Heart defects and surgical repairs

Transposition of the great arteries (D-type)

the aorta and pulmonary artery artery are connected to the wrong ventricles. Ao and PA will arise parallel to each other. May have a PDA, ASD, and/or VSD.

Most common associated defect with TGA D type

anomalous coronary arteries 33%

Transposition of the great arteries (L-TGA) or corrected

The aorta and pulmonary artery are transposed and the right and left ventricles are inverted.

Associated conditions with L-TGA

• VSD (70-80%)

• pulmonary stenosis

• abnormal TV

Jatene procedure (arterial switch)

• The preferred surgical procedure for DTGA.

• usually performed within the first 2 weeks

• switches the AO and PA into their normal position and moving the coronaries to the new aorta.

Mustard and senning procedures (artrial switch)

• intra-aterial surgical repair used in the treatment of DTGA before the Jatene procedure.

• both operations involve creating a baffle within the atria to redirect blood.

Double switch procedure

• For patients with LTGA

• If pulmonary stenosis is not present, then you can so the atrial and arterial switch

• is pulmonary stenosis is present then the arterial switch cannot be performed but rather an atrial switch and a Rastelli conduit.

coarctation of the aorta

• narrowing of the proximal portion portion of the descending

Coarctation the aorta surgical correction

• resection with end-to-end anastomosis

• synthetic patch aortoplasty

• left subclavian artery patch

Tricuspid atresia surgical repair

• BT shunt

  • usually performed at 4-6 weeks

  • a systemic venous-to-pulmonary connection is established from the BA or RSA to the RPA through a homograft conduit.

• Glenn procedure

  • usually performed at 4-6 months as a bridge to fontan completion

  • BT shunt will be disconnected from the RPA and removed

  • SVC is connected to the RPA

• Fontan procedure

  • usually performed at 2-3yrs

  • ivc connected to the RPA

  • ASD is closed

Truncus Arteriosus

• A single great artery with a common trunk overriding a large VSD

• The Ao and PV are fused into a large semilunar valve with multiple leaflets called the truncal valve

Type 1 truncus arteriosus

a single pulmonary trunk arises from the common arterial trunk, with left and right pulmonary arteries originating from the pulmonary trunk.

Type 2 truncus arteriosus

• The left and right pulmonary arteries arise separately form the posterior portion of the common arterial trunk in close proximity to one another.

• A right aortic arch is common.

Type 3 truncus arteriosus

• The left and right pulmonary arteries arise as separated vessels from the common trunk.

• This type is generally considered to be a form of Pulmonary Atresia with VSD or TOF.