
• VSD• Overriding aorta• Pulmonary stenosis• Right ventricular hypertrophy
Procedure: Repair of VSD and pathching over pulmonary stenosis
Patent ductus arteriosus
• Ductus arteriosus facilitates the transfer of oxygenated blood from pulmonary artery to aorta
• Prostaglandins, indomethacin are used to close medically
• If persists, either ligation and division, or pericardial patching
Atrial septal defect
• Defect in atrial septum• Types:– Ostium secondum (Patent foramen ovale)– Ostium primum (Atrioventricular canal defect)– Superior venacaval– Inferior venacaval– Coronary sinus defect
• Operation: Pericardial patch or Dacron patch
Ventricular Septal defect
• Defect in interventricular septum• Left to right shunt• Types:– Perimembranous (Most common)– Muscular– Atrioventricular– Subarterial defect
Valvular Heart diseases
• Valve repair and valve replacement
Valve repair
• Improved hemodynamics• Avoids long term anticoagulation
But technically difficultHigher failure rate
Valve replacement
• Less failure rate
• But requires life long anticoagulation in case of mechanical valve, susceptible to infection
Valve replacement options
• Mechanical valve– Durable, longer life– But needs life long anticoagulation– Useful for <60 years patients
• Bioprosthetic valves– Short period of anticoagulation– Less life– Useful for >60 years patients
Mechanical valves
• Star Edwards valve• Bileaflet valves• Ball and cage valves
Bioprosthetic valves
• Porcine heterograft stented valves• Porcine heterograft stentless valves