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Peds Surgery

defects/procedures

DefectProcedureDetailsKey Feature
d-transposition (of the great vessels) and DORV with pulmonary stenosis Damus-Kaye-Stansel Procedure anastomosing the PA to the Ao • VSD is repaired • P. flow is reestablished by graft from subcl. artery or thoracic aorta PA to the Ao
d-transposition Great Artery Switch • The aorta and pulmonary artery are transected above the valve and coronary arteries • The appropriate vessel is attached to the existing stump transected above the coronary arteries
Tricuspid Atresia/Tetralogy Glenn Anastomosis • Procedure used to divert flow from SVC to Right PA • Classic Procedure attaches SVC to Right PA • Bidirectional Procedure connects SVC to the MAIN PA for bidirectional flow 2 procedures: Classic and Bidirectional
Tetralogy of Fallot Blalock-Taussig Anastomosis Attaches Right Subclavian artery to Right Pulmonary Artery creating a permanent ductus arteriosus Creates permanent DA
Coarctation Two types of repair: 1)End to end: Used in older children 2)Subclavian Flap Procedure:Used in young children/infants 1)End to end:Area of narrowing is resected and the two ends are sewn together 2)Subclavian Flap Procedure: Subclavian Artery is ligated and sewn over coarct creating a live tissue graft 2 types: End to end & Subclavian Flap
ASD Blalock-Hanlon Atrial Septostomy Surgical creation of an ASD via a RIGHT THORACOTOMY creation of an ASD
• Persistent truncus arteriosus • DORV • D-transposition with VSD Rastelli Procedure Consists of: • An external conduit from RV to pulmonary artery and • An internal conduit from LV to aorta external & internal conduits
hypoplasia of aortic annulus or tunnel subaortic obstruction Konno Procedure (Konno-Rastan) • Widening of the LVOT with an incision that creates enlargement of the aortic root • Incision of aortic annulus with AVR (aortic valve replacement) Widening the LVOT
d-transposition and DORV Mustard/Senning Operation Atrial septum is excised and atria are redirected: • Systemic venous return to MV and LV • Pulmonary venous return to TV and RV IAS is excised
mitral stenosis Balloon Valvulotomy Catheter used across ASD then placed in MV orifice. Balloon is inflated, splitting the valve along the commissures without causing traumatic damage to valve leaflet balloon placed in MV
hypoplastic left heart syndrome Norwood Procedure Done in 3 stages: • Stage I: new aorta made using PA with Blalock-Taussig shunt and creation of ASD • Stage II: Glenn anastomosis made. Blalock-Taussig shunt ligated and SVC is anastomosed to PA • Stage III: IVC is diverted to the PA w/ atrial tunnel 3 stages
Tricuspid Atresia/Single Ventricle/Tetralogy of Fallot Fontan Procedure • Separates RV from rest of the heart with GoreTex baffle • SVC and IVC flow into the RA. The right atrial appendage is attached to the PA and pulmonary artery is oversewn (sewn shunt) • NOTE: Stage I uses Glenn Anastomosis first GoreTex baffle
Small ASD single suture • Most repairs done in the first 5 years of life • Some require open heart; others are done via the cath lab • Post-op echo – look for any flow across repair first 5 years
Larger ASD Patch of pericardium or prosthetic material • Most repairs done in the first 5 years of life • Some require open heart; others are done via the cath lab • Post-op echo – look for any flow across repair first 5 years
Created by: lefut
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