Khonsari’s Cardiac Surgery: Safeguards and Pitfalls in Operative Technique

 

Description:

Unique in the field of cardiac surgery, Khonsari's Cardiac Surgery: Safeguards and Pitfalls in Operative Technique details the most important techniques in a concise, readable, and richly illustrated format, with a focus on avoiding and managing surgical pitfalls and complications. From general considerations through the surgical correction of acquired and congenital heart conditions, it provides a wealth of practical, hands-on guidance to help both seasoned and less-experienced cardiac surgeons achieve optimal outcomes. Key Features: •Apply the very latest know-how with new sections on endovascular procedures, transcatheter aortic valve replacement (TAVR), new approaches to Norwood reconstruction and repair of Ebstein anomaly, and alternative anatomic repairs of congenitally corrected transposition, as well as thorough updates to all chapters.•Master nuances of surgical technique thanks to a wealth of step-by-step illustrations, many of them new, others colorized for greater clarity.•Optimize outcomes with special coverage of avoiding and managing technical pitfalls and complications.•Spot important details with the aid of distinctive "Nota Bene" notations.Now with the print edition, enjoy the bundled interactive eBook edition, offering tablet, smartphone, or online access to: •Complete content with enhanced navigation•A powerful search that pulls results from content in the book, your notes, and even the web•Cross-linked pages, references, and more for easy navigation•Highlighting tool for easier reference of key content throughout the text•Ability to take and share notes with friends and colleagues•Quick reference tabbing to save your favorite content for future use

 

 

Table of Contents:

 

 

 

Section I: General Considerations

 

Chapter 1: Surgical Approaches to the Heart and Great Vessels

Primary Median Sternotomy

Technique

Figure

1. 1

Figure

1. 2

Figure

1. 3

Repeat Sternotomy

Technique

Figure

1. 4

Figure

1. 5

Figure

1. 6

Figure

1. 7

Figure

1. 8

Sternal Closure

Technique

Figure

1. 9

Figure

1. 10

Figure

1. 11

Figure

1. 12

Postoperative Sternal Wound Infection

General Considerations

Specific Technical Considerations

Pectoralis Muscle Flap

Technique

Superior Rectus Flap

Technique

Myocutaneous Flap

Technique

Figure

1. 13

Thoracotomy

Alternative Surgical Approaches

Full Sternotomy through Submammary Incision

Technique

Full Sternotomy through a Limited Midline Incision

Technique

Lower Ministernotomy

Technique

Lower Ministernotomy Closure

Upper Ministernotomy

Technique

Submammary Right Thoracotomy

Technique

Closure of Submammary Right Thoracotomy

Figure

1. 14

Figure

1. 15

Figure

1. 16

Figure

1. 17

Figure

1. 18

Figure

1. 19

Figure

1. 20

Chapter 2: Preparation for Cardiopulmonary Bypass

Exposure of the Heart

Technique

Dissection Around the Aorta

Dissection Around the Cavae

Figure

2. 1

Figure

2. 2

Figure

2. 3

Figure

2. 4

Figure

2. 5

Figure

2. 6

Figure

2. 7

Figure

2. 8

Arterial Cannulation

Aortic Cannulation

Technique

Femoral Artery Cannulation

Technique

Axillary Artery Cannulation

Technique

Transapical Aortic Cannulation

Technique

Figure

2. 9

Figure

2. 10

Figure

2. 11

Figure

2. 12

Figure

2. 13

Figure

2. 14

Figure

2. 15

Figure

2. 16

Venous Cannulation

Right Atrial Cannulation

Technique

Bicaval Cannulation

Technique

Technique of Direct Caval Cannulation

Inferior Vena Cava

Superior Vena Cava

Femoral Venous Cannulation

Technique

Adequacy of Bypass

Signs of Aortic Dissection

Improper Positioning of Caval Cannula

Retrograde Aortic Dissection

Traumatic Disruption and Dissection of the Ascending Aorta

Figure

2. 17

Figure

2. 18

Figure

2. 19

Figure

2. 20

Figure

2. 21

Figure

2. 22

Figure

2. 23

Figure

2. 24

Figure

2. 25

Chapter 3: Myocardial Preservation

Chapter 3 Introduction

Aortic Root Infusion Technique

Direct Coronary Artery Perfusion

Figure

3. 1

Myocardial Preservation by the Retrograde Perfusion Method

Technique

Retrograde Cardioplegic Infusion by the Open Technique

Figure

3. 2

Figure

3. 3

Chapter 4: Venting and Deairing of the Heart

Chapter 4 Introduction

Left Ventricular Apical Venting

Technique

Figure

4. 1

Figure

4. 2

Venting through the Right Superior Pulmonary Vein

Figure

4. 3

Figure

4. 4

Venting through the Superior Aspect of the Left Atrium

Figure

4. 5

Pulmonary Artery Venting

Figure

4. 6

Venting through the Foramen Ovale

Technique

Deairing of the Heart

Section Ii: Surgery for Acquired Heart Disease

Chapter 5: Surgery of the Aortic Valve

Chapter 5 Introduction

Surgical Anatomy of the Aortic Valve

Figure

5. 1

Approach to the Aortic Valve

Myocardial Preservation

Technique

Exposure of the Aortic Valve by Transverse Aortotomy

Exposure of the Aortic Valve by Oblique Aortotomy

Figure

5. 2

Figure

5. 3

Figure

5. 4

Aortic Valve Replacement

Excision of the Aortic Valve

Sizing the Aortic Prosthesis

Technique for Suture Insertion

Seating the Prosthesis

Aortotomy Closure

Technique

Figure

5. 5

Figure

5. 6

Figure

5. 7

Figure

5. 8

Figure

5. 9

Figure

5. 10

Figure

5. 11

Figure

5. 12

Figure

5. 13

Figure

5. 14

Figure

5. 15

Figure

5. 16

Figure

5. 17

Figure

5. 18

Figure

5. 19

Figure

5. 20

Figure

5. 21

Figure

5. 22

Figure

5. 23

Figure

5. 24

Figure

5. 25

Figure

5. 26

Figure

5. 27

Figure

5. 28

Homograft, Autograft, and Porcine Stentless Aortic Root in Aortic Valve Replacement

Technique: Pulmonary Autograft Replacement of the Aortic Root: the Ross Procedure

Technique: Aortic Valve Replacement Using Stentless Bioprosthesis or Aortic Homograft

Figure

5. 29

Figure

5. 30

Figure

5. 31

Figure

5. 32

Figure

5. 33

Figure

5. 34

Figure

5. 35

Figure

5. 36

Figure

5. 37

Figure

5. 38

Figure

5. 39

Figure

5. 40

Figure

5. 41

Figure

5. 42

Figure

5. 43

Figure

5. 44

Figure

5. 45

Figure

5. 46

Figure

5. 47

Figure

5. 49

Figure

5. 48

Figure

5. 50

Figure

5. 51

Figure

5. 52

Figure

5. 53

Figure

5. 54

Aortic Valve Repair

Techniques

Figure

5. 55

Figure

5. 56

Figure

5. 57

Problematic Cases

Management of Unclampable Aorta

Technique

Apicoaortic Valve Conduit

Technique

Management of the Small Aortic Root

Tilted Prosthesis Technique

Patch Enlargement Technique

Endocarditis

Figure

5. 58

Figure

5. 59

Figure

5. 60

Figure

5. 61

Figure

5. 62

Figure

5. 63

Paravalvular Leaks

Technique for Repair

Figure

5. 64

Transcatheter Aortic Valve Replacement

Patient Selection

Operative Technique

Figure

5. 65

Figure

5. 66

Chapter 6: Surgery of the Mitral Valve

Chapter 6 Introduction

Surgical Anatomy of the Mitral Valve

Technical Considerations

Incision

Myocardial Preservation

Exposure of the Mitral Valve

Interatrial Groove Approach

Transatrial Oblique Approach

Transatrial Longitudinal Septal Approach

Figure

6. 1

Figure

6. 2

Figure

6. 3

Figure

6. 4

Figure

6. 5

Figure

6. 6

Figure

6. 7

Figure

6. 8

Figure

6. 9

Open Mitral Commissurotomy for Mitral Stenosis

Figure

6. 10

Closed Mitral Commissurotomy for Mitral Stenosis

Technique

Conversion of a Closed Mitral Valvotomy to the Open Technique

Figure

6. 11

Figure

6. 12

Figure

6. 13

Mitral Valve Reconstruction

Reconstruction of the Mitral Valve Leaflets

Quadrangular or Triangular Resection

Creation of Artificial Chordae

Gore-Tex Chordal Replacement

Technique

Edge-to-Edge Mitral Valve Repair

Technique

Anterior Mitral Leaflet Abnormalities

Technique

Reconstruction of the Mitral Valve Annulus

Commissuroplasty

Annuloplasty

Complete Mitral Annuloplasty Ring

Technique

Incomplete Mitral Annuloplasty Ring

Technique

Reconstruction of the Chordae Tendineae

Attachment of the Chords to the Mitral Leaflets

Ischemic Mitral Regurgitation

Figure

6. 14

Figure

6. 15

Figure

6. 16

Figure

6. 17

Figure

6. 18

Figure

6. 19

Figure

6. 20

Figure

6. 21

Figure

6. 22

Figure

6. 23

Figure

6. 24

Figure

6. 25

Mitral Valve Replacement

Technique

Technique for Chord Replacement

Sizing the Mitral Orifice

Valve Choices

Technique for Suture Insertion

Mitral Valve Replacement in Children

Figure

6. 26

Figure

6. 27

Figure

6. 28

Figure

6. 29

Figure

6. 30

Figure

6. 31

Figure

6. 32

Figure

6. 33

Figure

6. 34

Figure

6. 35

Figure

6. 36

Figure

6. 37

Figure

6. 38

Figure

6. 39

Figure

6. 40

Figure

6. 41

Late Annular Complications

Posterior Subannular Aneurysm

Paravalvular Leaks

Figure

6. 42

Atrial Closure

Interatrial Groove Approach

Transatrial Oblique Approach

Transatrial Longitudinal Septal Approach

Figure

6. 43

Figure

6. 44

Figure

6. 45

Chapter 7: Surgery of the Tricuspid Valve

Chapter 7 Introduction

Technical Considerations

Surgical Anatomy of the Tricuspid Valve and the Right Ventricle

Incision

Cannulation

Exposure of the Tricuspid Valve

Figure

7. 1

Figure

7. 2

Figure

7. 3

Functional Tricuspid Regurgitation

Technique

De Vega Annuloplasty

Ring Annuloplasty

Bicuspidization of the Tricuspid Valve

Figure

7. 4

Figure

7. 5

Figure

7. 6

Figure

7. 7

Organic Tricuspid Valve Disease

Rheumatic Tricuspid Disease

Technique of Tricuspid Commissurotomy

Degenerative Tricuspid Disease

Technique

Pacemaker Lead–Induced Tricuspid Regurgitation

Figure

7. 8

Tricuspid Valve Replacement

Tricuspid Valve Endocarditis

Figure

7. 9

Figure

7. 10

Figure

7. 11

Figure

7. 12

Chapter 8: Surgery of the Aorta

Acute Aortic Dissection

Figure

8. 1

Aortic Aneurysms

Replacement of the Ascending Aorta

Retrograde Cerebral Perfusion

Selective Antegrade Cerebral Perfusion

Technique

Clamping of the Aorta

Myocardial Protection

Figure

8. 2

Figure

8. 3

Figure

8. 4

Figure

8. 5

Figure

8. 6

Figure

8. 7

Figure

8. 8

Figure

8. 9

Aortic Root Replacement

The Interposition Technique

Techniques for Aortic Root Replacement with a Bioprosthesis

Aortic Valve-Sparing Root Replacement

Figure

8. 10

Figure

8. 11

Figure

8. 12

Figure

8. 13

Figure

8. 14

Figure

8. 15

Figure

8. 16

Figure

8. 17

Technique for Replacement of an Aortic Arch Aneurysm

Elephant-Trunk Technique

Figure

8. 18

Figure

8. 19

Figure

8. 20

Figure

8. 21

Figure

8. 22

Figure

8. 23

Figure

8. 24

Management of Type B Aortic Dissection

Technique for Replacement of the Descending Thoracic Aorta

Technique

Drainage of Cerebrospinal Fluid

Figure

8. 25

Figure

8. 26

Figure

8. 27

Figure

8. 28

Endovascular Repair of Descending Thoracic Aortic Aneurysms

Technique

Figure

8. 29

Figure

8. 30

Figure

8. 31

Figure

8. 32

Endovascular Repair of Aortic Arch Aneurysm

Technique

Figure

8. 33

Figure

8. 34

Chapter 9: Surgery for Coronary Disease

Chapter 9 Introduction

Technique for Internal Thoracic Artery Harvest

Figure

9. 1

Technique for Radial Artery Harvest

Endoscopic Radial Artery Harvest

Open Radial Artery Harvest

Figure

9. 2

Figure

9. 3

Techniques for Greater Saphenous Vein Harvest

Endoscopic Saphenous Vein Harvest

Open Greater Saphenous Vein Harvest

Skin Closure

Figure

9. 4

Figure

9. 5

Figure

9. 6

Figure

9. 7

Figure

9. 8

Figure

9. 9

Figure

9. 10

Figure

9. 11

Figure

9. 12

Figure

9. 13

Coronary Artery Bypass Grafting with Cardiopulmonary Bypass

Myocardial Preservation

General Principles of Arteriotomy

Positioning the Heart to Expose Coronary Arteries

Exposure of the Anterior Surface of the Heart

Exposure of the Right Coronary Artery and Branches

Exposure of the Circumflex Coronary Artery and Branches

Anastomotic Techniques

Alternate Distal Anastomotic Techniques

Interrupted Suture Technique

Sequential Anastomosis

Toe-First Anastomosis

Endarterectomy

Technique

Proximal Anastomoses

Technique for Proximal Anastomosis

Figure

9. 14

Figure

9. 15

Figure

9. 16

Figure

9. 17

Figure

9. 18

Figure

9. 19

Figure

9. 20

Figure

9. 21

Figure

9. 22

Figure

9. 23

Figure

9. 24

Figure

9. 25

Figure

9. 26

Figure

9. 27

Figure

9. 28

Figure

9. 29

Figure

9. 30

Figure

9. 31

Figure

9. 32

Figure

9. 33

Figure

9. 34

Figure

9. 35

Figure

9. 36

Figure

9. 37

Figure

9. 38

Figure

9. 39

Figure

9. 40

Figure

9. 41

Figure

9. 42

Figure

9. 43

Figure

9. 44

Figure

9. 45

Figure

9. 46

Figure

9. 47

Figure

9. 48

Figure

9. 49

Figure

9. 50

Figure

9. 51

Figure

9. 53

Figure

9. 52

Figure

9. 54

Figure

9. 55

Figure

9. 56

Figure

9. 57

Figure

9. 58

Figure

9. 59

Figure

9. 60

Figure

9. 61

Figure

9. 62

Figure

9. 63

Figure

9. 64

Figure

9. 65

Figure

9. 66

Figure

9. 67

Off-Pump Coronary Artery Bypass Grafting

Anesthetic Considerations

Anterior Vessels

Left Anterior Descending and Diagonal Branch

Ramus Intermedius and High Obtuse Marginal Branches

Posterior Vessels: Obtuse Marginal Branches

Posterior Vessels

Posterior Descending Artery

Distal Right Coronary Artery

Conduct of the Surgery

Transmyocardial Revascularization

Technique

Figure

9. 68

Figure

9. 69

Figure

9. 70

Figure

9. 71

Figure

9. 72

Figure

9. 73

Figure

9. 74

Figure

9. 75

Figure

9. 76

Figure

9. 77

Figure

9. 78

Figure

9. 79

Figure

9. 80

Considerations in Reoperative Coronary Artery Bypass Surgery

Chapter 10: Surgery for Mechanical Complications of Myocardial Infarction

Chapter 10 Introduction

Exposure and Cannulation of the Heart

Acute Myocardial Rupture

Ventricular Septal Rupture

Technique for the Surgical Treatment of a Ventricular Septal Defect

Figure

10. 1

Figure

10. 2

Figure

10. 3

Figure

10. 4

Papillary Muscle Rupture

Figure

10. 5

Surgical Ventricular Restoration

Technique

Figure

10. 6

Figure

10. 7

Figure

10. 8

Figure

10. 9

Figure

10. 10

Pseudoaneurysm

Ischemic Mitral Regurgitation

Intraaortic Balloon Pump

Technique for Placement of Intraaortic Balloon Pump

Figure

10. 11

Chapter 11: Heart Transplantation

Chapter 11 Introduction

Donor Selection

Preservation Solution

Donor Operation

Figure

11. 1

Figure

11. 2

Figure

11. 3

Recipient Surgery

Bicaval Technique

Figure

11. 4

Figure

11. 5

Figure

11. 6

Figure

11. 7

Chapter 12: Cardiac Tumors

Benign Tumors

Myxoma

Technique

Right Atrial Myxoma

Left Atrial Myxoma

Rhabdomyoma

Fibroma

Papillary Fibroelastoma

Lipoma

Figure

12. 1

Figure

12. 2

Figure

12. 3

Figure

12. 4

Malignant Tumors

Right Atrial Extension of Tumors below the Diaphragm

Chapter 13: Surgery for Atrial Fibrillation

Chapter 13 Introduction

Technique

Omitting Right Atrial Ablation Lines

Figure

13. 1

Figure

13. 2

Figure

13. 3

Figure

13. 4

Figure

13. 5

Figure

13. 6

Figure

13. 7

Figure

13. 8

Section Iii: Surgery for Congenital Heart Defects

Chapter 14: Patent Ductus Arteriosus

Incision

Surgical Anatomy

Technique for Exposing and Dissecting the Ductus Arteriosus

Technique for Dividing and Ligating the Ductus Arteriosus

Closure of the Ductus Arteriosus in Premature Infants

Completing the Operation

Thoracoscopic Closure of the Ductus Arteriosus

Transcatheter Closure of the Ductus Arteriosus

Calcification of the Ductus Arteriosus

Figure

14. 1

Figure

14. 2

Figure

14. 3

Figure

14. 4

Figure

14. 5

Figure

14. 6

Figure

14. 7

Figure

14. 8

Figure

14. 9

Figure

14. 10

Figure

14. 11

Anterior Approach to Closure of the Patent Ductus Arteriosus

Technique in Infants and Children

Technique in Adults

Figure

14. 12

Figure

14. 13

Figure

14. 14

Chapter 15: Coarctation of the Aorta

Chapter 15 Introduction

Incision

Surgical Anatomy

Figure

15. 1

Exposure of the Coarctation

Figure

15. 2

Coarctectomy

Technique with Partial Bypass

Figure

15. 3

Fig.

15. 4

Figure

15. 5

Subclavian Flap Angioplasty

Figure

15. 6

Figure

15. 7

Figure

15. 8

Figure

15. 9

Figure

15. 10

Long-Segment Coarctation

Figure

15. 11

Figure

15. 12

Figure

15. 13

Reversed Subclavian Angioplasty

Figure

15. 14

Extended Resection and Anastomosis

Figure

15. 15

Alternate Techniques

Chapter 16: Pulmonary Artery Banding

Chapter 16 Introduction

Incision

Technique

Figure

16. 1

Figure

16. 2

Adjustable Pulmonary Band Device

Pulmonary Artery Debanding

Figure

16. 3

Figure

16. 4

Chapter 17: Vascular Ring and Pulmonary Artery Sling

Chapter 17 Introduction

Figure

17. 1

Double Aortic Arch

Incision

Technique

Figure

17. 2

Figure

17. 3

Pulmonary Artery Sling

Incision

Median Sternotomy Technique

Figure

17. 4

Figure

17. 5

Figure

17. 6

Figure

17. 7

Chapter 18: Systemic Pulmonary Shunting

Chapter 18 Introduction

Types of Shunts

Modified Blalock–Taussig Shunt with Gore-Tex Tube Graft Interposition

Median Sternotomy Approach

Incision

Technique

Modified Right Blalock–Taussig Shunt

Incision

Technique

Figure

18. 1

Figure

18. 2

Figure

18. 3

Figure

18. 4

Figure

18. 5

Figure

18. 6

Central Shunt

Technique

Figure

18. 7

Figure

18. 8

Figure

18. 9

Prosthetic Ascending Aorta–Right Pulmonary Artery Shunt

Incision

Technique

Figure

18. 10

Figure

18. 11

Closure of Systemic Pulmonary Shunts

Right-Sided Modified Blalock–Taussig Shunts

Left-Sided Modified Blalock–Taussig Shunts

Central Shunt

Prosthetic Ascending Aorta–Right Pulmonary Artery Shunt

Waterston and Potts Shunts

Technique: Waterston Shunt

Technique: Potts Shunt

Figure

18. 12

Figure

18. 13

Chapter 19: Atrial Septal Defect

Chapter 19 Introduction

Figure

19. 1

Surgical Anatomy of the Right Atrium

Incision

Cannulation

Myocardial Preservation

Figure

19. 2

Sinus Venosus Atrial Septal Defect

Technique

Figure

19. 3

Figure

19. 4

Figure

19. 5

Figure

19. 6

Ostium Secundum Atrial Septal Defect

Technique

Figure

19. 7

Figure

19. 8

Figure

19. 9

Transcatheter Closure of Atrial Septal Defects

Common Atrium

Figure

19. 10

Figure

19. 11

Figure

19. 12

Right-Sided Partial Anomalous Pulmonary Venous Return

Figure

19. 13

Figure

19. 14

Left-Sided Partial Anomalous Pulmonary Venous Return

Technique

Figure

19. 15

Chapter 20: Total Anomalous Pulmonary Venous Connection

Chapter 20 Introduction

Technique

Intracardiac Type

Infracardiac Type

Supracardiac Type: Superior Approach

Figure

20. 1

Figure

20. 2

Figure

20. 3

Pulmonary Venous Obstruction

Conventional Technique

Sutureless Technique

Figure

20. 4

Figure

20. 5

Figure

20. 6

Figure

20. 7

Cor Triatriatum

Surgical Technique

Figure

20. 8

Chapter 21: Ventricular Septal Defect

Chapter 21 Introduction

Surgical Anatomy

Figure

21. 1

Figure

21. 2

Surgical Approach

Cannulation

Myocardial Preservation

Transatrial Approach to a Ventricular Septal Defect

Technique for Closure

Continuous Suture Technique

Figure

21. 3

Figure

21. 4

Figure

21. 5

Figure

21. 6

Figure

21. 7

Figure

21. 8

Figure

21. 9

Figure

21. 10

Figure

21. 11

Transventricular Approach to Ventricular Septal Defect

Interrupted Suture Technique

Figure

21. 12

Figure

21. 13

Figure

21. 14

Figure

21. 15

Figure

21. 16

Figure

21. 17

Subarterial Ventricular Septal Defect

Technique for Closure

Figure

21. 18

Muscular Ventricular Septal Defects

Chapter 22: Atrioventricular Septal Defect

Chapter 22 Introduction

Figure

22. 1

Figure

22. 2

Figure

22. 3

Ostium Primum Atrial Septal Defect

Incision

Cannulation

Myocardial Preservation

Technique

Figure

22. 4

Figure

22. 5

Figure

22. 6

Complete Atrioventricular Septal Defect

Cannulation

Two-Patch Technique

One-Patch Technique

One-Patch Technique with Direct Ventricular Defect Closure

Completion of the Operation

Figure

22. 7

Figure

22. 8

Figure

22. 9

Figure

22. 10

Figure

22. 11

Figure

22. 12

Figure

22. 13

Unbalanced Atrioventricular Septal Defect

Chapter 23: Right Ventricular Outflow Tract Obstruction

Chapter 23 Introduction

Double-Chambered Right Ventricle

Technique for Repair

Tetralogy of Fallot

Staged Approach

Technique for Complete Repair

Transatrial Technique

Transventricular Technique

Transpulmonary Approach to Pulmonic Valve and Annulus

Figure

23. 1

Figure

23. 2

Figure

23. 3

Figure

23. 4

Figure

23. 5

Figure

23. 6

Figure

23. 7

Figure

23. 8

Pulmonary Atresia and Ventricula Septal Defect

Technique for Complete Repair

Figure

23. 9

Absent Pulmonary Valve Syndrome

Technique

Figure

23. 10

Figure

23. 11

Figure

23. 12

Pulmonary Atresia, Intact Ventricular Septum

Surgical Technique

Definitive Repair

Pulmonary Stenosis and an Intact Ventricular Septum

Technique for Repair

Reoperation on Right Ventricular Outflow Tract

Technique

Figure

23. 13

Appendix

Sizing the Pulmonary Outflow Tract

Chapter 24: Left Ventricular Outflow Tract Obstruction

Congenital Aortic Stenosis

Valvotomy Technique

Figure

24. 1

Figure

24. 2

Resection of the Subvalvular Diaphragm

Figure

24. 3

Figure

24. 4

Hypertrophic Obstructive Cardiomyopathy

Figure

24. 5

Left Ventricular Tunnel Obstruction

Rastan-Konno Aortoventricular Septoplasty

Modified Rastan-Konno Procedure

Figure

24. 6

Figure

24. 7

Figure

24. 8

Figure

24. 9

Figure

24. 10

Figure

24. 11

Figure

24. 12

Supravalvular Aortic Stenosis

Figure

24. 13

Figure

24. 14

Figure

24. 15

Figure

24. 16

Figure

24. 17

Figure

24. 18

Figure

24. 19

Figure

24. 20

Figure

24. 21

Figure

24. 22

Figure

24. 23

Management of Left Ventricular Outflow Tract Obstruction Associated with Other Cardiac Anomalies

Interrupted Aortic Arch with Ventricular Septal Defect

Transposition of the Great Arteries with Ventricular Septal Defect and Left Ventricular Outflow Tract Obstruction

Technique

Figure

24. 24

Figure

24. 25

Figure

24. 26

Figure

24. 27

Figure

24. 28

Chapter 25: Transposition of the Great Vessels

Chapter 25 Introduction

Surgical Anatomy

Surgical Anatomy of the Right Atrium

Figure

25. 1

Figure

25. 2

The Arterial Switch Operation

Incision

Preparation

Cannulation

Transection of the Great Arteries

Coronary Artery Reimplantation

Reconstructing the Aorta

Intracardiac Repair

Reconstructing the Pulmonary Artery

Completing the Operation

Figure

25. 3

Figure

25. 4

Figure

25. 5

Figure

25. 6

Figure

25. 7

Figure

25. 8

Figure

25. 9

Figure

25. 10

Figure

25. 11

Figure

25. 12

Figure

25. 13

Congenitally Corrected Transposition of the Great Arteries

The Senning Procedure

Cannulation

Atrial Incision

The Atrial Septum

The Septal Flap

Sewing the Anterior Edge of the Posterior Segment

Sewing the Posterior Edge of the Anterior Segment

Figure

25. 14

Figure

25. 15

Figure

25. 16

Figure

25. 17

Figure

25. 18

Figure

25. 19

Figure

25. 20

Figure

25. 21

Figure

25. 22

Figure

25. 23

The Mustard Procedure

The Baffle

Technique for Preparing the Baffle

Right Atrial Incision

Excision of the Atrial Septum

Baffle Insertion

Figure

25. 24

Figure

25. 25

Figure

25. 26

Figure

25. 27

Figure

25. 28

Figure

25. 29

Figure

25. 30

Figure

25. 31

Figure

25. 32

Figure

25. 33

Figure

25. 34

Management of Late Complications of the Mustard Procedure

Hemodynamic Deterioration

Baffle Leaks

Obstruction to the Superior Vena Cava

Obstruction to the Inferior Vena Cava

Obstruction to the Pulmonary Veins

Figure

25. 35

Figure

25. 36

Hemi-Mustard/Rastelli

Figure

25. 37

Figure

25. 38

Figure

25. 39

Chapter 26: Aortopulmonary Window

Chapter 26 Introduction

Figure

26. 1

Technique

Figure

26. 2

Figure

26. 3

Chapter 27: Truncus Arteriosus

Chapter 27 Introduction

Figure

27. 1

Incision

Technique

Figure

27. 2

Figure

27. 3

Figure

27. 4

Figure

27. 5

Figure

27. 6

Figure

27. 7

Figure

27. 8

Figure

27. 9

Truncus Arteriosus with Interrupted Aortic Arch

Chapter 28: Ebstein Anomaly

Chapter 28 Introduction

Figure

28. 1

Presentation

Surgery for the Neonate

Technique

Figure

28. 2

Surgery beyond Infancy

Technique

Tricuspid Valve Replacement

Figure

28. 3

Figure

28. 4

Figure

28. 5

Figure

28. 6

Figure

28. 7

Figure

28. 8

Figure

28. 9

Figure

28. 10

Figure

28. 11

Figure

28. 12

Figure

28. 13

Figure

28. 14

Chapter 29: Interrupted and Hypoplastic Aortic Arch

Interrupted Aortic Arch

Figure

29. 1

Hypoplastic Aortic Arch

Incision

Cannulation

Technique: General

Technique: Interrupted Aortic Arch

Technique: Hypoplastic Aortic Arch

Completion of the Operation

Yasui Procedure

Figure

29. 2

Figure

29. 3

Figure

29. 4

Figure

29. 5

Figure

29. 6

Figure

29. 7

Figure

29. 8

Figure

29. 9

Figure

29. 10

Figure

29. 11

Figure

29. 12

Chapter 30: The Norwood Principle

Chapter 30 Introduction

Stage I Palliative Reconstruction for Hypoplastic Left Heart Syndrome

Incision

Cannulation

Procedure

Figure

30. 1

Figure

30. 2

Figure

30. 3

Aortic Arch Reconstruction

Patch Reconstruction Technique

Direct Anastomotic Arch Reconstruction

Figure

30. 4

Figure

30. 5

Figure

30. 6

Figure

30. 7

Figure

30. 8

Figure

30. 9

Figure

30. 10

Figure

30. 11

Figure

30. 12

Pulmonary Blood Flow

Right Ventricle-Pulmonary Artery Shunt

Systemic–Pulmonary Shunt

Figure

30. 13

Figure

30. 14

Figure

30. 15

Figure

30. 16

Figure

30. 17

Damus–Kaye–Stansel Procedure

Incision

Cannulation

Procedure

Completion of the Operation

Figure

30. 18

Figure

30. 19

Figure

30. 20

Chapter 31: The Fontan Principle

Chapter 31 Introduction

Pathophysiology of a Single Ventricle

Surgical Management

Management after the Neonatal Period

Bidirectional Glenn Procedure

Cannulation

Completing the Shunt

Figure

31. 1

Figure

31. 2

Bidirectional Glenn on Cardiopulmonary Bypass

Hemi-Fontan Procedure

Technique

Figure

31. 3

Figure

31. 4

Figure

31. 5

Figure

31. 6

Completion Fontan Procedure

Total Cavopulmonary Connection

Incision

Cannulation

Technique for the Extracardiac Fontan Procedure

Technique for a Lateral Tunnel Fontan Procedure

Completing the Operation

High-Risk Candidates for the Fontan Procedure

Technique

Figure

31. 7

Figure

31. 8

Figure

31. 9

Figure

31. 10

Figure

31. 11

Figure

31. 12

Figure

31. 13

Chapter 32: Coronary Artery Anomalies

Chapter 32 Introduction

Anomalous Left Coronary Artery from the Pulmonary Artery

Surgical Anatomy

Incision

Technique

Figure

32. 1

Figure

32. 2

Figure

32. 3

Figure

32. 4

Coronary Fistulae

Technique

Anomalous Coronary Artery Origin and Course between Great Vessels

Technique

Figure

32. 5