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BIRD’S EYE VIEW OF PEDIATRIC CARDIAC SURGERY

BIRD’S EYE VIEW OF PEDIATRIC CARDIAC SURGERY. Dr Roy Varghese Consultant - Pediatric Cardiac Surgery. Tributes. Alfred Blalock - 1945. C Walton Lillehei - 1955. Classification of Lesions. Shunt Lesions Left Ventricular Outflow Tract Obstructions

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BIRD’S EYE VIEW OF PEDIATRIC CARDIAC SURGERY

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  1. BIRD’S EYE VIEW OF PEDIATRIC CARDIAC SURGERY Dr Roy Varghese Consultant - Pediatric Cardiac Surgery ICVD. Chennai

  2. Tributes Alfred Blalock - 1945 C Walton Lillehei - 1955 ICVD. Chennai

  3. Classification of Lesions • Shunt Lesions • Left Ventricular Outflow Tract Obstructions • Right Ventricular Outflow Tract Obstructions • Single Ventricle Lesions • Other Lesions ICVD. Chennai

  4. Normal Anatomy ICVD. Chennai

  5. Patent Ductus Arteriosus ICVD. Chennai

  6. PDA Physiology Blood flows from the aorta across the duct into the pulmonary arteries resulting in increased pulmonary blood flow ICVD. Chennai

  7. PDA Repaired PDA ligated via left thoracotomy ICVD. Chennai

  8. Atrial Septal Defect ICVD. Chennai

  9. Atrial Septal Defect Physiology Enlarged pulmonary artery with increased pulmonary blood flow Oxygen rich blood flows across ASD from left atrium into the right atrium Enlarged right ventricle ICVD. Chennai

  10. Atrial Septal Defect Repaired Patch sewn over ASD ICVD. Chennai

  11. Ventricular Septal Defect ICVD. Chennai

  12. Ventricular Septal Defect Oxygen rich blood flows across the VSD from the left ventricle to the right ventricle and out the pulmonary artery resulting in increased pulmonary blood flow ICVD. Chennai

  13. VSD Repaired Patch sewn across VSD ICVD. Chennai

  14. AVSD - Anatomy ICVD. Chennai

  15. AVSD - Physiology Balance between the two ventricles ICVD. Chennai

  16. AVSD - Repaired ICVD. Chennai

  17. Truncus Arteriosus - Anatomy ICVD. Chennai

  18. Truncus Arteriosus - Physiology Single truncal valve gets blood from both ventricles Proportion of aortic and pulmonary artery blood flow is dependent on the vascular resistance in the respective vascular beds ICVD. Chennai

  19. Truncus Arteriosus - Repaired Pulmonary arteries Conduit (+/- valve) between right ventricle and main pulmonary artery Patch hood from right ventricle to conduit ICVD. Chennai

  20. Truncus Arteriosus - Repaired ICVD. Chennai

  21. Tetralogy of Fallot - Anatomy 3. Aortic override 2. Subpulmonary stenosis 1. VSD 4. Right ventricular hypertrophy ICVD. Chennai

  22. Tetralogy of Fallot - Physiology Infundibular spasm causes more blood from the right ventricle to be shunted into the aorta leading to increasing desaturation ICVD. Chennai

  23. Trans atrial approach to VSD & RVOT ICVD. Chennai

  24. VSD Closure ICVD. Chennai

  25. Tetralogy of Fallot - Repaired VSD closed with patch Infundibular stenosis resected ICVD. Chennai

  26. Tetralogy of Fallot - Repaired Transannular patch ICVD. Chennai

  27. Transposition of great arteries- Anatomy ICVD. Chennai

  28. TGA - Physiology Two circuits in parallel: the only mixing occurs at the level of the PDA/PFO/VSD ICVD. Chennai

  29. TGA – Arterial Switch Operation ICVD. Chennai

  30. TGA – Arterial Switch Operation ICVD. Chennai

  31. TGA – The ‘French’ Manoeuvre ICVD. Chennai

  32. TGA - Repaired ICVD. Chennai

  33. TGA - Repaired ICVD. Chennai

  34. Single Ventricle Lesions • Tricuspid Atresia • Hypoplastic Left Heart Syndrome • Double inlet left ventricle • Indeterminate morphology ICVD. Chennai

  35. Single Ventricle - Physiology ICVD. Chennai

  36. Single ventricle with increased pulmonary blood flow • Pulmonary artery banding ICVD. Chennai

  37. Hypoplastic left heart syndrome ICVD. Chennai

  38. Stage I Norwood operation ICVD. Chennai

  39. Bi-Directional Glenn ICVD. Chennai

  40. Bi-Directional Glenn ICVD. Chennai

  41. Fontan Operation ICVD. Chennai

  42. Advances in congenital cardiac surgery • Minimally invasive surgery • Hybrid surgical procedures • Pharmacological adjuncts ICVD. Chennai

  43. Minimally invasive procedures Surgical expertise Safety/ Results Cosmetic incisions Patient awareness Peer pressure ICVD. Chennai

  44. Correction of “simple” anomalies • Atrial septal defects • Ventricular septal defects • Partial atrioventricular defects • Patent ductus arteriosus ICVD. Chennai

  45. Anterior Thoracotomy Posterior Upper Mini sternotomy Lower VATS ICVD. Chennai

  46. Anterior thoracotomy Advantages: Ease of approach to RA Submammary incision Less keloid ICVD. Chennai

  47. Anterior thoracotomy Disadvantages: Breast development (pre pubertal) Areolar Hypo/hyperaesthesia ICVD. Chennai

  48. Posterior thoracotomy Advantages: Ease of approach – aorta Breast development No keloid ICVD. Chennai

  49. Posterior thoracotomy Disadvantages: Approach – RA in older pts Operative accidents (?) Air embolism ICVD. Chennai

  50. Mini sternotomy • Advantages: Cosmesis • Disadvantages: Poor access to PDA, LSVC, PAPVC ICVD. Chennai

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