Congenital Heart Diseases

Congenital heart diseases Cardiovascular surgery department, The first affiliated hospital of zhengzhou university Shu liliang

Cardiopulmonary bypass 1. Historical overview 2. Elements of cardiopulmonary

bypass

Historical overview

Elements of cardiopulmonary 1. Pump 2. Oxygenator 3. Venous reservoir 4. Heat exchanger 5. Cannulation 6. Intracardiac suction devices

ventricular septal defect (VSD)

Morphology 1. Perimembranous defects 2. Muscular defects 3. Sub-arterial defects

Associated lesions in “primary” ventricular septal defect 1. Patent ductus arteriosus: 6% 2. Severe coarctation: 12% 3. Valvar or subvalvar aortic stenosis: 4% 4. Arterial septal defect: 24%

Pathophysiology 1. Determinants of size and direction of

shunt. 2. Sequelae of left-to-right shunting.

Natural history 1. 2. 3. 4. 5. 6. 7.

Spontaneous closure. Pulmonary vascular disease. Bacterial endocarditis. Premature death. Symptoms. Development of aortic incompetence. Development of infundibular pulmonary stenosis.

Diagnosis 1. 2. 3. 4. 5. 6. 7. 8. 9.

Examination Tachypnea with marked subcostal retraction. Severe growth failure. Waxen complexion and profuse sweating. External jugular venous pulses. Bulging precordium. Rapid, overactive heart. Thrill and pansystolic murmur in the third to fifth intercostal spaces on the left. Liver and spleen enlarged. Protruding sternum (pigeon breast).

Diagnosis 1. 2.

3.

Chest film Small VSD : normal . Large VSD, mild elevation of pulmonary vascular resistance: pulmonary arteries large, the left atrium and left ventricular enlargement, the right ventricular dilated. Large VSD and severe rise of pulmonary vascular resistance: the peripheral pulmonary arteries are normal and the main pulmonary artery is often greatly enlarged.

Diagnosis Electrocardiogram 1. The R wave from the right precordial leads is tall. 2. A deeper S wave from the left precordial leads.

Diagnosis Cardiac catheterization

cineangiography

Indications for operation 1.

2.

Infants with large VSDs have severe intractable heart failure or intractable, severe respiratory symptoms at any time during the first 3 months of life, prompt primary repair is indicated. When severe symptoms, significant growth failure, or rising pulmonary vascular resistance is present in infants 3 months of age or older, prompt primary repair is advised.

Indications for operation 3. When infants reach 6 months of age with a single large VSD, operation generally should be advised at this time. If the pulmonary vascular resistance is high, repair is advisable without undue delay. 4. When the pulmonary vascular resistance is more than 10 units·m2, operation is not advisable.

Indication for operation 5. Children have a moderate-sized VSD should be kept under observation for about 5 years, if there is no change on subsequent recatheterization, closure is indicated. 6. Subpulmonary defects should be repaired promptly at an earlier age if an aortic diastolic murmur develops.

Surgical technique Right atrium approach: (1) perimembranous (2) midmuscular (3) apical and subarterial 2. Right ventricular approch: (1) subarterial (2) infundibular 3. Left ventriculotomy: multiple muscular VSDs in the trabecular septum. 1.

Tetralogy of Fallot (TOF)

Anatomy 1. Infundibular pulmonary stenosis.

2. Ventricular septal defect. 3. Dextroposition of the aorta. 4. Hypertrophy of the right ventricular.

Diagnosis Clinical manifestations: 1. Cyanotic 2. Heart failure 3. Paradoxical emboli 4. Cerebral or pulmonary thrombosis 5. Subacute bacterial endocarditis

Diagnosis Physical examination: 1. Duskiness. 2. Smaller than expected. 3. The fingers and toes show clubbing. 4. A thrill is present anteriorly. 5. A harsh systolic murmur over the pulmonary area and along the left sternal border. 6. The second heart sound is usually single.

Diagnosis Laboratory studies: 1. The hemoglobin, hematocrit, and erythrocyte count are elevated. 2. The oxygen saturation in the systemic arterial vary between 65 and 70%. 3. A diminution in a variety of the factors responsible for blood coagulation.

Diagnostic evaluation 1. Chest film: diminished vascularity in the

lungs and absence of prominence of the pulmonary artery, the classic boot-shaped heart. 2. Electrocardiogram: right ventricular hypertrophy. 3. Echocardiogram 4. Cardiac catheterization

Indications for operation Provide surgical correction as soon as possible ( often electively before the end of the first year of life ) and general by the time the patient has reached the age of 2 years.

Surgical techniques Palliative procedures: 1. Modified Blalock-Taussig shunt 2. Central aortopulmonary shunt 3. RVOT patch 4. Balloon angioplasty of RVOT

Surgical technique Total correction: 1. VSD closure 2. Relif of ROVT obstruction 3. Relif of pulmonary artery stenoses