Chd surgical procedure

1. OPERATIONS OF CONGENITAL HEART DISEASE
SUBJECT: PHYSIOTHERAPY IN
CARDIOPULMONARY CONDITIONS (BPT 402)
SUBMITTED TO: DR. JAMAL MOIZ
SUBMITTED BY: MEHPARA KHAN
BPT 4TH YEAR
JAMIA MILLIA ISLAMIA
Centre for Physiotherapy and Rehabilitation Sciences
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3. INTRODUCTION
Operations for congenital heart disease may be classified as palliative,
reparative or corrective with respect to the goals of treatment (i.e.,
obtaining normal heart function or relieving the symptoms of the heart
disease).
PALLIATIVE OPERATION
• A palliative operation does not correct but is required to improve an
abnormal heart function, minimizing the disorder, usually in children too
young for corrective surgery.
• The aim is to lessen cyanosis, control heart failure or prepare the
circulation for later correction when the baby grows up to an age and body
weight that are suitable for the available techniques.
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4. I. AORTOPULMONARY SHUNT
• It will benefit any patient with pulmonary obstruction, which usually presents
as cyanosis, dyspnea.
Blalock-Taussig’s shunt
• The classic Blalock-Taussig’s shunt is a direct anastomosis between the
transected subclavian artery (or the innominate artery) and the pulmonary
artery. It does not require the use of prosthetic material and offers the
theoretical possibility for growth but requires extensive surgical dissection and
sacrifices the subclavian artery
• This technique is rarely used.
MODIFIED BLALOCK –TAUSSIG SHUNT (MBT SHUNT)
• It consists of interposition of a polytetrafluroethelene tube graft betweem the
subclavian and right or left pumonary artery.
• It is most commonly performed shunt procedure.
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6. II. PULMONARY ARTETY BANDING
• Nowadays, pulmonary artery banding remains the preferred method of
palliation in children born with cardiac defects characterized by left-to-right
shunting and pulmonary over circulation. This technique has been
broadened to treat congestive heart failure caused by large ventricular septal
defects, atrioventricular canal defects and tricuspid atresia
• It reduces the pulmonary blood flow and pressure protecting the pulmonary
vasculature, aiming to avoid progression to irreversible pulmonary vascular
disease.
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7. CORRECTIVE SURGERY
Patent ductus arteriosus (PDA) ligation:
• Sometimes the PDA can be closed with a procedure that does not involve surgery.
The procedure is most often done in a laboratory that uses x-rays.
• In this procedure, the surgeon makes a small cut in the groin. A wire and tube called
a catheter is inserted into an artery in the leg and passed it up to the heart. Then, a
small metal coil or another device is passed through the catheter into the infant's
ductus arteriosus artery. The coil or other device blocks the blood flow, and this
corrects the problem.
• Another method is to make a small surgical cut on the left side of the chest. The
surgeon finds the PDA and then ties off or clips the ductus arteriosus, or divides and
cuts it. Tying off the ductus arteriosus is called ligation. This procedure may be
done in the neonatal intensive care unit (NICU).
• We prefer to doubly clamp the structure, in order to be sure of permanent closure.
• Simple ligation is limited to the very sick premature infant when speed during
recovery is mandatory.
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8. Coarctation of the aorta repair:
• To repair this defect, a cut is most often made on the left side of the
chest, between the ribs. There are several ways to repair coarctation of
the aorta.
• The most common way to repair it is to cut the narrow section and
make it bigger with a patch made of Gore-tex, a man-made (synthetic)
material.
• Another way to repair this problem is to remove the narrow section of
the aorta and stitch the remaining ends together. This can most often be
done in older children.
• A third way to repair this problem is called a subclavian flap. First, a
cut is made in the narrow part of the aorta. Then, a patch is taken from
the left subclavian artery (the artery to the arm) to enlarge the narrow
section of the aorta.
• A fourth way to repair the problem is to connect a tube to the normal
sections of the aorta, on either side of the narrow section. Blood flows
through the tube and bypasses the narrow section.
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9. • BALLOON ANGIOPLASTY
A newer method does not require surgery. A small wire is placed through an
artery in the groin and up to the aorta. A small balloon is then opened up in
the narrow area. A stent or small tube is left there to help keep the artery
open. The procedure is done in a laboratory with x-rays. This procedure is
often used when the coarctation reoccurs after it has been fixed.
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10. ASD repair:
• Sometimes, an ASD can be closed without open-heart surgery.
• First, the surgeon makes a tiny cut in the groin. Then the surgeon inserts a wire
into a blood vessel that goes to the heart. Next, two small umbrella-shaped
"clamshell" devices are placed on the right and left sides of the septum. These
two devices are attached to each other. This closes the hole in the heart.
• Open-heart surgery may also be done to repair ASD/VSD. In this operation, the
defect can usually be closed working through the right atrium and using primary
sutures to approximate the margins of the defect.
• Occasionally, in the presence of multiple atrial defects or with partial anomalous
pulmonary venous drainage, a patch of dacron material may facilitate the
closure.
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12. Vsd repair:
• Surgery is often mandatory for small babies with single/multiple ventricular
septal defects, or defects with serious associated anomalies.
• In these conditions, the pulmonary artery is usually banned. A thin tape of
synthetic material is passed around the proximal portion of the main pulmonary
artery, and this vessel is slowly constricted until pulmonary artery pressure
beyond the band is reduced to about one-half systemic pressure.
• Postoperatively these infants grow and develop normally and become
candidates for corrective surgery later on. At this time, ventricular septal defect
is closed and the band is removed.
• Elective surgery for the older asymptomatic child is indicated when pulmonary
blood flow caused by VSD is twice that of systemic blood flow.
• Patch closure of the defect is carried out with cardiopulmonary bypass and mild
hypothermia(32C).
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13. Tetralogy of Fallot repair:
Once TOF is recognized in any patient, surgical repair is indicated.
Obstruction of blood flow in the region of the right ventricular outflow tract is
progressive, and these children may develop life-threatening peripheral
cyanosis.
The surgery involves:
-Closing the ventricular septal defect with a patch.
-Opening the pulmonary valve and removing the thickened muscle (stenosis).
-Placing a patch on the right ventricle and main pulmonary artery to improve
blood flow to the lungs.
• The child may have a shunt procedure done first. A shunt moves blood from
one area to another. This is done if the open-heart surgery needs to be delayed
because the child is too sick to go through surgery.
• Once the child is older, the shunt is closed and the main repair in the heart is
performed.
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14. Transposition of the great vessels repair:
• In a normal heart, the aorta comes from the left side of the heart, and the
pulmonary artery comes from the right side. In transposition of the great
vessels, these arteries come from the opposite sides of the heart. The child may
also have other birth defects.
• Correcting transposition of the great vessels requires open-heart surgery. If
possible, this surgery is done shortly after birth.
• The most common repair is called an arterial switch. The aorta and pulmonary
artery are divided. The pulmonary artery is connected to the right ventricle,
where it belongs. Then, the aorta and coronary arteries are connected to the left
ventricle, where they belong.
• Before the surgery is performed, a drug called prostaglandin will be given to
keep the ductus arteriosus open to improve circulation. Another temporary
procedure that can help mixing of the blood is a balloon atrial septostomy,
which puts a hole or opening between the left and right atria. This is a
temporary measure until the child is old enough for surgery to establish normal
blood circulation.
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15. References:
• Yuan, S.-M., & Jing, H. (2009). Palliative procedures for
congenital heart defects. Archives of Cardiovascular Diseases,
• Friedberg, D. Z., & Litwin, S. B. (1976). Cardiology Review :
The Medical and Surgical Management of Patients with
Congenital Heart Disease. Clinical Pediatrics,
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