Friday, 28 December 2012

Pediatric Cardiac Surgery (PDA/ASD/VSD/TOF) India…



A ventricular septal defect (VSD) is an abnormal openning between the right ventricle and the left ventricle. VSD’s occur both as isolated lesions and in combination with other lesions, such as coarctation of the aorta. There are several types of VSD, categorized by their anatomic location. Some VSD’s may close spontaneously. Small muscular and small perimembranous VSD’s may close spontaneously in the first few years of life). AVSD that is being partially closed aortic valve tissue is a very dangerous situation and frequently requires surgical intervention. Pda surgery India, pediatric heart surgery India

Symptomatic patients are operated on when the lesion is discovered. Symptoms may include rapid breathing, shortness of breath, poor weight gain or poor exercise tolerance. In addition, any patient with significant involvement of the aortic valve (aortic insufficiency, or a leaking aortic valve) should be operated on expeditiously.
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Asymptomatic patients are operated on depending upon the amount of blood flow across the VSD (shunt). In general, patients with more than a 50% increase in blood flow through the lungs require repair.
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Ventricular septal defects are typically closed using the heart lung machine and by placing a patch over the defect. The patch may be a piece of fabric (Dacron) or the patient’s own tissue (pericardium) and it is secured with fine sutures.
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Tetralogy of Fallot (TOF)

Tetralogy of Fallot is caused by an abnormal location of the muscle that separates the aortic valve and the pulmonary valve in the normal heart (anterior and cephalad displacement – malalignment – of the infundibular septum).
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etralogy of Fallot requires surgical repair. Repair is accomplished, in the usual circumstance, electively between two and six months of age. Repair is indicated at any time when the child is symptomatic or has "Tet spells". Repair requires:
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  • closure of the ventricular septal defect with a patch
  • relief of pulmonary outflow tract obstruction, which may8 require resection of right ventricular muscle bundles, pulmonary valvotomy or excision
  • repair of associated defects
PDA (patent ductus arteriousus)

The patent ductus arteriousus is an unnatural connection when it remains open after birth. It connects the pulmonary (blue blood) circulation to the systemic (red blood) circulation. Blood flows across the ductus depending on the relative resistance on the pulmonary circulation (pulmonary vascular resistance, PVR) and systemic circulation (systemic vascular resistance, SVR). In the usual circumstance the SVR is high and the PVR is low and therefore, oxygenated blood flows from the systemic circulation into the pulmonary circulation. This results in increased pulmonary blood flow.
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  A patent ductus in an infant older than three months or so, or a symptomatic ductus in a premature infant or a neonate, is an indication for closure. Closure may be accomplished electively, usually before 2 or 3 years of age.
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