Surgical Procedures
1. Fontan
Definition:
A conduit inserted between RA appendage and pulmonary artery. Prerequisits include normal pulmonary resistance, pulmonary arteries of adequate size, sinus rhythm, and absence of significant mitral regurgitation.
Advantages:
Normal cardiac index post-op, increased ejection fraction, greate ventricular end diastolic volume, increased PA pressures during exercise, increased pulmonary blood flow with normal inspiration.
Complications:
Protein losing enteropathy, thrombloembolic complications, slower than normal flow through caval veins predisposes patient to thrombus formation.
Uses:
Used to correct tricuspid atresia and all types of univentricular atrioventricular connections. Post-op problems include obstruction between RA and PA, and LA hypertension.
2. Rastelli
Definition: Consists of VSD closure to direct LV to aorta and connect RV to PA. Designed to achieve both physiologic and anatomic correction.
Advantages:
LV function is normal, normal contractility, normal dimensions, and normal wall thickness, ejection fraction is normal.
Complications: PA distension occurs in about 12% of patients, early mortality (within 1st 6 months) is 35%. RV outflow obstruction may develop.
Uses: VSD, left ventricular outflow obstrucion, truncus arteriosus, and pseudotruncus.
3. Jatene
Definition:
Arterial switch. PA and aorta are interchanged reversing the outflow of the heart and creating an anatomical repair.
Advantages:
Designed to correct clinical manifestations associated with the transposition of the great arteries.
Complications:
Coronary ostial stenosis, LV size and contractility is lowered in 2-3 year intervals.
Uses:
Used to correct transposition of the great arteries.
4. Le Compte
Definition:
LV connected to aorta, and RV connected to PA. RV to pulmonary trunck pahtway is completed by suturing into place a roof of perricardium, Dacron, or Gore-Tex.
Advantages:
Designed to correct clinical manifestations associated with the transposition of the great arteries.
Complications:
Same as with Jatene procedure.
Uses:
Used to correct transposition of the great arteries.
5. Norwood
Definition:
Performed by:
1) Placing an unobstructed aorta over RV functionally.
2) Maintaining adequate coronary flow.
3) Providing appropriate pulmonary blood flow.
Advantages:
Increases the flow of oxygenated blood to systemic circulation and improves pulmonary blood flow.
Complications:
Very small size of the ascending aorta (less than 2mm in diameter) has been implicated as an important risk factor for post-op mortality. Pre-op tricuspid regurgitation has been correlated with an increased post-op mortality.
Uses:
Used to correct aortic atresia and hypoplastic left heart.
6. Ross
Definition:
The Ross procedure is an aortic valve replacement that utilizes a patient's own pulmonary valve to replace his or her damaged aortic valve.
Advantages:
Anticoagulation not required, low incidence of thromboembolic complications, low incidence of endocarditis, growth of the autograft with the heart.
Disadvantages:
Technically demanding operation.
Complications:
Some reoperations required for pulmonary avlve allograft degeneration.
Uses:
To correct conditions associated with aortic valve abnormalities.
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