1) Closed Heart Surgery: Surgery on Heart or Great Vessels done without using the Heart-Lung machine.
2) Open Heart Surgery: Surgery done on the Heart or Great vessels using a Heart-Lung machine.
Salient points on certain common types of Congenital Heart Surgery: Shunts
Blalock Shunts are connections between systemic arteries such as a subclavian arteiy with its respective pulmonary arteiy. Currently all such shunts are performed using a PTFE conduit. These are pelformed via a thoracotomy usually, though they could be peiormed via a steinotomy in certain indications.
Glenn Shunts are those where the SVC is connected to the respective pulmonary artery to increase pulmonary blood flow without causing volume overload of the ventricle like the Blalock shunts. This is usually an open heart procedure especially in young children though it could be attempted as a closed procedure in older ones.
Perfoimed through a sternotomy or a Right thoracotomy.Coactation of aorta repairs:-Depending on the anatomy the repairs performed are
using several techniques.
ASD Closures
Small ASD's can be closed directly. Others will need a pericardial patch. Piimum ASD and Sinus Venosus ASD are always closed with a patch.
VSD Closures: Is done with a prosthetic material like Dacron or PTFE patch (Gore Can be approached by many routes depending on location. Most are approached through the Right atrium and tricuspid valve.Hea-t block after VSD closure is seen in less than 1 per cent of patients in today's practice. Tex).
Tetralogy of Fallot Repair: This involves RV outflow resection, closure of the VSD and enlargement of the RV outflow tract.
2) Open Heart Surgery: Surgery done on the Heart or Great vessels using a Heart-Lung machine.
Salient points on certain common types of Congenital Heart Surgery: Shunts
Blalock Shunts are connections between systemic arteries such as a subclavian arteiy with its respective pulmonary arteiy. Currently all such shunts are performed using a PTFE conduit. These are pelformed via a thoracotomy usually, though they could be peiormed via a steinotomy in certain indications.
Glenn Shunts are those where the SVC is connected to the respective pulmonary artery to increase pulmonary blood flow without causing volume overload of the ventricle like the Blalock shunts. This is usually an open heart procedure especially in young children though it could be attempted as a closed procedure in older ones.
Perfoimed through a sternotomy or a Right thoracotomy.Coactation of aorta repairs:-Depending on the anatomy the repairs performed are
using several techniques.
ASD Closures
Small ASD's can be closed directly. Others will need a pericardial patch. Piimum ASD and Sinus Venosus ASD are always closed with a patch.
VSD Closures: Is done with a prosthetic material like Dacron or PTFE patch (Gore Can be approached by many routes depending on location. Most are approached through the Right atrium and tricuspid valve.Hea-t block after VSD closure is seen in less than 1 per cent of patients in today's practice. Tex).
Tetralogy of Fallot Repair: This involves RV outflow resection, closure of the VSD and enlargement of the RV outflow tract.
Transposition of great Arteries: (TGA) The problem here is that the ventriculoarteiial connections heve been reversed with the RV giving rise to the aorta and the LV giving rise to the PA. This could be associated with a VSD, PDA Pulmonay stenosis or Coarctation1 Aot-tic arch inten-uptions.
Timing of surgical corrections depend on the absence or presence of a VSD or a large PDA. The LV will regress in its ability to support a systemic afterload once the PVR starts to come down in the perinatal period. This will be delayed in the presence of a large VSD 01. PDA as these lesions will continue to subject the LV to a systemic pressure and retain its ability to handle the systemic afterload.Corrective surgeries are usually planned in the neonatall infant age groups as the rate of attrition and development of PAH is very early in these children.
Arterial Switch Operation: Switching the Great arteries to restore the normal Ventriculoarterial connections. The coronary arteries also need to be transfel~ed in the process which is the most delicate par& of the susgeiy. This operation is also called anatomical correction as the nolmal anatonly is restored. Long-term results are the best with this form of surgery. In cases where there is no largeVSD or PDAthis operation is best done at birth or within 2 to 3 weeks of age at the most.
Atrial Switch Operation: (Senning or Mustard procedures) By means of a baffle the systemic v enous blood could be diverted to the LV across the mitral valve and the pulmonary venous blood into the RV across the tricuspid valve, thus 'physiologically colrecting the circulation' as the venous blood goes to the lungs and the oxygenated blood to the sol-ta.
Rastelli Operation: An operation which involves closure of a large VSD and establishing RV to PA conilection with an external conduit, valved or no11 valved.Fontan Operation: The Fontan principle involves redirecting the whole systemic retuin into the lungs bypassing the 'RV' and using the single ventricle present to support the systemic circulation. This results in non-pulsatile flow to the lungs andthe whole circulation depends on the single ventricle functioning at a low end diastolic pressure.
Ross Operation: It consists of harvesting the native pulmonary valve and implanting it in the aortic position and replacing a homograft valve in the pulmonary position.
Timing of surgical corrections depend on the absence or presence of a VSD or a large PDA. The LV will regress in its ability to support a systemic afterload once the PVR starts to come down in the perinatal period. This will be delayed in the presence of a large VSD 01. PDA as these lesions will continue to subject the LV to a systemic pressure and retain its ability to handle the systemic afterload.Corrective surgeries are usually planned in the neonatall infant age groups as the rate of attrition and development of PAH is very early in these children.
Arterial Switch Operation: Switching the Great arteries to restore the normal Ventriculoarterial connections. The coronary arteries also need to be transfel~ed in the process which is the most delicate par& of the susgeiy. This operation is also called anatomical correction as the nolmal anatonly is restored. Long-term results are the best with this form of surgery. In cases where there is no largeVSD or PDAthis operation is best done at birth or within 2 to 3 weeks of age at the most.
Atrial Switch Operation: (Senning or Mustard procedures) By means of a baffle the systemic v enous blood could be diverted to the LV across the mitral valve and the pulmonary venous blood into the RV across the tricuspid valve, thus 'physiologically colrecting the circulation' as the venous blood goes to the lungs and the oxygenated blood to the sol-ta.
Rastelli Operation: An operation which involves closure of a large VSD and establishing RV to PA conilection with an external conduit, valved or no11 valved.Fontan Operation: The Fontan principle involves redirecting the whole systemic retuin into the lungs bypassing the 'RV' and using the single ventricle present to support the systemic circulation. This results in non-pulsatile flow to the lungs andthe whole circulation depends on the single ventricle functioning at a low end diastolic pressure.
Ross Operation: It consists of harvesting the native pulmonary valve and implanting it in the aortic position and replacing a homograft valve in the pulmonary position.
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