Cardiovascular surgery, Congenital heart disease Dr. Robin Man Karmacharya, Lecturer, Department of Surgery, Dhulikhel Hospital

Introduction Cardiac anomalies since birth 1% child at birth

Classifications Cyanotic: Right to left shunt with decreased pulmonary blood flow: TOF Parallel: TGV Acyanotic: Left to right shunt with increased pulmonary blood flow: PDA, ASD, VSD

Tetralogy of Fallot VSD Overriding aorta Pulmonary stenosis Right ventricular hypertrophy Procedure: Repair of VSD and pathching over pulmonary stenosis

Patent ductus arteriosus Ductus arteriosus facilitates the transfer of oxygenated blood from pulmonary artery to aorta Prostaglandins, indomethacin are used to close medically If persists, either ligation and division, or pericardial patching

Atrial septal defect Defect in atrial septum Types: – Ostium secondum (Patent foramen ovale) – Ostium primum (Atrioventricular canal defect) – Superior venacaval – Inferior venacaval – Coronary sinus defect Operation: Pericardial patch or Dacron patch

Ventricular Septal defect Defect in interventricular septum Left to right shunt Types: – Perimembranous (Most common) – Muscular – Atrioventricular – Subarterial defect

Valvular Heart diseases Valve repair and valve replacement

Valve repair Improved hemodynamics Avoids long term anticoagulation But technically difficult Higher failure rate

Valve replacement Less failure rate But requires life long anticoagulation in case of mechanical valve, susceptible to infection

Valve replacement options Mechanical valve – Durable, longer life – But needs life long anticoagulation – Useful for <60 years patients Bioprosthetic valves – Short period of anticoagulation – Less life – Useful for >60 years patients

Mechanical valves Star Edwards valve Bileaflet valves Ball and cage valves

Bioprosthetic valves Porcine heterograft stented valves Porcine heterograft stentless valves