Single Ventricle Physiology

Single Ventricle Physiology Spectrum of Management from Birth to Surgery Dr. J. Burzynski Division of Pediatric Critical Care University of Iowa

At the end of the talk you should be able to… ,[object Object],[object Object],[object Object],[object Object]

3 main ways babies present with congenital heart disease… ,[object Object],[object Object],[object Object],[object Object]

Anatomic variants of the single ventricle: ,[object Object],[object Object],[object Object]

Examples of systemic outflow obstruction… ,[object Object],[object Object],[object Object],[object Object],[object Object],Among others!

Lesions with obstruction to pulmonary blood flow… ,[object Object],[object Object],[object Object],[object Object]

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Key feature for presentation and management decisions is: ,[object Object],[object Object],[object Object]

The importance of the atrial septum… ,[object Object],[object Object],[object Object],[object Object]

Hypoplastic left heart syndrome (HLHS) 1 - patent foramen ovale 2 - pinched aorta 3 - patent ductus arteriosus 4 - narrowed aorta 5 - hypoplastic left ventricle 6 - aortic atresia Complete mixing at atrial level through PFO

Interrupted aortic arch 1 - interruption of aortic arch 2 - descending aorta connected to pulmonary artery by large patent ductus arteriosus 3 - ventricular septal defect

Systemic outflow obstruction lesions cont’d… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Keys to adequate resuscitation… ,[object Object],[object Object],[object Object],[object Object]

Resuscitation cont’d… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Resuscitation cont’d… ,[object Object],[object Object],[object Object],Transfer to appropriate ICU!

Pre-operative ICU management ,[object Object],[object Object],[object Object],[object Object],[object Object]

Pre-operative circulatory management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],Mixed venous oxygen saturation Pulmonary venous saturation [Assuming that SpvO2 = 95% (probably close to true in pre-op but NOT post-op care]

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Managing Qp ,[object Object],[object Object],[object Object]

Therapeutic interventions… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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The systemic circulation… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Other systems… ,[object Object],[object Object],[object Object]

Surgical management… ,[object Object],[object Object],[object Object],[object Object]

Options: ,[object Object],[object Object],[object Object],[object Object]

Sano modification: ,[object Object],[object Object],[object Object],[object Object]

Sano shunt with augmented aortic arch Beginning of arch augmentation

Sano modification cont’d… ,[object Object],[object Object]

Hybrid procedures… ,[object Object],[object Object],[object Object]

Post-operative management… ,[object Object],[object Object],[object Object]

Post-operative management cont’d… ,[object Object],[object Object],[object Object]

Summary… ,[object Object],[object Object],[object Object]

Single Ventricle Physiology

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Single Ventricle Physiology