RSVC to RPA - Classic Glenn (1950s)
-bidirectional Glenn = SVC to RPA w Q to both lungs
Classic BT Shunt- subclavian to PA, with loss of Q to the ipsilateral arm
Modified BT Shunt- R innominate to RPA w Gortex (usually 3.5mm)
Waterston Shunt- Asc Ao to RPA direct anastomosis- grows w pt, so no resistor, so much incr Qp w growth
Waterston Cooley- Asc Ao to RPA w Dacron or Gortex - allows for more resistance so less Qp w pt growth
Potts- LPA to Desc Ao - in pts w Eisenmenger syndrome- less likely to have parodoxical emboli to brain than a Waterston shunt
Mee (Cental) Shunt- MPA to Aorta (fr confluence of PAs) w prosthetic material or direct anastomosis
TGA Repair
Atrial Switch - switch w baffle at atria
-Mustard- uses artificial material (Dacron/Gortex)
-Senning- uses RA/LA wall instead of artificial material (harder to perform)
-xx = large atrial scar w IART
Arterial Switch
-switch the GAs
-able to be done now bc we move the coronaries...
-Lecompte Maneuver- PA is entirely anterior to Aorta (instead of LPA going underneath the Ao Arch)--> risk for prox PA branch stenosis
Yacoub- classification of coronaries in TGA
HLHS
Norwood- started Norwood procedure in 1982
-Neoaorta created
-separate pulm and systemic Q
-usually combine with a BT shunt or Sano/Brawn
Sano- RV to LPA
Brawn- RV to RPA
Hybrid- stent the PDA and band the PA
-advantage of Sano/Brawn- less hypoperfusion during diastole...
Damus Kaye Stansel
-direct anastomose of proximal PA to Asc Ao to ensure Q to Ao (for situation of Ao obstruction)
ddx fr Norwood- no Ao reconstruction, and here you put PA to side of Ao, not Ao to side of PA...
Glenn- SVC to PA
-bidirectional done currently (unidirectional done in past)
Fontan- SVC and IVC to PA - first done in 1968
-+/-extracardiac
- +/- fenestration
Pulmonary Atresia with VSD
-MAPCAs- Major Aorto Pulmonary Collateral Arteries- seen w pulm atresia/severe PS to supply Qp
-?enlarged bronchial arteries
-come fr Desc Ao usually, but also fr arch, subclavian, coronaries
-sometimes must grow the PA's before attaching them to a graft connecting PAs to the RV
-Contegra bovine jugular graft- use a jugular venous valve
Rastelli-
-(ddx Rastelli Classification of AV canal defects)
-Tx dTGA + VSD + PS
-tunnel LV to Ao with a baffle, closing the VSD, and place an RV to PA conduit
-xx- may have obstructed conduit, baffle leak, and later need conduit change as pt grows
Nikaidoh
-harvest Ao root fr RV (may move coronaries too), relieve LVOTO by dividing outlet septum and excising pulm vlv, and reconstruct LVOT, anastomose PA to RV, and Ao to LV... --> free Pulm regurg
-includes a Lacompte too
REV Procedure = Reparation a l'Etag VEntriculare
-Ao connect to LV via the VSD, like the rastelli
-remove conal septum, pulm trunk directly reimplant to RV w/o conduit, and do a Lacompte
--> avoid subAo stenosis, late ventric deterioration, and arrhythmia/sudden death
ccTGA
-might not do anything
-might do Double Switch- mustard/senning + arterial switch
Ross Procedure
-excise pulm valve and implant it as a neoaorta valve
-use RV-PA conduit for Qp
-must move coronaries to neoaorta...
Yasui
= Norwood-Rastelli
-Aortic Atresia/LVOTO with a VSD, but normal MV annulus size and normal LV size
-LV fx and size good enough for systemic circulation (is apex forming)
-Repair Aorta, and connect to PA w a DKS, then use an RV to PA conduit and close the VSD w a baffle
(ddx fr Sano bc here you get 2 ventricles)
Bentall Procedure
-indication- combined asc ao and ao vlv dz- ao aneurysm/dilation, AR, Ao dissection
-replace the asc ao and valve with a graft and replace the cor arts into the graft
-Alternative: Valve sparing root replacement- keep the Ao vlv
Konno
-Aortoventriculinfundibuloplasty
-used fro complex LVOTO
-initially used to tx severe subAo stenosis...
-originally a patch enlargement of LVOTO and RVOTO and insert mechanical Ao vlv prosthetic
-then = multilevel LVOTO espec if small Ao annulus
-Now- Modified Konno - make a VSD and then patch it to open the LVOTO; often done w a Ross for pts w Ao vlv severe stenosis
Warden
-for Partial Anom Pulm vn Return w R PVns to SVC near RA jct, along with a Superior Sinus Venosus ASD
-connect RA appendage to SVC to transect it and use it to baffle the SVC inflow to LA and then anast the SVC to the RA...