成人先心病(79p).pptVIP

* * * * * * * * * * * * * * * * * * * * * Repair of Tetralogy of Fallot Subclavian Artery to Pulmonary Artery Anastomosis (Blalock-Taussig Shunt) Ascending Aorta to Right Pulmonart Artery Anastomosis (Waterston-Cooley Shunt) Modified Blalock-Taussig Shunt Central Shunt Repair of Tetralogy of Fallot Tetralogy of Fallot Repair TOFLong term Results 20-30 year follow-up, 90% survival Majority of pts. In NYHA, I and II Women, 93% live births (7% had major cardiac defects) Right Ventricle Nonobstructed transannular patch often results in significant PI PI directly related to RV dilation. Decreased exercise tolerance Arrhythmias ? Sudden death TOF, Pulmonary Valve Complete relief of valvar/annular obstruction may result in significant PI requiring valve insertion TOF, Pulmonary Valve Insertion TOFArrhythmias Heart block Most patients have RBBB post-op RBBB + left anterior hemiblock may have slightly higher risk of heart block but not sudden death. SVT, 2-26% Ventricular tachycardia. Major cause of late sudden death post-op. Tetralogy of Fallot SUDDEN DEATH: The largest single cause of late mortality associated with repaired TOF TOFRepair in Adults Higher risk surgery than in children Higher incidence of pre and post-op arrhythmias Improves quality of life Repair in adults is warranted ! Single Ventricle Defects 1. Atretic (missing) Tricuspid Valve. 2. Hypoplastic Right Ventricle. 3. Ventricular septal defect. 4. Atrial septal defect. 5. Pulmonary Stenosis. Restricted Blood Flow to Lung – Tricuspid Atresia 1. Mitral valve atresia.2. Severe aortic valve stenosis. 3. Hypoplastic left ventricle. 4. Hypoplastic ascending aorta.5. Patent ductus arteriosus (PDA). Restricted Blood Flow to Body – Hypoplastic Left Heart Syndrome 1. Rudimentary right ventricle2. Ventricular septal defect (VSD)3. Transposition of the great arteries4.Double inlet left ventricle5.Atrial septal defect (ASD)6. Ventricular inversion7. Left aortic arch  Little or no Restrict