repair of congenital aortic valve disease
DESCRIPTION
Repair of Congenital Aortic Valve Disease. Department of Thoracic and Cardiovascular Surgery Seoul National University Hospital Yong Jin Kim, M.D. Patient Profile ( I ). Male / 9 years History Heart murmur detected at birth (1992-02-13) 95-05-11 Lateral tunnel Fontan Op. - PowerPoint PPT PresentationTRANSCRIPT
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Repair of
Congenital Aortic Valve Disease
Repair of
Congenital Aortic Valve Disease
Department of Thoracic and Cardiovascular Surgery
Seoul National University Hospital
Yong Jin Kim, M.D.
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Patient Profile ( I )Patient Profile ( I )
Male / 9 years
History Heart murmur detected at birth (1992-02-13)
95-05-11 Lateral tunnel Fontan Op.
00-12-19 Coil embolization RPA & RUPV arteriovenous collateral
Left IMA collateral to left lung
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Patient Profile ( II )Patient Profile ( II )
Chief complaints DOE (Functional Class II- III)
Systemic review Clubbing, cyanosis
Physical examination Gr II~III/VI systolic murmur at apex Peripheral O2 saturation : 80% at room air
EKG HR : 80~100 beats/min NSR with occasional PVC
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Initial DiagnosisInitial Diagnosis
{A, D, L}
RV type SV ( Rudimentary LV )
SA (Common AV valve)
Bilateral SVC, IVC to hemiazygos( Left SVC )
PS & PDA
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00
Age : 3yr
Bwt 13kg / Height 94cm / BSA 0.58m2
Fenestrated Fontan Operation Fenestration 5.5mm
Lateral tunneling with GoreTex patch
Bilateral BCPC
PDA division
MPA division
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Lateral Tunnel Fontan Op.Lateral Tunnel Fontan Op.
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Pre-op Chest X-ray ( 2001.4.10)Pre-op Chest X-ray ( 2001.4.10)
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Preoperative Diagnosis Preoperative Diagnosis
Hepatic vein into pulmonary atrium Adjacent to the coronary sinus & intrahepatic collateral formation
Atrioventricular valve regurgitation ; moderate Aortic insufficiency ; moderate to severe Aortic Root (Echocardiography)Aortic Root (Echocardiography)
Aortic annulus : 24 mm. Sinus : 35~37 mm. Sinotubular junction : 30~32 mm
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Pre-Op Cardiac CatheterizationPre-Op Cardiac Catheterization
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Operation (2001-04-16)Operation (2001-04-16)
Extracorporeal circulation CPB time : 159 min / ACC time : 88 min
Cannulation Arterial cannular : Ascending aorta
Venous cannula : Into the lateral tunnel
Cardioplegics Blood cardioplegics : Direct antegrade
400cc/time × 3 times / Total Amount : 1200 cc
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Operative Technique ( I )Operative Technique ( I )
A. Triangular resections of the dilated sinus wall• Excision varies with the redundancy of the sinus wall & degree of reduction of the sinotubular junction
B. Reconstruction of the aortic root
A B
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Operative Technique ( II )Operative Technique ( II )
Ascending aorta reduction plasty
Subcommissural annuloplasty
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Operation (2001-04-16)Operation (2001-04-16)
Hepatic vein ligation & clipping
Aortic root reconstruction
Subcommissural annuloplasty, reduction of sinus
& sinotubular junction by triangular resection
(Valve sizer 21mm in reduced sinotubular junction)
Ascending aorta reduction plasty
Atrioventricular valve repair
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Post-Op Chest X-ray Post-Op Chest X-ray
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Postoperative EchoCG Postoperative EchoCG
Aortic valve regurgitation Trivial
Atrioventricular valve regurgitation Trivial
Atrioventricular valve stenosis None
Ligated left hepatic vein Good ventricular contraction Good pulmonary venous inflow