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