If you've had a heart attack, you may have already had certain procedures to help you survive your heart attack and diagnose your condition. For example, many heart attack patients have undergone thrombolysis, a procedure that involves injecting a clot-dissolving agent to restore blood flow in a coronary artery.

1. TYPES OF CARDIAC SURGERIES
ATRENDYNUSRE

2. INTRODUCTION
Congenital heart defects are heart
problems that develop before birth.
They can occur in the heart's
chambers, valves or blood vessels.
A baby may be born with only one
defect or with several defects. Of
the dozens of heart defects, some
are mild and may need little or no
medical treatment even through
adulthood. Other types of
congenital heart defects are life-
threatening, either immediately to
the newborn or over time.

3. PATENT DUCTUS ARTERIOSUS (PDA)
 Before birth, a blood vessel called the ductus
arteriosus connects the pulmonary artery — the
artery carrying blood to your lungs — and the
aorta, the large artery that carries blood away
from the heart.
Before a baby is born, the ductus arteriosus
allows blood to bypass the lungs because the
baby receives oxygen through the placenta and
umbilical cord.
The ductus arteriosus normally closes within
soon after birth. If the ductus arteriosus remains
open (patent), some blood that should flow
through the body goes to the lungs.

4. PATENT DUCTUS ARTERIOSUS (PDA)
MEDICAL MANAGEMENT:
Intravenous (IV) indomethacin (or the newer
preparation of IV ibuprofen) is frequently
effective in closing a patent ductus arteriosus
(PDA) if it is administered in the first 10-14
days of life. Other options are catheter closure
(Cardiac Catheterization) and surgical ligation,
which entails a thoracotomy

5. • Sometimes the PDA can be closed with a
procedure that does not involve surgery. The
procedure is usually done in a laboratory that
uses x-rays. In this procedure, the surgeon inserts
a wire into an artery in the leg and passes it up to
the heart. There are no cuts, except for a tiny
hole in the groin. Then, a small metal coil or
another device is passed through the wire into
the infant's arteriosus artery. The coil or other
device blocks the blood flow, and this corrects the
problem.
PATENT DUCTUS ARTERIOSUS (PDA)

6. 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).
PATENT DUCTUS ARTERIOSUS (PDA)
LIGATION

7. PATENT DUCTUS ARTERIOSUS (PDA)
LIGATION Surgical Ligation

8. VENTRICULAR SEPTAL DEFECT

9. • Sometimes called a hole in the heart, this
defect — the most common congenital heart
defect — occurs when the muscular wall
(septum) separating the bottom chambers of
the heart (right and left ventricles) doesn't
fully form.
VENTRICULAR SEPTAL DEFECT

10. • By age 1, most small VSDs close on their own.
However, those VSDs that do stay open after this
age must be closed.
• Some septal defects can be closed without
surgery. The procedure involves passing a small
wire into the heart and placing a patch over the
defect. The surgeon is guided by x-rays.
• Larger VSDs, small ones in certain parts of the
ventricular septum, or ones that cause heart
failure or endocarditis (inflammation) need open-
heart surgery. The hole in the septum is usually
closed with a patch(Dacron /PTFE)
VENTRICULAR SEPTAL DEFECT

11. ATRIAL SEPTAL DEFECT

12. • Atrial septal defect is a hole that occurs when
the muscular wall (septum) separating the top
two chambers of the heart (right and left
atria) doesn't close properly.
• Minor cases may cause no symptoms and may
not require treatment. Larger defects may
require surgery or cardiac catheterization to
repair the hole.
ATRIAL SEPTAL DEFECT

13. • Cardiac Catheterization :
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. Using open-heart surgery, the septum can
be closed using stitches. Another way to cover
the hole is with a patch ( Pericardium)
ATRIAL SEPTAL DEFECT

14. PULMONARY VALVE STENOSIS

15. PULMONARY VALVE STENOSIS
• In this condition, blood flow from one of the
heart's bottom chambers, the right ventricle, to
the pulmonary artery is slowed by narrowing at
the pulmonary valve.
• Pulmonary valve stenosis may occur along with
other defects, such as thickening of the muscle of
the right ventricle below the valve.
• In many cases, pulmonary valve stenosis is mild
and doesn't require treatment. But because it can
cause heart failure, arrhythmias or enlargement
of the right heart chambers, it may be necessary
to correct the defect.
• In many cases, a balloon (pulmonary
valvuloplasty) opens the narrowed valve.

16. • Occasionally, balloon valvuloplasty is not successful. These
patients tend to have valvular dysplasia
( developmental abnormality) eg, Noonan syndrome
(relatively common autosomal dominant congenital
disorder that affects both males and females equally) or a
hypoplastic pulmonic valve annulus and, therefore, may
require surgical valvotomy ( replace the diseased valve
with an artificial valve).
• Pulmonary artery balloon angioplasty with or without
placement of an expandable metal stent can be used to
treat supravalvular PS.
• Expandable metal stents can overcome an obstruction
successfully; however, the need for stent re-expansion as
the individual grows remains problematic.
PULMONARY VALVE STENOSIS

17. AORTIC STENOSIS

18. • Aortic stenosis is a defect that narrows or blocks
the aortic valve opening, making it difficult for
the heart to pump blood into the aorta — the
main artery leading away from the heart — on to
the rest of your body.
• The defect can cause the heart to get bigger, left-
sided heart failure, abnormal heart rhythms
(arrhythmias), infections of the heart
(endocarditis) and fainting.
• Treatment includes surgery to repair or replace
the valve or, in young children, widening of the
valve through a surgical procedure called balloon
valvuloplasty, in which a balloon-like device
widens the valve so that blood can flow through.
AORTIC STENOSIS

19. COARCTATION OF THE AORTA

20. Coarctation of the aorta repair:
• Coarctation of the aorta occurs when a part of the aorta has a
very narrow section, like in an hourglass timer.
• To repair this defect, a cut is usually made on the left side of the
chest, between the ribs.
There are many 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 is to remove the narrow section of the aorta and
stitch the remaining ends together. This can usually 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.

21. Coarctation of the aorta repair:
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.
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
occurs after it has already been fixed.

22. TRANSPOSITION OF THE GREAT VESSELS

23. 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.
• This condition would quickly be fatal to a newborn
except it's generally accompanied by another defect —
commonly a septal defect or patent ductus arteriosus
— that allows oxygen-rich blood to get to the body.
OPEN-HEART SURGERY is required to repair the
condition is usually necessary shortly after birth.
TRANSPOSITION OF THE GREAT
VESSELS

24. • 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.
TRANSPOSITION OF THE GREAT
VESSELS

25. ATRIOVENTRICULAR SEPTAL DEFECT

26. • This is a combination of defects, including a large hole
in the center of the heart and a single common valve
instead of the separate tricuspid and mitral valves.
• Also called atrioventricular septal defect, this defect is
classified by whether it's only partial (involving only
the upper chambers of the heart), or complete (in
which blood can travel freely among all four chambers
of the heart).
• Both forms of the defect allow extra blood to circulate
to the lungs, causing the heart to enlarge.
• The condition occurs most often in children with Down
syndrome. Infants may also have trouble breathing and
not grow well. Surgery is often done in infancy to close
the hole and reconstruct the valves.
ATRIOVENTRICULAR SEPTAL DEFECT

27. TOTAL ANOMALOUS PULMONARY
VENOUS CONNECTION
• Total anomalous pulmonary venous return (TAPVR)
correction:
• TAPVR occurs when the pulmonary veins bring oxygen-rich
blood from the lungs back to the right side of the heart,
instead of the left side of the heart, where it usually goes in
healthy people.
• This condition must be corrected with surgery. When the
surgery is done depends on how sick the baby is. The
surgery may be done in the newborn period if the infant
has severe symptoms. If it is not done right after birth, it is
done in the first 6 months of the baby's life.
• TAPVR repair requires open-heart surgery. The pulmonary
veins are routed back to the left side of the heart, where
they belong, and any abnormal connections are closed.
• If a PDA is present, it is tied off and divided

28. Total anomalous pulmonary venous connection (showing pulmonary veins
connected to the left innominate vein)
1 - superior vena cava
2 - atrial septal defect
3 - left innominate vein
4 - pulmonary veins
Oxygenated blood returning from the lungs is routed back into the superior vena
cava, rather than the left atrium. The presence of an atrial septal defect is necessary
to allow partially oxygenated blood to reach the left side of the heart.

29. PARTIAL ANOMALOUS PULMONARY
VENOUS CONNECTION /DRAINAGE
• Partial anomalous pulmonary venous drainage (PAPVD)
exists when one or more of the pulmonary veins drain
to the left atrium while the other vein is connected to
the right atrium. The result is that some oxygen-rich
blood is returned to the right atrium and mixes with
venous blood, and is then returned to the lungs instead
of flowing out of the heart to the body.
• The result of this anomaly is that the right side of the
heart must work harder. PAPVC is often associated with
an ASD or with more complex cardiac defects.
• Surgery is needed when the child has increasing
pulmonary pressures or develops congestive heart
failure. Depending on the complexity of the PAPVC,
surgery usually involves connecting the pulmonary
veins to the left atrium

30. Partial anomalous pulmonary venous drainage
1 - location where right pulmonary veins normally enter left
atrium
2 - right pulmonary veins entering right atrium
Oxygenated blood flows from the right pulmonary veins into the
right atrium instead of into the left atrium.

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