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Surgery for Congenital Heart DiseaseSurgery for Congenital Heart Disease
Z.C. Weng, CMCVGHZ.C. Weng, CMCVGH
Principal Groups of CHDPrincipal Groups of CHD
Acyanotic CHDAcyanotic CHD
L't-to-R't shunt groupL't-to-R't shunt group
Obstruction group Obstruction group
Cyanotic CHD Cyanotic CHD
Obstruction group Obstruction group
Venous mixture groupVenous mixture group
Surgery for Congenital Heart DiseaseSurgery for Congenital Heart Disease
Z.C. Weng, CMCVGHZ.C. Weng, CMCVGH
Three Basic Lesions of CHDThree Basic Lesions of CHD
DefectDefect e.g. : ASD , VSDe.g. : ASD , VSD ObstructionObstruction e.g. : AS , PSe.g. : AS , PS Congenital malformation (TransposCongenital malformation (Transpos
ition ,Hypoplasia) ition ,Hypoplasia) e.g. : TGA e.g. : TGA , , HLHSHLHS
Surgery for Congenital Heart DiseaseSurgery for Congenital Heart Disease
Z.C. Weng, CMCVGHZ.C. Weng, CMCVGH
Acyanotic CHD c L't-to-R't ShuntAcyanotic CHD c L't-to-R't Shunt
ASD (ASD (atrial septal defectatrial septal defect)) VSD (VSD (ventricular septal defectventricular septal defect)) CAVC (CAVC (Complete Atrioventricular Complete Atrioventricular
Canal )Canal )
PDA (PDA (patent ductus arteriosuspatent ductus arteriosus))
Surgery for Congenital Heart DiseaseSurgery for Congenital Heart Disease
Z.C. Weng, CMCVGHZ.C. Weng, CMCVGH
Acyanotic CHD c ObstructionAcyanotic CHD c Obstruction
CoA (CoA (Coarctation of AortaCoarctation of Aorta)) Congenital AS (Congenital AS (Aortic StenosisAortic Stenosis)) Congenital PS (Congenital PS (Pulmonary StenosisPulmonary Stenosis))
Surgery for Congenital Heart DiseaseSurgery for Congenital Heart Disease
Z.C. Weng, CMCVGHZ.C. Weng, CMCVGH
Cyanotic CHD c Obstruction Cyanotic CHD c Obstruction
ToF (Tetralogy of Fallot)ToF (Tetralogy of Fallot) Tricuspid AtresiaTricuspid Atresia Ebstein's anomalyEbstein's anomaly
Surgery for Congenital Heart DiseaseSurgery for Congenital Heart Disease
Z.C. Weng, CMCVGHZ.C. Weng, CMCVGH
Cyanotic CHD c Venous Mixture Cyanotic CHD c Venous Mixture
TAPVRTAPVR ( (Tatal anomalous pulmonary venous ReturnTatal anomalous pulmonary venous Return)) Truncus ArteriosusTruncus Arteriosus TGATGA (Transposition of Great Artery)(Transposition of Great Artery)
HLHSHLHS (Hypoplastic Left Heart Syndrome)(Hypoplastic Left Heart Syndrome)
Single Ventricle VariantsSingle Ventricle Variants Common AtriumCommon Atrium
Surgery for Congenital Heart DiseaseSurgery for Congenital Heart Disease
Z.C. Weng, CMCVGHZ.C. Weng, CMCVGH
Acyanotic CHD c L-to-R ShuntAcyanotic CHD c L-to-R Shunt
e.g. : ASD ,VSD ,CACV ,PDAe.g. : ASD ,VSD ,CACV ,PDA Main lesion : Defect Main lesion : Defect Pulmonary blood flow Pulmonary blood flow Ventricular volume load Ventricular volume load
Surgery for Congenital Heart DiseaseSurgery for Congenital Heart Disease
Z.C. Weng, CMCVGHZ.C. Weng, CMCVGH
Acyanotic CHD c Obstruction Acyanotic CHD c Obstruction
e.g. : e.g. : CoA , AS , PSCoA , AS , PS Main lesion : ObstructionMain lesion : Obstruction Ventricular Pressure Load Ventricular Pressure Load
Surgery for Congenital Heart DiseaseSurgery for Congenital Heart Disease
Z.C. Weng, CMCVGHZ.C. Weng, CMCVGH
Cyanotic CHD c ObstructionCyanotic CHD c Obstruction
e.g.: ToF , Tricuspid atresia , e.g.: ToF , Tricuspid atresia ,
Ebstein's anomalyEbstein's anomaly Main lesion : ObstructionMain lesion : Obstruction Associated lesion : DefectAssociated lesion : Defect Pulmonary Blood Flow Pulmonary Blood Flow
Surgery for Congenital Heart DiseaseSurgery for Congenital Heart Disease
Z.C. Weng, CMCVGHZ.C. Weng, CMCVGH
Cyanotic CHD c Venous Mixture Cyanotic CHD c Venous Mixture e.g.: TGA , TAPVR , Truncus Arteriosus, e.g.: TGA , TAPVR , Truncus Arteriosus,
Common Atrium , Single V. ,HLHSCommon Atrium , Single V. ,HLHS Main lesion: Congenital Malformation Main lesion: Congenital Malformation
(Transposition , Hypoplasia) (Transposition , Hypoplasia) Associated lesion:Defect and/or obstructionAssociated lesion:Defect and/or obstruction Pulmonary Blood Flow Pulmonary Blood Flow Ventricular volume load Ventricular volume load
Surgery for Congenital Heart DiseaseSurgery for Congenital Heart Disease
Z.C. Weng, CMCVGHZ.C. Weng, CMCVGH
Palliative Surgery ( I )Palliative Surgery ( I )
Pulmonary Blood Flow Pulmonary Blood Flow PA Banding PA Banding
Pulmonary Blood FlowPulmonary Blood Flow Blalock-Taussig shunt (Modified or Classical) Blalock-Taussig shunt (Modified or Classical)
Waterston shunt Waterston shunt Pott's shunt Pott's shunt Central shuntCentral shunt
Surgery for Congenital Heart DiseaseSurgery for Congenital Heart Disease
Z.C. Weng, CMCVGHZ.C. Weng, CMCVGH
Palliative Surgery ( II )Palliative Surgery ( II )
Venous Mixing Venous Mixing Blalock-Hanlon shuntBlalock-Hanlon shunt Balloon Atrial SeptostomyBalloon Atrial Septostomy Blade Atrial Septectomy Blade Atrial Septectomy
Surgery for Congenital Heart DiseaseSurgery for Congenital Heart Disease
Z.C. Weng, CMCVGHZ.C. Weng, CMCVGH
Closed Heart Surgery Closed Heart Surgery
PDA ( ligation or division )PDA ( ligation or division ) CoA repairCoA repair Interrupted Aorta repair Interrupted Aorta repair Pulmonary ValvotomyPulmonary Valvotomy
(Brock Procedure)(Brock Procedure)
Surgery for Congenital Heart DiseaseSurgery for Congenital Heart Disease
Z.C. Weng, CMCVGHZ.C. Weng, CMCVGH
Open Heart Surgery Open Heart Surgery
1953, Dr. Gibbon in USA1953, Dr. Gibbon in USA Cardiopulmonary bypass support Cardiopulmonary bypass support Intracardiac repair of ASD under Intracardiac repair of ASD under
direct vision direct vision
Surgery for Congenital Heart DiseaseSurgery for Congenital Heart Disease
Z.C. Weng, CMCVGHZ.C. Weng, CMCVGH
Acyanotic CHD c Shunt Acyanotic CHD c Shunt Indications of SurgeryIndications of Surgery Failure to thrive Failure to thrive Congestive heart failureCongestive heart failure Qp/Qs >1.5 Qp/Qs >1.5 Progressive Pulmonary vascular change Progressive Pulmonary vascular change Timing of Surgery Timing of Surgery At any age At any age Prevent Eisenmenger's complex Prevent Eisenmenger's complex Perimembranous VSD variedPerimembranous VSD varied (30% spontaneous closure)(30% spontaneous closure)
Surgery for Congenital Heart DiseaseSurgery for Congenital Heart Disease
Z.C. Weng, CMCVGHZ.C. Weng, CMCVGH
Acyanotic CHD c ObstructionAcyanotic CHD c Obstruction
Indications of Surgery Indications of Surgery
Pressure gradient > 50mmHg Pressure gradient > 50mmHg
Progressive heart failure Progressive heart failure Timing of Surgery Timing of Surgery
At any age At any age
Mostly during infancyMostly during infancy
Surgery for Congenital Heart DiseaseSurgery for Congenital Heart Disease
Z.C. Weng, CMCVGHZ.C. Weng, CMCVGH
Cyanotic CHD c Obstruction Cyanotic CHD c Obstruction
Indications of Surgery Indications of Surgery
Symptoms and signs Symptoms and signs
Depends on size of PA Depends on size of PA Timing of Surgery Timing of Surgery
Primary repair during infancy Primary repair during infancy
Staged repair before school age Staged repair before school age
Surgery for Congenital Heart DiseaseSurgery for Congenital Heart Disease
Z.C. Weng, CMCVGHZ.C. Weng, CMCVGH
Cyanotic CHD c Venous Mixture Cyanotic CHD c Venous Mixture
Indications of Surgery Indications of Surgery
Failure to thrive Failure to thrive
Varied in single ventricle variantsVaried in single ventricle variants Timing of Surgery Timing of Surgery
Primary repair during infancy Primary repair during infancy
Staged repair before school age Staged repair before school age