cardiovascular surgery, congenital heart disease dr. robin man karmacharya, lecturer, department of...
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![Page 1: Cardiovascular surgery, Congenital heart disease Dr. Robin Man Karmacharya, Lecturer, Department of Surgery, Dhulikhel Hospital](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649ee55503460f94bf4e8a/html5/thumbnails/1.jpg)
Cardiovascular surgery, Congenital heart disease
Dr. Robin Man Karmacharya,Lecturer, Department of Surgery,
Dhulikhel Hospital
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Introduction
• Cardiac anomalies since birth• 1% child at birth
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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
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Tetralogy of Fallot
• VSD• Overriding aorta• Pulmonary stenosis• Right ventricular hypertrophy
Procedure: Repair of VSD and pathching over pulmonary stenosis
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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
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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
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Ventricular Septal defect
• Defect in interventricular septum• Left to right shunt• Types:– Perimembranous (Most common)– Muscular– Atrioventricular– Subarterial defect
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Valvular Heart diseases
• Valve repair and valve replacement
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Valve repair
• Improved hemodynamics• Avoids long term anticoagulation
But technically difficultHigher failure rate
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Valve replacement
• Less failure rate
• But requires life long anticoagulation in case of mechanical valve, susceptible to infection
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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
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Mechanical valves
• Star Edwards valve• Bileaflet valves• Ball and cage valves
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Bioprosthetic valves
• Porcine heterograft stented valves• Porcine heterograft stentless valves
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