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Septal Defects

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Surgical Management of Congenital Heart Disease II

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Abstract

Atrial septal defect

An atrial septal defect is defined as an opening in the interatrial septum. This chapter elaborates:

1. Indication for surgery

2. Approach and cardiopulmonary bypass strategy

3. Secundum atrial septal defect closure through a postero-lateral thoracotomy (video)

Atrioventricular Septal Defects

Atrioventricular septal defects are characterized by varying degrees of incomplete development of the septal tissue surrounding the atrioventricular junction. This chapter elaborates:

1. Anatomy

2. Indication for surgery

3. Approach and cardiopulmonary bypass strategy

4. Correction of partial atrioventricular septal defect (video)

5. Correction of complete atrioventricular septal defect by two-patch technique (video)

6. Biventricular repair by ventricular septation and a double mechanical valve replacement in a complete atrioventricular septal defect (video)

7. Posterior aortic translocation and correction of complete atrioventricular septal defect by two-patch technique (video)

Truncus Arteriosus Communis

Truncus arteriosus is an uncommon congenital heart anomaly in which a single arterial trunk arises from the heart, giving origin to the coronary arteries, the pulmonary arteries, and the systemic arterial circulation. This chapter elaborates:

1. Anatomy

2. Indication for surgery

3. Approach and cardiopulmonary bypass strategy

4. Truncus arteriosus communis type A1 repair (video)

5. Truncus arteriosus communis type A1 ½ repair (video)

6. Truncus arteriosus communis type A2 repair (video)

Aortopulmonary window

An aortopulmonary window is a communication between the main pulmonary artery and the ascending aorta, in the presence of two separate semilunar valves. This chapter elaborates:

1. Anatomy

2. Indication for surgery

3. Approach and cardiopulmonary bypass strategy

4. Repair of the aortopulmonary window with two patches (video)

5. Fenestrated patch closure of the aortopulmonary window (video)

6. Repair of the aortopulmonary window with interrupted aortic arch (video)

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Recommended References

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Authors and Affiliations

  1. Department of Cardiac Surgery, German Pediatric Heart Center, Sankt Augustin, Arnold Janssen Straße 29, 53757, Sankt Augustin, Germany

    Viktor Hraška MD Ph.D. & Peter Murín MD

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  1. Viktor Hraška MD Ph.D.
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  2. Peter Murín MD
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Electronic supplementary material

Secundum Atrial Septal Defect Closure Through a Postero-Lateral Thoracotomy

Clip 1: Preoperative findings.

Clip 2: Postero-lateral thoracotomy approach.

Clip 3: Bypass initiation and closure of the atrial septal defect.

Clip 4: Postoperative echocardiogram.

Fullversion

Correction of a Partial Atrioventricular Septal Defect

Clip 1: Preoperative findings.

Clip 2: Orientation and anatomy.

Clip 3: Intracardiac anatomy.

Clip 4: Closure of the right-sided zone of apposition.

Clip 5: Closure of the left-sided zone of apposition – the mitral valve cleft.

Clip 6: Closure of the primum atrial septal defect.

Fullversion

Correction of a Complete Atrioventricular Septal Defect Using a Two-Patch Technique

Clip 1: Preoperative findings.

Clip 2: Orientation and anatomy.

Clip 3: Inspection of the intracardiac anatomy.

Clip 4: Inspection of the leaflets and subvalvar apparatus.

Clip 5: Closure of the ventricular septal defect.

Clip 6: Separation of the common atrioventricular valves into the mitral and the tricuspid components.

Clip 7: Closure of the left-sided zone of apposition – the mitral valve cleft.

Clip 8: Closure of the primum atrial septal defect and reconstruction of the right-sided valve.

Clip 9: Postoperative result.

Fullversion

Correction of a Complete Atrioventricular Septal Defect Using a Two-Patch Technique

Clip 1: Preoperative findings.

Clip 2: Orientation and anatomy.

Clip 3: Inspection of the intracardiac anatomy.

Clip 4: Closure of the ventricular septal defect.

Clip 5: Separation of the common atrioventricular valves into the mitral and the tricuspid components.

Clip 6: Closure of the left-sided zone of apposition – the mitral valve cleft.

Clip 7: Closure of the primum atrial septal defect.

Fullversion

Biventricular Repair by Ventricular Septation and a Double Mechanical Valve Replacement in a Complete Atrioventricular Septal Defect

Clip 1: Preoperative findings.

Clip 2: Ventricular septation and double valve replacement.

Clip 3: Postoperative findings.

Fullversion

Posterior Aortic Translocation and Correction of a Complete Atrioventricular Septal Defect Using a Two-Patch Technique

Clip 1: Preoperative findings.

Clip 2: Orientation and anatomy.

Clip 3: Mobilization of the coronaries.

Clip 4: Harvesting of the aortic root.

Clip 5: Lecompte maneuver.

Clip 6: Transection of the infundibular septum.

Clip 7: Posterior translocation of the aortic root.

Clip 8: Reinforcement of the aortic root.

Clip 9: Reconstruction of the ascending aorta.

Clip 10: Closure of the inlet part of the ventricular septal defect.

Clip 11: Reconstruction of the left ventricular outflow tract.

Clip 12: Downsizing of the right ventricular outflow tract.

Clip 13: Reconstruction of the atrioventricular valves.

Clip 14: Septation of the common atrium.

Clip 15: Reconstruction of the right ventricular outflow tract.

Clip 16: Final Result.

Clip 17: Postoperative Findings.

Fullversion

Truncus Arteriosus Communis Type A1 Repair

Clip 1: Preoperative findings.

Clip 2: Orientation and anatomy.

Clip 3: Cannulation.

Clip 4: Inspection of the intracardiac anatomy.

Clip 5: Transection of the common arterial trunk.

Clip 6: Inspection of the truncal valve.

Clip 7: Reduction plasty of the ascending aorta.

Clip 8: Re-anastomosis of the aorta.

Clip 9: Closure of the ventricular septal defect.

Clip 10: Conduit implantation.

Clip 11: Final result.

Clip 12: Postoperative echocardiogram.

Fullversion

Truncus Arteriosus Communis Type A1 ½ Repair

Clip 1: Preoperative findings.

Clip 2: Orientation and anatomy.

Clip 3: Cannulation.

Clip 4: Right ventriculotomy.

Clip 5: Closure of the ventricular septal defect.

Clip 6: Transection of the common arterial trunk.

Clip 7: Anastomosis of the distal conduit.

Clip 8: Reconstruction of the ascending aorta.

Clip 9: Anastomosis of the proximal conduit.

Clip 10: Final result.

Clip 11: Postoperative findings.

Fullversion

Truncus Arteriosus Communis Type A2 Repair

Clip 1: Preoperative findings.

Clip 2: Orientation and anatomy.

Clip 3: Mobilisation of the pulmonary arteries.

Clip 4: Reconstruction of the neoaorta.

Clip 5: Closure of the ventricular septal defect.

Clip 6: Anastomosis of the conduit.

Clip 7: Final result.

Clip 8: Postoperative findings.

Fullversion

Truncus Arteriosus Communis Type A 4 Repair

Clip 1: Preoperative findings.

Clip 2: Setting up of the cardiopulmonary bypass.

Clip 3: Cannulation.

Clip 4: Mobilisation of the descending aorta.

Clip 5: Closure of the ventricular septal defect.

Clip 6: Transection of the pulmonary trunk.

Clip 7: Anteposition of the pulmonary arteries.

Clip 8: Partial end-to-side anastomosis of the ascending and the descending aorta.

Clip 9: Reconstruction of the aortic arch.

Clip 10: Direct anastomosis of the pulmonary bifurcation with the right ventriculotomy.

Clip 11: Final result.

Clip 12: Postoperative findings.

Fullversion

Bilateral Pulmonary Artery Banding in a Preterm Baby with Truncus Arteriosus Type A2

Clip 1: Banding of both branches of the pulmonary arteries.

Repair of the Truncal Valve Regurgitation

Clip 1: Preoperative findings

Clip 2: Inspection of the geometry and function of the neoaortic valve.

Clip 3: Reconstruction of the neo-aortic valve.

Clip 4: Final result.

Clip 5: Postoperative findings.

Fullversion

Pericardial Patch Replacement of the Dysplastic Truncal Cusps

Clip 1: Preoperative findings.

Clip 2: Orientation and anatomy.

Clip 3: Resection of the dysplastic cusps.

Clip 4: Replacement of the left-sided cusp.

Clip 5: Replacement of the posterior cusp.

Clip 6: Postoperative finding.

Fullversion

Repair of a ubcommissural and Intramural Left Coronary Artery in Truncus Arteriosus Type A1 ½

978-3-662-44070-4_5_MOESM114_ESM.mp4

Clip 1: Preoperative findings.

Clip 2: Detachment and reimplantation of the aortic cusp under the offspring of the left coronary artery.

Clip 3: Postoperative finding.

Fullversion

Clip 1: Preoperative findings.

Hemitruncus Arteriosus – Anomalous Origin of the Right Pulmonary Artery from the Ascending Aorta

Clip 1: Preoperative findings.

Clip 2: Orientation and anatomy.

Clip 3: Detachment of the right pulmonary artery.

Clip 4: Reimplantation of the right pulmonary artery into the pulmonary trunk.

Clip 5: Final result.

Clip 6: Postoperative finding.

Fullversion

Repair of an Aortopulmonary Window Using Two Patches

Clip 1: Preoperative findings.

Clip 2: Orientation and anatomy.

Clip 3: Transection of the aortopulmonary window.

Clip 4: Reconstruction of the ascending aorta and the pulmonary trunk.

Clip 5: Resection of the coarctation and reconstruction of the aortic arch.

Clip 6: Postoperative result.

Fullversion

Fenestrated Patch Closure of an Aortopulmonary Window

Clip 1: Preoperative findings.

Clip 2: Orientation and anatomy.

Clip 3: Opening of the aortopulmonary window.

Clip 4: Fenestrated patch septation of the great vessels.

Clip 5: Final result.

Clip 6: Postoperative findings.

Fullversion

Repair of an Aortopulmonary Window with Interrupted Aortic Arch

Clip 1: Preoperative findings.

Clip 2: Orientation and anatomy.

Clip 3: Cannulation.

Clip 4: Transection of the aortopulmonary window.

Clip 5: Antegrade cerebral perfusion.

Clip 6: Partial end-to-side anastomosis of the aortic arch.

Clip 7: Patch enlargement of the aortic arch.

Clip 8: Reconstruction of the pulmonary trunk.

Clip 9: Final result.

Clip 10: Postoperative findings.

Fullversion

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Hraška, V., Murín, P. (2015). Septal Defects. In: Surgical Management of Congenital Heart Disease II. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-44070-4_5

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  • DOI: https://doi.org/10.1007/978-3-662-44070-4_5

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-44069-8

  • Online ISBN: 978-3-662-44070-4

  • eBook Packages: MedicineMedicine (R0)

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