Surgery for Congenital Heart Disease Z.C. Weng, CMCVGH Principal Groups of CHD l Acyanotic CHD...

Surgery for Congenital Heart DiseaseSurgery for Congenital Heart Disease

Z.C. Weng, CMCVGHZ.C. Weng, CMCVGH

Principal Groups of CHDPrincipal Groups of CHD

Acyanotic CHDAcyanotic CHD

L't-to-R't shunt groupL't-to-R't shunt group

Obstruction group Obstruction group

Cyanotic CHD Cyanotic CHD

Obstruction group Obstruction group

Venous mixture groupVenous mixture group



Three Basic Lesions of CHDThree Basic Lesions of CHD

DefectDefect e.g. : ASD , VSDe.g. : ASD , VSD ObstructionObstruction e.g. : AS , PSe.g. : AS , PS Congenital malformation (TransposCongenital malformation (Transpos

ition ,Hypoplasia) ition ,Hypoplasia) e.g. : TGA e.g. : TGA , , HLHSHLHS



Acyanotic CHD c L't-to-R't ShuntAcyanotic CHD c L't-to-R't Shunt

ASD (ASD (atrial septal defectatrial septal defect)) VSD (VSD (ventricular septal defectventricular septal defect)) CAVC (CAVC (Complete Atrioventricular Complete Atrioventricular

Canal )Canal )

PDA (PDA (patent ductus arteriosuspatent ductus arteriosus))



Acyanotic CHD c ObstructionAcyanotic CHD c Obstruction

CoA (CoA (Coarctation of AortaCoarctation of Aorta)) Congenital AS (Congenital AS (Aortic StenosisAortic Stenosis)) Congenital PS (Congenital PS (Pulmonary StenosisPulmonary Stenosis))



Cyanotic CHD c Obstruction Cyanotic CHD c Obstruction

ToF (Tetralogy of Fallot)ToF (Tetralogy of Fallot) Tricuspid AtresiaTricuspid Atresia Ebstein's anomalyEbstein's anomaly



Cyanotic CHD c Venous Mixture Cyanotic CHD c Venous Mixture

TAPVRTAPVR ( (Tatal anomalous pulmonary venous ReturnTatal anomalous pulmonary venous Return)) Truncus ArteriosusTruncus Arteriosus TGATGA (Transposition of Great Artery)(Transposition of Great Artery)

HLHSHLHS (Hypoplastic Left Heart Syndrome)(Hypoplastic Left Heart Syndrome)

Single Ventricle VariantsSingle Ventricle Variants Common AtriumCommon Atrium



Acyanotic CHD c L-to-R ShuntAcyanotic CHD c L-to-R Shunt

e.g. : ASD ,VSD ,CACV ,PDAe.g. : ASD ,VSD ,CACV ,PDA Main lesion : Defect Main lesion : Defect Pulmonary blood flow Pulmonary blood flow Ventricular volume load Ventricular volume load



Acyanotic CHD c Obstruction Acyanotic CHD c Obstruction

e.g. : e.g. : CoA , AS , PSCoA , AS , PS Main lesion : ObstructionMain lesion : Obstruction Ventricular Pressure Load Ventricular Pressure Load



Cyanotic CHD c ObstructionCyanotic CHD c Obstruction

e.g.: ToF , Tricuspid atresia , e.g.: ToF , Tricuspid atresia ,

Ebstein's anomalyEbstein's anomaly Main lesion : ObstructionMain lesion : Obstruction Associated lesion : DefectAssociated lesion : Defect Pulmonary Blood Flow Pulmonary Blood Flow



Cyanotic CHD c Venous Mixture Cyanotic CHD c Venous Mixture e.g.: TGA , TAPVR , Truncus Arteriosus, e.g.: TGA , TAPVR , Truncus Arteriosus,

Common Atrium , Single V. ,HLHSCommon Atrium , Single V. ,HLHS Main lesion: Congenital Malformation Main lesion: Congenital Malformation

(Transposition , Hypoplasia) (Transposition , Hypoplasia) Associated lesion:Defect and/or obstructionAssociated lesion:Defect and/or obstruction Pulmonary Blood Flow Pulmonary Blood Flow Ventricular volume load Ventricular volume load



Palliative Surgery ( I )Palliative Surgery ( I )

Pulmonary Blood Flow Pulmonary Blood Flow PA Banding PA Banding

Pulmonary Blood FlowPulmonary Blood Flow Blalock-Taussig shunt (Modified or Classical) Blalock-Taussig shunt (Modified or Classical)

Waterston shunt Waterston shunt Pott's shunt Pott's shunt Central shuntCentral shunt



Palliative Surgery ( II )Palliative Surgery ( II )

Venous Mixing Venous Mixing Blalock-Hanlon shuntBlalock-Hanlon shunt Balloon Atrial SeptostomyBalloon Atrial Septostomy Blade Atrial Septectomy Blade Atrial Septectomy



Closed Heart Surgery Closed Heart Surgery

PDA ( ligation or division )PDA ( ligation or division ) CoA repairCoA repair Interrupted Aorta repair Interrupted Aorta repair Pulmonary ValvotomyPulmonary Valvotomy

(Brock Procedure)(Brock Procedure)



Open Heart Surgery Open Heart Surgery

1953, Dr. Gibbon in USA1953, Dr. Gibbon in USA Cardiopulmonary bypass support Cardiopulmonary bypass support Intracardiac repair of ASD under Intracardiac repair of ASD under

direct vision direct vision



Acyanotic CHD c Shunt Acyanotic CHD c Shunt Indications of SurgeryIndications of Surgery Failure to thrive Failure to thrive Congestive heart failureCongestive heart failure Qp/Qs >1.5 Qp/Qs >1.5 Progressive Pulmonary vascular change Progressive Pulmonary vascular change Timing of Surgery Timing of Surgery At any age At any age Prevent Eisenmenger's complex Prevent Eisenmenger's complex Perimembranous VSD variedPerimembranous VSD varied (30% spontaneous closure)(30% spontaneous closure)



Acyanotic CHD c ObstructionAcyanotic CHD c Obstruction

Indications of Surgery Indications of Surgery

Pressure gradient > 50mmHg Pressure gradient > 50mmHg

Progressive heart failure Progressive heart failure Timing of Surgery Timing of Surgery

At any age At any age

Mostly during infancyMostly during infancy



Cyanotic CHD c Obstruction Cyanotic CHD c Obstruction


Symptoms and signs Symptoms and signs

Depends on size of PA Depends on size of PA Timing of Surgery Timing of Surgery

Primary repair during infancy Primary repair during infancy

Staged repair before school age Staged repair before school age



Cyanotic CHD c Venous Mixture Cyanotic CHD c Venous Mixture


Failure to thrive Failure to thrive

Varied in single ventricle variantsVaried in single ventricle variants Timing of Surgery Timing of Surgery

Primary repair during infancy Primary repair during infancy

Staged repair before school age Staged repair before school age

Surgery for Congenital Heart Disease Z.C. Weng, CMCVGH Principal Groups of CHD l Acyanotic CHD...

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