DOCSLIB.ORG

Transposition of the Great Arteries and Intact Ventricular Septum: Anatomical Repair in the Neonate Aldo R

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Transposition of the Great Arteries and Intact Ventricular Septum: Anatomical Repair in the Neonate Aldo R Transposition of the Great Arteries and Intact Ventricular Septum: Anatomical Repair in the Neonate Aldo R. Castaneda, M.D., William I. Norwood, M.D., Richard A. Jonas, M.D., Steve D. Colon, M.D., Stephen P. Sanders, M.D., and Peter Lang, M.D. ABSTRACT Fourteen neonates 18 hours to 32 days old differently from the left when challenged with increased with transposition of the great arteries (TGA) and virtually afterload by the infusion of methoxamine hydrochloride intact ventricular septum (IVS) underwent arterial switch [l]. Also, atrial dysrhythmias related to dysfunction of operations under deep hypothennic circulatory arrest. the sinus and atrioventricular nodes are associated with Preoperative left ventricular to right ventricular peak sys- serious morbidity and mortality in a significant number tolic pressure ratios ranged from 0.7 to 1.0 (mean, 0.92), of patients who have undergone atrial inversion repair of TGA. and the echocardiogram showed a centrally positioned Jatene’s successful arterial switch operation in 1975 ventricular septum in 10 patients and a rightward dis- resulted in a renewed and increasing interest in anatom- placed ventricular septum in 4. One patient died twelve ical repair of TGA [2]. Jatene recognized early in his hours after operation. Postoperative complications in- experience that a left ventricle that has developed for cluded bleeding from the left coronary artery-pulmonary some time in the low-resistqnce pulmonary circuit may artery anastomosis (1 patient), stenosis of the pulmonary fail acutely following an arterial switch operation. Con- artery-aorta anastomosis requiring reoperation (2 pa- sequently, he recommended the operation principally tients), transient ST segment and T wave abnormalities for patients with TGA and a ventricular septa1 defect consistent with ischemia (3), and development of patho- (VSD) or a large patent ductus arteriosus (PDA). Since logical Q waves suggestive of clinically silent infarction TGA most often is not associated with either of these anomalies, for anatomical repair to have wide applica- (2). tion in the management of TGA, a more comprehensive The capacity of the left ventricle in a neonate to effec- selection process is necessary. Yacoub and associates [3] tively take over the systemic circulation was clearly dem- have investigated the concept of preparing the left ven- onstrated. A longer follow-up period is needed to assess tricle for systemic pressure work in patients with TGA late ventricular function, coronary ostial growth, growth of and intact ventricular septum (IVS) by preliminary band- the aorta-pulmonary artery anastomosis, late aortic valve ing of the pulmonary artery followed later by debanding (anatomical pulmonary valve) function before definitive and an arterial switch operation. Alternatively, it can be recommendations about the superiority of the arterial reasoned that the left ventricle of the newborn should be switch operation in neonates with TGA plus IVS can be well suited for systemic function, as it has supported formulated. systemic pressure during gestation. This report constitutes our initial experience with the arterial switch operation in neonates with TGA and IVS. Intraatrial repair by the Senning or Mustard technique has dramatically enhanced the prospects for survival of Material and Methods children with transposition of the great arteries (TGA). From May, 1983, through December 1,1983,14 consecu- Over the years, the operative mortality and the inci- tive neonates with TGA {S,D,D} and IVS underwent an dence of many late complications of these operations arterial switch operation. There were 9 boys and 5 girls. have decreased significantly. Supported by the observa- They ranged in age from 18 hours to 32 days (mean age, tion that right ventricular (RV) failure or tricuspid regur- 6.6 days) and in weight from 1.8 to 4.4 kg (mean weight, gitation develops late in some patients after atrial inver- 3.4 kg). Ten of these neonates (71.4%)underwent the sion repair, an impression exists that the right ventricle arterial switch operation during the first week of life. is somehow inherently different from the left and may Ratios of RV to left ventricular (LV) pressure ranged not be well suited to support the systemic circulation from 0.7 to 1.0 (mean, 0.92) (Table). Associated car- indefinitely. Indeed, there is suggestive evidence that diovascular lesions included PDA (10 patients), a small the right ventricle in the systemic circulation responds VSD (2), coarctation of the aorta (l),and left juxtaposi- tion of the atrial appendages and dextrocardia (1). Before the arterial switch operation, 8 patients had a From the Departments of Cardiac Surgery and Pediahic Cardiology, Children’s Hospital Medical Center, and the Departments of Surgery balloon atrial septostomy, 9 received prostaglandin El, and Pediatrics, Harvard Medical School, Boston, MA. and 1 had resection of coarctation of the aorta. The Presented at the Twentieth Annual Meeting of The Society of Thoracic preoperative electrocardiogram demonstrated right-axis Surgeons, San Antonio, TX, Jan 23-25, 1984. deviation and pure R wave in V1 in 12 and an R waveIS Address reprint requests to Lk. Castanecla, Children’s Hospital Medical wave ratio of less than 1 in V6 in 9 neonates. Center, 300 Longwood Ave, Boston, MA 02115. All patients underwent preoperative echocardio- 438 439 Castaneda et al: TGA and Intact Ventricular Septum in Neonate Preoperative Left Ventricular and Right Ventricular Peak Systolic Pressures and Pressure Ratios Age at LV RV LV/RV Operation Pressure Pressure Pressure (day) (mm Hg) (mm Hg) Ratio 1 50 52 0.9 2 52 55 0.9 2 48 48 1.0 2 70 70 1.0 2 65 68 0.9 2 70 70 1.0 2 50 52 0.9 4 75 75 1.0 5 60 62 0.9 7 70 95 0.7 Fig 1. Sites of implantation of the left and right corona arteries on 10 60 78 0.7 y the pulmonary artery are marked by reference stitches. 10 62 62 1.0 14 58 67 0.8 32 82 92 0.8 - - - - were inspected and the sites where the left and right 6.6 62.2 67.5 0.92 coronary arteries were to be implanted on the pulmo- LV = left ven~cular;RV = right ventricular. nary artery were marked by reference stitches (Fig 1). During circulatory arrest, the aorta was transected ap- proximately 1 cm distal to the coronary arteries and the graphic evaluation and heart catheterization; LV and RV main pulmonary artery was divided in its midportion. In pressures were measured in all patients, and the LVIRV the neonates, we encountered little discrepancy be- pressure ratios were calculated (see Table). The echocar- tween the sizes of the great arteries. The left and right diogram showed a rightward displacement of the ven- coronary ostia were excised using either a button of tricular septum (type I) in 4 patients (28.6%) and a cen- aortic wall (Fig 2A) or a segment of aortic wall extending trally positioned ventricular septum (type 11) in 10 from the rim of the aortotomy incision to the base of the patients (71.4%). None had a type I11 or leftward dis- coronary sinus (Fig 2B). We made certain to include the placed septum. largest possible segment of aortic wall around the coro- All infants were intubated and artificially ventilated nary ostium. An equivalent oval segment of pulmonary for a minimum of twenty-four hours after operation. arterial wall (previously marked) (Fig 3) was then ex- Postoperative assessment included continuous moni- cised, and the coronary arteries were sutured to the pul- toring of systemic arterial blood pressure, right and left monary artery using a continuous 7-0 polydioxanone atrial pressures, and the ECG. (PDS) suture material. Next, the distal pulmonary artery was brought anterior to the ascending aorta (Lecompte Surgical Technique maneuver) [4], and the proximal pulmonary artery was Deep hypothermic circulatory arrest was used for all ne- anastomosed to the distal aorta using a continuous 6-0 onates. Following a median sternotomy, cardiopulmo- PDS suture (Fig 4). At this point in the operation, the nary bypass was instituted by cannulation of the distal right atrial cannula was replaced and cardiopulmonary ascending aorta and placement of a single venous can- bypass was restarted. During rewarming, the sites of nula through the right atrial appendage. By means of a explantation of the coronary arteries were repaired using heat exchanger interposed on cardiopulmonary bypass, either a patch of circular Gore-Tex (Fig 5A) or a segment core cooling was carried out with cold (15°C) perfusion of pericardium (Fig 5B). Finally, the proximal aorta was until the nasopharyngeal and rectal temperatures sutured directly to the distal pulmonary artery with a reached 20°C. During core cooling, the ductus arteriosus continuous 6-0 PDS suture (see Fig 5). At a rectal tem- was divided and both the left and right pulmonary ar- perature of 36"C, cardiopulmonary bypass was discon- teries were dissected beyond their point of branrhing. tinued. At 20°C the aorta was clamped, cardioplegic solution was infused, and cardiopulmonary bypass was stopped. Results The duration of circulatory arrest ranged from 47 to 64 Deaths minutes. The right atrial cannula was then removed. In There have been 1 hospital death and no late deaths. those patients who had a balloon atrial septostomy, the. The 7-day-old patient died twelve hours after operation. atrial septa1 defect was closed. This patient had an accessory right coronary orifice sup- While the patient was on bypass, the coronary arteries plying a rather large right conal branch. In the attempt to 440 The Annals of Thoracic Surgery Vol 38 No 5 November 1984 Fig 2. The aorta is transected and the lejt and right coronary arteries are excised using (A)either a button of aortic wall or (B) a segment of Fig 4.
Load more

Recommended publications
  • Cardiac Surgery in Early Infancy J
    Postgrad Med J: first published as 10.1136/pgmj.48.562.478 on 1 August 1972. Downloaded from Postgraduate Medical Journal (August 1972) 48, 478-485. Cardiac surgery in early infancy J. STARK M.D. Hospital for Sick Children, Great Ormond Street, London, W.C. 1 IMPORTANT advances have been made in the diagnosis and treatment of congenital heart disease (CHD) in early infancy. Accurate diagnosis is now possible in the first days or even hours of life. Operation is also 3530- possible at this early age and very often it provides 0 the only chance for survival. The risk of conservative E .4In15 treatment often exceeds the risk of the operation. O- An aggressive approach to the diagnosis and treat- II II II ment of CHD is dictated by statistics. The estimated z a 10 5 incidence of CHD is 6-8/1000 live births. About 500o 963 99 6 of the children born with CHD die before their first 3 1 1 5 1 16 birthday unless effectively treated. The achievements in the treatment of CHD in infancy are the result of 1963~51964 1965 1966 1967 1968 1969 1970 1971 the combined efforts of paediatricians, cardiologists, FIG. 1. Open-heart surgery under I year of age at the copyright. surgeons, anaesthetists and nurses. Many other Great Ormond Street Thoracic Unit, February 1963 to specialists and technical staff contribute to the September 1971 (115 patients). Open columns, survived; diagnosis and treatment. closed columns, died. The experience of the Thoracic Unit, Hospital for Sick Children at Great Ormond Street, forms the Diagnosis basis of this report (unless otherwise stated).
    [Show full text]
  • BAS Talk Linz
    Balloon atrial septostomy Dr Aphrodite Tzifa, MD(Res), FRCPCH! ! Director, Paediatric Cardiology Department, ! Mitera Children's Hospital, Athens, Greece September 10, 2003 ! BAS ! ! 1. The technique of atrial septostomy (BAS) was introduced in 1966 by Rashkind! ! 2. The interventional procedure is performed in neonates that are significantly cyanosed with preductal O2 saturations below 75% after birth or that need an atrial septal defect to offload the LA! “A technique for producing an atrial septal defect without thoracotomy or anesthesia is presented. It can be performed rapidly in any cardiac catheterization laboratory.” (William J. Rashkind, 1966) ! History ! ! “...The initial response to this report varied between admiration and horror but, in either case, the procedure stirred the imagination of the “invasive” cardiologists throughout the entire cardiology world and set the stage for all future intracardiac interventional procedures – the true beginning of pediatric and adult interventional cardiology.” (Charles E. Mullins, 1998) ! HOW to CREATE AN ASD? ! ! 1. Septostomy Balloons! 2. Low profile balloon (Tyshak)! 3. Static balloon (Powerflex, Opta)! 4. Cutting balloons! 5. Blade septostomy catheter! 6. Stenting! ! Transeptal puncture or RF perforation may occasionally be needed Need for creation or enlargement of an ASD: ! WHEN? ! ! 1. TGA: In some units, an atrial septostomy is performed routinely after birth, to ensure mixing of the blood at intracardiac level and discontinue the prostaglandin infusion. However, most would not advocate this due to the potential risk of complications in neonates that are otherwise stable. ! 2. Tricuspid or mitral atresia! 3. PA / IVS! 4. TAPVD with restrictive septum! 5. During hybrid procedures for HLHS syndrome! 6.
    [Show full text]
  • Balloon Atrial Septostomy in Complete Transposition of Great Arteries in Infancy
    Br Heart J: first published as 10.1136/hrt.32.1.61 on 1 January 1970. Downloaded from British HeartJournal, I970, 32, X6i. Balloon atrial septostomy in complete transposition of great arteries in infancy A. W. Venables From Royal Children's Hospital, Melbourne, Australia The results of 26 completed balloon atrial septostomies in complete arterial transposition in infancy are described, and complications discussed. Of 7 deaths following this procedure, 3 were clearly or probably related to it or to its failure to produce an adequate septal defect, while 4 were unrelated. Atrial perforations occurred on 4 occasions. Necropsy information regarding the defects produced by the procedure is given. Anatomical features of the fossa ovalis appear to determine the size of the defect created. The effect of the procedure is illustrated by photographs of representative necropsy specimens. Apparently adequate initial defects do not guarantee satisfactory long-term palliation, and 4 of iI infants followed for more than 6 months after effective initial palliation have required surgical procedures to provide more adequate atrial mixing of blood. Despite this, the procedure appears to offer considerable advantage over initial surgical procedures to create atrial defects. The value of palliative procedures in com- Subjects and methods plete arterial transposition is indisputable. From to mid-May I23 cases of trans- ig60 i969, http://heart.bmj.com/ Most commonly, atrial septal defects arz cre- position of the great arteries in infancy were diag- ated in order to increase effective pulmonary nosed in the Cardiac Unit of the Royal Children's flow. Since I966 the balloon catheter tech- Hospital, Melbourne.
    [Show full text]
  • ICD-9-CM Procedures (FY10)
    2 PREFACE This sixth edition of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is being published by the United States Government in recognition of its responsibility to promulgate this classification throughout the United States for morbidity coding. The International Classification of Diseases, 9th Revision, published by the World Health Organization (WHO) is the foundation of the ICD-9-CM and continues to be the classification employed in cause-of-death coding in the United States. The ICD-9-CM is completely comparable with the ICD-9. The WHO Collaborating Center for Classification of Diseases in North America serves as liaison between the international obligations for comparable classifications and the national health data needs of the United States. The ICD-9-CM is recommended for use in all clinical settings but is required for reporting diagnoses and diseases to all U.S. Public Health Service and the Centers for Medicare & Medicaid Services (formerly the Health Care Financing Administration) programs. Guidance in the use of this classification can be found in the section "Guidance in the Use of ICD-9-CM." ICD-9-CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Centers for Medicare & Medicaid Services are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9- CM is the responsibility of the Federal Government. However, because the ICD-9-CM represents the best in contemporary thinking of clinicians, nosologists, epidemiologists, and statisticians from both public and private sectors, no future modifications will be considered without extensive advice from the appropriate representatives of all major users.
    [Show full text]
  • Images Paediatr Cardiol
    W Boehm, M Emmel, and N Sreeram. Balloon Atrial Septostomy: History and Technique. Images Paediatr Cardiol. 2006 Jan-Mar; 8(1): 8–14. in PAEDIATRIC CARDIOLOGY IMAGES Images Paediatr Cardiol. 2006 Jan-Mar; 8(1): 8–14. PMCID: PMC3232558 Balloon Atrial Septostomy: History and Technique W Boehm, M Emmel, and N Sreeram University Hospital of Cologne, Germany. Contact information: N. Sreeram, Department of Paediatric Cardiology, University Hospital of Cologne, Kerpenerstrasse 62, 50937 Cologne, Germany Phone: +49 221 47886301 +49 221 47886301 Fax: +49 221 47886302 ; Email: [email protected] MeSH: Transposition of the great arteries, Heart defects, congenital, Catheter, invervention, Balloon atrial septostomy Copyright : © Images in Paediatric Cardiology This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction “A technique for producing an atrial septal defect without thoracotomy or anesthesia is presented. It can be performed rapidly in any cardiac catheterization laboratory.” (William J. Rashkind, 1966)1 “...The initial response to this report varied between admiration and horror but, in either case, the procedure stirred the imagination of the “invasive” cardiologists throughout the entire cardiology world and set the stage for all future intracardiac interventional procedures – the true beginning of pediatric and adult interventional cardiology.” (Charles E. Mullins, 1998)2 The natural history of untreated transposition of the great vessels in the neonate is poor. Complete correction has been possible since 1959 with the atrial switch procedure, first described by Senning.3 Mustard simplified this method, reducing mortality rates to a reasonable level.4 Best results with both operations were achieved in children beyond six months of age.
    [Show full text]
  • Left Atrial Decompression by Percutaneous Cannula Placement While on Extracorporeal Membrane Oxygenation
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE Brief Communications provided by Elsevier - Publisher Connector Left atrial decompression by percutaneous cannula placement while on extracorporeal membrane oxygenation Anthony M. Hlavacek, MD, Andrew M. Atz, MD, Scott M. Bradley, MD, and Varsha M. Bandisode, MD, Charleston, SC enoarterial extracorporeal membrane oxygenation serially dilated with 10F and 16F transseptal sheath dilators. With (ECMO) is often used in pediatric patients with severe transesophageal echocardiography guidance, a 17F cannula was myocardial dysfunction, typically after cardiac sur- advanced over the guidewire into the LA and connected to the gery, or in patients with acute myocarditis. A problem venous ECMO circuit. Chest radiography confirmed resolution of Vfrequently encountered in these patients is left atrial hypertension, his pulmonary edema by the subsequent day. An echocardiogram which may result in pulmonary edema, ventricular distention, and revealed normalization of his LA size and an estimated LA pres- subendocardial ischemia.1,2 Decompression of the left atrium (LA) sure decrease to 18 mm Hg by Doppler measurement of the mitral will reduce diastolic pressures in the left heart, resulting in an regurgitation gradient. He remained on ECMO for 42 days until a improvement in coronary perfusion and lessen pulmonary edema. successful orthotopic heart transplant was performed. We describe the percutaneous placement of a venous cannula in the LA while on ECMO in a child with severe
    [Show full text]
  • Interventional Echocardiography: Opportunities and Challenges in an Emerging Field
    Henry Ford Health System Henry Ford Health System Scholarly Commons Cardiology Articles Cardiology/Cardiovascular Research 10-23-2020 Interventional echocardiography: Opportunities and challenges in an emerging field James Lee Tiffany Chen Edward Gill Follow this and additional works at: https://scholarlycommons.henryford.com/cardiology_articles Received: 1 June 2020 | Revised: 10 September 2020 | Accepted: 12 September 2020 DOI: 10.1111/echo.14874 REVIEW Interventional echocardiography: Opportunities and challenges in an emerging field James Lee MD1 | Tiffany Chen MD2 | Edward Gill MD3 1Division of Cardiology, Henry Ford Heart and Vascular Institute, Detroit, MI, USA Abstract 2Division of Cardiovascular Medicine, The growth of transcatheter structural heart disease interventions has created a Perelman School of Medicine, Hospital of subspecialty of interventional imagers who focus on preprocedural planning and the the University of Pennsylvania, Philadelphia, PA, USA periprocedural guidance of these complex cases. In particular interventional imag- 3Division of Cardiology, University of ers who focus on periprocedural guidance have developed a specific expertise in Colorado School of Medicine, Aurora, CO, USA interventional transesophageal echocardiography (iTEE). This nascent field has chal- lenges in training, reimbursement, and occupational hazards which are unique to this Correspondence James Lee, MD, Division of Cardiology, field. This review encompasses the evolution of iTEE, current challenges, and future Henry Ford Heart and Vascular
    [Show full text]
  • NATIONAL QUALITY FORUM National Voluntary Consensus Standards for Pediatric Cardiac Surgery Measures
    NATIONAL QUALITY FORUM National Voluntary Consensus Standards for Pediatric Cardiac Surgery Measures Measure Number: PCS‐001‐09 Measure Title: Participation in a national database for pediatric and congenital heart surgery Description: Participation in at least one multi‐center, standardized data collection and feedback program that provides benchmarking of the physician’s data relative to national and regional programs and uses process and outcome measures. Participation is defined as submission of all congenital and pediatric operations performed to the database. Numerator Statement: Whether or not there is participation in at least one multi‐center data collection and feedback program. Denominator Statement: N/A Level of Analysis: Group of clinicians, Facility, Integrated delivery system, health plan, community/population Data Source: Electronic Health/Medical Record, Electronic Clinical Database (The Society of Thoracic Surgeons Congenital Heart Surgery Database), Electronic Clinical Registry (The Society of Thoracic Surgeons Congenital Heart Surgery Database), Electronic Claims, Paper Medical Record Measure Developer: Society of Thoracic Surgeons Type of Endorsement: Recommended for Time‐Limited Endorsement (Steering Committee Vote, Yes‐9, No‐0, Abstain‐0) Attachments: “STS Attachment: STS Procedure Code Definitions” Meas# / Title/ Steering Committee Evaluation and Recommendation (Owner) PCS-001-09 Recommendation: Time-Limited Endorsement Yes-9; No-0; Abstain-0 Participatio n in a Final Measure Evaluation Ratings: I: Y-9; N-0 S: H-4; M-4; L-1 U: H-9; M-0; L-0 national F: H-7; M-2; L-0 database for Discussion: pediatric I: The Steering Committee agreed that this measure is important to measure and report. and By reporting through a database, it is possible to identify potential quality issues and congenital provide benchmarks.
    [Show full text]
  • STS/EACTS Short List Mapping to European Paediatric Cardiac Code Short List with ICD-9 & ICD-10 Crossmapping
    12S02-05.qxd 22/Sep/02 1:23 PM Page 50 Cardiol Young 2002; 12 (Suppl. 2): 50–62 © Greenwich Medical Media Ltd./AEPC ISSN 1047-9511 STS/EACTS Short List mapping to European Paediatric Cardiac Code Short List with ICD-9 & ICD-10 crossmapping [Boxed items ϭ codes where 2 or 3 EPCC items required for single STS/EACTS item] STS/EACTS term EPCC term EPCC ICD-9 ICD-9 ICD-10 ICD-10 code additional additional Appendix IIIA – Noncardiac Abnormalities Short List None Hereditary/non-cardiac abnormality not apparent, 10.23.00 nc nc Asplenia Spleen absent (asplenia), 03.07.03 759.0 Q20.6 Polysplenia Multiple spleens (polysplenia), 03.07.04 759.0 Q20.6 Down Syndrome Trisomy 21 – Down’s syndrome, 14.01.02 758.0 Q90.9 Turner Syndrome 45XO – Turner’s syndrome, 14.01.05 758.6 Q96 DiGeorge DiGeorge sequence, 14.02.06 279.1 D82.1 Williams Beuren syndrome Williams syndrome (infantile hypercalcaemia), 14.02.30 275.4 747.2 Q93.8 Alagille syndrome (intrahepatic biliary Alagille syndrome: arteriohepatic dysplasia, 14.02.66 751.6 Q44.7 duct agenesis) 22q11 deletion 22q11 microdeletion – CATCH 22, 14.01.21 758.3 Q93.8 Other chromosomal/syndromic abnormality No exact equivalent 759.9 Q87.8 Rubella Fetal rubella syndrome, 14.02.32 771.0 P35.0 Marfan syndrome Marfan syndrome, 14.02.17 759.8 Q87.4 Other preoperative noncardiac abnormality No exact equivalent Appendix IIIB – General Preoperative Risk Factor Short List None No pre-procedural risk factors, 10.20.00 nc nc Preoperative mechanical circulatory support Pre-procedural mechanical circulatory support, 10.20.15
    [Show full text]
  • PROCEDURES Group Subgroup Name Code Anesthetic Procedures
    PROCEDURES group subgroup name code Anesthetic procedures Anesthetic procedures Echocardiography procedure, Sedated transesophageal PROC-2010-2420 echocardiogram Anesthetic procedures Anesthetic procedures Echocardiography procedure, Sedated transthoracic echocardiogram PROC-2010-2430 Anesthetic procedures Anesthetic procedures Non-cardiovascular, Non-thoracic procedure on cardiac patient with PROC-2010-2435 cardiac anesthesia Anesthetic procedures Anesthetic procedures Radiology procedure on cardiac patient, Cardiac Computerized PROC-2010-2440 Axial Tomography (CT Scan) Anesthetic procedures Anesthetic procedures Radiology procedure on cardiac patient, Cardiac Magnetic PROC-2010-2450 Resonance Imaging (MRI) Anesthetic procedures Anesthetic procedures Radiology procedure on cardiac patient, Diagnostic radiology PROC-2010-2460 Anesthetic procedures Anesthetic procedures Radiology procedure on cardiac patient, Non-Cardiac Computerized PROC-2010-2470 Tomography (CT) on cardiac patient Anesthetic procedures Anesthetic procedures Radiology procedure on cardiac patient, Non-cardiac Magnetic PROC-2010-2480 Resonance Imaging (MRI) on cardiac patient Anesthetic procedures Anesthetic procedures Radiology procedure on cardiac patient, Therapeutic radiology PROC-2010-2490 Cardiomyopathy Cardiomyopathy Partial left ventriculectomy (LV volume reduction surgery) (Batista) PROC87 Cardiomyopathy Cardiomyopathy Transplant, Heart PROC85 Cardiomyopathy Cardiomyopathy Transplant, Heart and lung PROC86 Conduit operations Conduit operations Conduit placement,
    [Show full text]
  • Transposition of the Great Arteries in the Neonate in THIS ISSUE
    NEONATOLOGY TODAY News and Information for BC/BE Neonatologists and Perinatologists Volume 5 / Issue 8 August 2010 Transposition of the Great Arteries in the Neonate IN THIS ISSUE Transposition of the Great By P. Syamasundar Rao, MD Arteries in the Neonate atrium and right ventricle and from there into by P. Syamasundar Rao, MD the aorta while the pulmonary venous blood Page 1 INTRODUCTION enters the left atrium and left ventricle and from there into the pulmonary artery (Figure 1). Therefore, the circulation is parallel in- DEPARTMENT In the previous issues of Neonatology Today, I discussed perinatal circulation,1,2 an ap- stead of normal in-series circulation. There- Global Neonatology Today: A proach to the diagnosis of cyanotic neonate,3 Monthly Column principles of management of the neonate by Dharmapuri Vidyasagar, MD, FAAP, with congenital heart disease4 and neonatal FCCM cardiac emergencies5 -- all addressing the Page 9 general topics of congenital heart disease in the neonate. In this and future issues, com- Medical News, Products & Information monly encountered cardiac defects in the Page 10 neonate. TRANSPOSITION OF THE GREAT ARTERIES NEONATOLOGY TODAY Transposition of the great arteries (TGA) is Editorial and Subscription Offices the most common cyanotic congenital heart 16 Cove Rd, Ste. 200 defect (CHD) in the neonate. It constitutes Westerly, RI 02891 USA 5% of all CHDs and 10% of all neonatal cya- www.NeonatologyToday.net notic CHDs.6 A number of definitions have Neonatology Today (NT) is a monthly been used to describe TGA, but the most newsletter for BC/BE neonatologists and accurate description is “a defect in which the Figure 1.
    [Show full text]
  • Balloon Atrial Septostomy Via the Umbilical Vein
    Br Heart J: first published as 10.1136/hrt.36.10.1040 on 1 October 1974. Downloaded from Case reports British Heart Journal, I974, 36, I040-IO4. Balloon atrial septostomy via the umbilical vein H. H. Kaye' and Michael Tynan From the Department ofCardiology, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne A case of transposition of the great arteries is presented in which an adequate balloon septostomy was per- formed through the umbilical vein. Some diffxiculty was experienced in traversing the ductus venosus. The possible complications of umbilical vein catheterization are reviewed but it is suggested that some of them may be avoided since the procedure is carried out under x-ray control. The outlook for children with transposition of the left ventricle, but this reverted spontaneously to sinus great arteries has improved in recent years. Balloon rhythm. A diagnosis of transposition of the great atrial septostomy (Rashkind and Miller, I966) has arteries with only an interatrial communication was made. shown to be the Bidirectional shunting was demonstrated before septo- been palliative treatment of choice stomy which could only have been taking place at atrial (Tynan, I97I) and considerable success has been level. An unsuccessful attempt was then made to intro- achieved by surgical correction (Clarkson et al., duce a 5 5 French Rashkind catheter into the right copyright. 1972), particularly in infancy (Breckenridge et al., femoral vein, and owing to extensive damage to the 1972). vein it had to be tied off. Because the baby's condition Technical difficulties, however, can be a problem had deteriorated, it was decided to attempt a balloon in the catheter room and some authors have drawn septostomy via the umbilical vein thus saving time and attention to this when discussing balloon atrial limiting further surgical trauma.
    [Show full text]