Surgical Management of Congenital Heart Disease II: Single Ventricle and Hypoplastic Left Heart Syndrome Aortic Arch Anomalies Septal Defects and Anomalies in Pulmonary Venous Return Anomalies of Thoracic Arteries and Veins A Video Manual

312 Pages·2015·14.57 MB·English

by  Viktor Hraška MD Ph.D.

Viktor Hraška · Peter Murín
Surgical Management
of Congenital
Heart Disease II
Single Ventricle and Hypoplastic Left Heart Syndrome
Aortic Arch Anomalies
Septal Defects and Anomalies in
Pulmonary Venous Return
Anomalies of Thoracic Arteries and Veins

A Video Manual
DVDROM
123
INCLUDED
Surgical Management of Congenital
Heart Disease II
Viktor Hraška · Peter Murín
Surgical Management
of Congenital Heart
Disease II
Single Ventricle and Hypoplastic Left Heart
Syndrome
Aortic Arch Anomalies
Septal Defects and Anomalies in Pulmonary Venous
Return
Anomalies of Thoracic Arteries and Veins
A Video Manual
1 3
Viktor Hraška, MD Ph.D. Peter Murín, MD
German Pediatric Heart German Pediatric Heart
Centre, Sankt Augustin Centre, Sankt Augustin
Department of Cardiac Surgery Department of Cardiac Surgery
Arnold Janssen Straße 29 Arnold Janssen Straße 29
53757 Sankt Augustin 53757 Sankt Augustin
Germany Germany
[email protected] [email protected]
ISBN 978-3-662-44069-8 ISBN 978-3-662-44070-4 (eBook)
DOI 10.1007/978-3-662-44070-4
Library of Congress Control Number: 2012932861
Springer Heidelberg Dordrecht London New York
© Springer-Verlag Berlin Heidelberg 2015
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Dedicated to the medical personnel at the Deutsches Kinderherzzentrum,
Sankt Augustin, Germany
Preface
Encouraged by the success of the first volume of the multimedia cardiac sur-
gical video manual, we have put a lot of effort into completing the second
volume, which includes the remaining operations carried out in patients with
congenital heart disease that were not dealt with in the previous volume. The
proven format of the first volume has been preserved. Each individual chapter
first addresses a specific surgical anatomy and indication for surgery; this is
followed by narrated video clips depicting the operative approach and tech-
nique. Recently, some aspects of perfusion and operative management have
been modified and refined. Therefore, some chapters, such as “Hypoplastic left
heart syndrome”, show the progress in different strategies of perfusion and
surgical management, with the aim of mirroring my current surgical practice.
I believe that the second volume will again be of benefit to all clinicians, rang-
ing from medical students and nurses to cardiologists and cardiac surgeons, in
other words, all those responsible for the care of children with congenital heart
diseases. It may also assist cardiac surgeons when dealing with rare defects,
such as pulmonary artery sling, biventricular management of hypoplastic left
heart complex, the Nikaidoh operation for the transposition of the great arteries
with pulmonary stenosis, and complete atrioventricular septal defect etc.
Viktor Hraška Sankt Augustin, Germany, 2014
VII
VIII V. Hraška, P. Murín
Acknowledgements
I am grateful to my coauthor, Peter Murín MD, for his assistance in all op-
erations and for editing the video clips. I am indebted to Christian Walter for
his technical support in processing the edited video clips. I wish to thank to
Prof. Boulos Asfour MD, not only for his support, but for his contribution
to the chapter “Atrial septal defect”, in which he elaborates his technique of
mini-invasive closure of an atrial septal defect. I would like to thank Elizabeth
Grundy for her help in preparing the manuscript. I thank our team of cardiac
surgeons, cardiologists, anaesthetists, intensivists, perfusionists, pediatricians,
scrub nurses and nurses who take care of our patients at the Deutsches Kinder-
herzzentrum Sankt Augustin. The last, but not least I thank Stiftung Deutsches
Kinderherzzentrum Sankt Augustin for sponsoring this project.
Viktor Hraška Sankt Augustin, Germany, 2014
Contents
1 Single Ventricle 1
◙ Introduction 2
◙ Anatomy 3
◙ Single Ventricle with DILV 3
◙ Single Ventricle with DIRV 4
◙ Single Ventricle with Mitral Atresia 5
◙ Single Ventricle with Tricuspid Atresia 5
◙ Single Ventricle with Unbalanced AV Canal Defect 6
◙ Single Ventricle with Heterotaxy Syndrome 6
◙ Other Single Ventricle 6
◙ Indication for Surgery 7
◙ Stage I Palliation – Initial Palliative Procedures
(Neonates & Infants < 4 Months Old) 7
◙ Stage II Palliation – Superior Cavopulmonary
Anastomosis (Infants 4–6 Months of Age) 8
◙ Stage III Palliation – The Total Cavopulmonary
Connection (Children >18 Months Age) 9
◙ Approach and Cardiopulmonary Bypass Strategy 10
◙ Initial Palliative Procedures without Cardiopulmonary Bypass 10
◙ Initial Palliative Procedures with Cardiopulmonary Bypass 10
◙ Physiologically Corrective Procedures 10
◙ Bidirectional Cavopulmonary Anastomosis without
Cannulation of the Superior Vena Cava 11
◙ Patient Characteristics 11
◙ Specific Steps of Surgery 11
◙ Bidirectional Cavopulmonary Anastomosis with Cannulation
of the Superior Vena Cava 16
◙ Patient Characteristics 16
◙ Specific Steps of Surgery 16
◙ Extracardiac Conduit with Fenestration 20
◙ Patient Characteristics 20
◙ Specific Steps of Surgery 21
◙ Extracardiac Conduit Connecting the Hepatic Veins with the Left
Pulmonary Artery in a Patient with Situs Inversus 26
◙ Patient Characteristics 26
◙ Specific Steps of Surgery 27
IX
X V. Hraška, P. Murín
◙ Decompression of the Thoracic Duct by Diverting the Innominate
Vein into the Right Atrium in a High-Risk Fontan Patient 32
◙ Patient Characteristics 32
◙ Specific Steps of Surgery 33
◙ Recommended References 36
2 Hypoplastic Left Heart Syndrome 39
◙ Introduction 40
◙ Anatomy 41
◙ Indication for Surgery 42
◙ Initial Procedures (Neonates) 42
◙ Approach and Cardiopulmonary Bypass Strategy 43
◙ Hybrid Procedure 43
◙ Norwood Stage I Palliation 43
◙ Norwood Stage I. Palliation with Double Aortic
Cannulation and Whole Body Perfusion 44
◙ Patient Characteristics 44
◙ Specific Steps of Surgery 45
◙ Double Barrel Damus-Kaye-Stansel Anastomosis with Reconstruction
of the Aortic Arch and Modified Blalock-Taussig Shunt 50
◙ Patient Characteristics 50
◙ Specific Steps of Surgery 51
◙ Norwood Stage I. Palliation After Bilateral Pulmonary
Artery Banding – Staged Approach 58
◙ Patient Characteristics 58
◙ Specific Steps of Surgery 59
◙ Biventricular Repair – The First Stage: Norwood Stage I. Palliation with
Sano Shunt and Enlargement of the Ventricular Septal Defect 66
◙ Patient Characteristics 66
◙ Specific Steps of Surgery 66
◙ Biventricular Repair – The Second Stage: Intraventricular Rerouting of the Left Ventricle
to the Systemic Outflow and the Right Ventricle to the Pulmonary Artery Conduit 72
◙ Patient Characteristics 72
◙ Specific Steps of Surgery 73
◙ Recommended References 78
3 Coarctation of the Aorta 81
◙ Introduction 82
◙ Anatomy 83
◙ Indication for Surgery 84
Contents XI
◙ Neonates 84
◙ Infants 86
◙ Childhood and Adolescence 86
◙ Re-Coarctation 86
◙ Management Consideration – Controversy 87
◙ Approach and Cardiopulmonary Bypass Strategy 88
◙ Resection of Aortic Coarctation and Extended End-to-End Anastomosis 90
◙ Patient Characteristics 90
◙ Specific Steps of Surgery 90
◙ Resection of Aortic Coarctation and End-to-Side Anastomosis
Through a Median Sternotomy 95
◙ Patient Characteristics 95
◙ Specific Steps of Surgery 95
◙ Resection of a Stented Isthmus of the Aorta and Reconstruction of the Aortic
Arch with Partial End-to-End Anastomosis and Pericardial Patch Plasty 100
◙ Patient Characteristics 100
◙ Specific Steps of Surgery 101
◙ Resection of a Stented Isthmus of the Aorta and Reconstruction
of the Aortic Arch by Pericardial Patch Plasty 105
◙ Patient Characteristics 105
◙ Specific Steps of Surgery 106
◙ Reimplantation of the Right Aberrant Subclavian Artery into the Right
Carotid Artery; Resection of the Stented Coarctation and End-to-End
Anastomosis; Patch Closure of the Ventricular Septal Defect 108
◙ Patient Characteristics 108
◙ Specific Steps of Surgery 109
◙ Extra-Anatomical Jump Graft Between the Ascending and
Descending Aorta, Using a 18 mm Ø Prosthesis 112
◙ Patient Characteristics 112
◙ Specific Steps of Surgery 113
◙ Recommended References 116
4 Interruption of the Aortic Arch 119
◙ Introduction 120
◙ Anatomy 120
◙ Indication for Surgery 121
◙ Approach and Cardiopulmonary Bypass Strategy 122
◙ Aortic Arch Reconstruction by Subclavian Flap and Pericardial Patch
Plasty in a Patient with an Interrupted Aortic Arch Type B 123
◙ Patient Characteristics 123
◙ Specific Steps of Surgery 124