先心病的非手术治疗.pptVIP

CHD 8 per 1000 live births ? million patients in the US with repaired, palliated or unoperated CHD Advances in Mx increasing survival Trend to early repair Anesthetic mx complicated by diversity of CHD and wide spectrum of surgeries performed CHD adds significantly to the mortality of non-cardiac surgery SPECTRUM OF CHD SPECTRUM OF INTERVENTION True correction PDA, ASD, some VSD Correction with residua Some VSD, Coartation of the Aorta Correction with sequelae TOF, TGA Complications Arrhythmias or conduction abn. from incisions or sutures Palliative surgery B-T shunt, PA banding Cath lab interventions Cure or palliation ISSUES TO RESOLVE Nature of repair Age and era of repair Ventricular outflow obstruction Ventricular dysfunction Arrhythmias and conduction abnormalities Hypoxemia Pulmonary Hypertension Endocarditis prophylaxis Extracardiac problems Monitoring NATURE OF THE REPAIR ANATOMIC – LV to aorta RV to pulm artery circulation in series cyanosis corrected a) Simple Recon – ASD, VSD, PDA treat as for normal heart b) Complex – outflow tract (TOF, AS, PS, coarct) conduits or baffles (PA) septum and AV valve repair NATURE OF THE REPAIR 2. PHYSIOLOGICAL – single or 2 ventricle circ in series cyanosis relieved significant sequelae a) Two ventricle repair - RV is systemic LV is pulmonary b) Single ventricle TA, HRHS, double inlet/outlet ventricles Venous return directly to PA success: RA to LA pressure grad, n AV valve, vent fn serious potential problems AGE AND ERA OF REPAIR The trend since the 80’s has shifted to early definitive repair, without prior palliation Also since the 80’s TGA is repaired w