Hrt TetralogyOfFallot

7/23/2019 Hrt TetralogyOfFallot

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Clinical Research Study

Research Goal:Test a new way to look at the right side of theheart by new ECHO technology and compare that with MRI

e stu y v s t w ast approx mate y ours an nvo ves acardiac MRI and ECHO

9 years old and up with Tetralogy of Fallot No devices such as ICD or Pacemaker

No RV to PA conduit For more information contact T. Aaron West at

[email protected] call (614)355-3448

Research incentive offered

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Tetralogy of FallotPast, Present, Future

. ,

Coordinator, COACH Program

Columbus Ohio Adult Congenital Heart

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1980 90

1970 Year

75

1960

Born with

CHD40

1940 20

0 10 20 30 40 50 60 70 80 90 100

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Pediatric to Adult Congenital Heart

seaseExpanding Population of

A o escents an A u ts

with CHDIncreased Mid TermSurvival

Increased Early

SurvivalLower Perioperative

MortalityEarly Complete

RepairImproved Surgical

Techniques

Incidence of CHD

vNICU Care

Fetal Diagnosis

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Ratio of Pediatric to Adult Patients

with CHD

Pediatric patientsAdult patients

1965 1985 2005

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ETIENNE-LOUIS ARTHUR FALLOT

Mixing red and

blue blood

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A Success StoryBlalock-Taussig-

Thomas and Blue Baby Syndrome

Alfred Blalock, MD Vivien Thomas Helen Taussig, MD

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On November 29, 1944, Drs. Blalock and Taussig decided to proceed with the anastomosis, or joining, of

the subclavian arter to the ulmonar arter in a c anotic child.

Dr. Helen Taussig was convinced that the operation would help the patient, and despite the technicalproblems of operating on a very small and very ill child, Dr. Alfred Blalock's skill was equal to the task.Blalock worked with his surgical team and his invaluable assistantVivien T. Thomas,who stood behind

.The tiny child who had been at such great risk survived the operation and slowly improved. Over the

succeeding days she gradually became less blue. By the end of the second postoperative week itwas clear she would recover.

When I saw Eileen for the first time, it was like a miracle...I was beside myself with happiness.

--mother of the first child to receive a Blalock-Taussi -Thomas shunt

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- -

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ournal of the American Medical Association

May 19, 1945

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Surgical Procedure Description of Surgery Results

Surgical Repairs in Tetralogy of Fallot

Pulmonary valvotomy Opening-up of a

stenotic pulmonary valve

Augments blood flow to the lungs

Infundibular resection Removal of muscular tissue

below the pulmonary valve

Augments blood flow to the lungs

RVOT atch Patch laced across the

RVOT

Transannular patch Patch placed across the

narrowed pulmonary valveDisrupts the pulmonary valve; may result

in severe pulmonary valve leaking

Pulmonary valve replacement Human or porcine (pig) tissue Used in adolescents and adults to treat

original pulmonary valve

Extracardiac conduit Conduit (or tube) connecting

the right ventricle to the

pulmonary artery

Treatment of pulmonary atresia

augmentation

pulmonary artery or stenosis of centralpulmonary arteries

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--

Direct Vision Intracardiac Surgical Correction of the Tetralogy

of Fallot, Pentalogy of Fallot, and Pulmonary Atresia Defects

Report of First Ten Cases

. , . ., , . ., . , . .,

RAYMOND C. READ, M.D., JOSEPH B. AUST, M.D., RICHARD A. DEWALL, M.D.,

AND RICHARD L. VARCO, M.D.

Minneapolis, Minn.

From the Department of Surgery, University of Minnesota Medical School, Minneapolis

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Cross-Circulation as the first heart-lung

machine

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Leakin of the ulmonar valve

Enlargement of the right ventricleWeakening of the right ventricle

Right sided heart failure

Narrowing of the lung arteriesNeed for multiple operations during lifetime

Arrhythmias

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-

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Stent therapy of a narrowed pulmonary

artery

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What does the human PV look like?

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Pulmonary HomograftPericardial valve

ancoc va ve con u t

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Transcatheter pulmonary valve

rep acement

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Melody valve inside tissue valve

Tissue valve narrowed

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The Melody pulmonary valve

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Limitations of the Melody Transcatheter

u monary a ve

The Melod TPV onl can treat 15% of the atients that need it(only 15% have RV PA Conduit)

What about the 85% of patients with native RVOT reconstruction

1st in ManPhilip Bonhoeffer, GOSH, London

Native Outflow Tract TPV Clinical Research Centers wererecently selected

NCH/OSU was chosen as the USA site, while TorontoSick Kids chosen for Canada, and Munich chosen for

Europeto be started in 1st quarter 2012

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First in Man: Philip BonhoefferFirst in Man: Philip Bonhoeffer


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Native right ventricular

ou ow rac s en va ve

Adapts to irregularities

of patient anatomy

Increases access tonon- surgical care for

many patients.


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Enough technologywhat about living

w t tetra ogy o a ot

At least 90% survival 30 ears after o eration

Studies indicate that academic achievement is average or above

Generally satisfied with life

May be somewhat underemployed

Severity of congenital heart disease is not associated with lowerqua y o e

Pregnancy can be safe and successful with appropriate care

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Living Long and Well with tetralogy of

a ot

Regular follow-up with ACHD team Routine physical exam, ECG, oximetry

Echocardiogram to monitor heart function and

blood flow through pulmonary valve

er o c o ter mon tor to oo or arr yt m as

We may recommend MRI or CT Scans to get moredetailed information about our heart

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a ot

ou may nee car ac ca e er za on o eva ua e an

treat: Narrowin in the ulmonar arter

Arrhythmias (Ablation)

You may need to have more surgery

Pacemaker / ICD placement

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a ot

Listen to our bod

Call us with any symptoms or concerns Take your medications as prescribed

Avoid tobacco products

Get regular exercise Eat healthy

Fruits and vegetables

o e gra ns Go easy on fats, processed carbohydrates and salt

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What does the future hold for people with

tetra ogy o a ot

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May you live long andwell enough to visit

the Golden Years

Clinic on Century

quare or p een

Readjustment and


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Hrt TetralogyOfFallot