Cyanosis surgery

Cyanosis Microchapters
Home
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Cyanosis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Cyanosis surgery On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Cyanosis surgery All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Cyanosis surgery
CDC on Cyanosis surgery
Cyanosis surgery in the news
Blogs on Cyanosis surgery
Directions to Hospitals Treating Cyanosis
Risk calculators and risk factors for Cyanosis surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Recommendation for surgery in cyanotic heart disease

Abbreviations:

TGA: Transposition of great arteries; PDA: Patent ductus arteriosus  ; ASD: Atrial septal defect; VSD: Ventricular septal defect; TAPVR: Total anomalous pulmonary venous return; TOF: Tetralogy of fallot; CCTGA: Congenitally corrected transposition of the great arteries;

Recommendation for surgery in cyanotic congenital heart disease

Indications for repair of a scimitar vein in Anomalous pulmonary venous connection (TAPVC) (Class I, Level of Evidence B ):

❑ Decreased functional capacity ❑ Right ventricle enlagment ❑ Net left to right shunt or QP/QS > 1.5/1 ❑ Pulmonary artery systolic pressure less than 50% systemic pressure ❑ Pulmonary vascular resistance less than 1/3 of systemic resistance ❑ Repair at the time of closure of a sinus venous defect or ASD Definition: Abnormal connection between pulmonary veins and systemic veins leading to right heart volume overload such as ASD

Indications for surgery in Anomalous Pulmonary Venous Connections (TAPVC)(Class 2a, Level of Evidence B) :

❑ Asymptomatic adults with right ventricle volume overload ❑ Large left to right shunt( QP/QS > 1.5/1 ❑Pulmonary artery pressure <50% systemic pressure and pulmonary artery resistance <1/3 systemic resistance ❑ Evidence of Right ventricle volume overload and QP/QS>1.5/1

Indications for surgery repair or reoperation in Ebstein anomaly : (Class I, Level of Evidence B)

❑ Significant tricuspid regurgitation in the presence of the following: ❑ Heart failure symptoms ❑ Decreased functional capacity ❑ Progressive right ventricular dysfunction by echocardiography or cardiac MRI Definition: Malformation of tricuspid valve and right ventricle , atrialization of right ventricle, huge right atrium, accompanied by ASD, VSD, PS

Indications for surgery repair or reoperation in Ebstein anomaly:(Class 2a, Level of Evidence B)

❑ Significant tricuspid regurgitation in the presence of the following: ❑ Progressive right ventricle enlargement ❑ Systemic desaturation due to right to left shunt via ASD, VSD ❑ Paradoxical emboli through ASD, VSD ❑ Atrial tachycardia

Indication for Glenn anastomousis at the time of repair in Ebstein anomaly : (Class 2b, Level of Evidence B)

❑ Severe right ventricle dilation ❑ Severe right ventricular systolic dysfunctionbr ❑ Normal left ventricle function ❑ Normal left atrium or left ventricle end diastolic pressure Glenn anastomosis: Bidirectional superior cavopulmonary anastomosis which is the connection between superior vena cava and pulmonary artery with bypassing right artium and right ventricle

Indication for pulmonary valve replacement ( surgical or percutaneous in Tetralogy of fallot (Class I, Level of Evidence B):

❑ Symptomatic Moderate to severe pulmonary regurgitation after repaired TOF in which symptoms can not be explained otherwise. Definition: The combination of Right ventricle hypertrophy, VSD, PS, Overridding aorta

Indication for Pulmonary valve replacement ( surgical or percutaneous in Tetralogy of fallot : (Class 2a, Level of Evidence B)

❑ Asymptomatic moderate to severe pulmonary regurgitation after repaired TOF Pulmonary stenosis valvotomy: Surgical or balloon valvotomy in case of severe PS during infancy or childhood is recommended. Both of interventions can result pulmonary regurgitation and right ventricle dilation in the future and the need for pulmonary valve replacement.

Indication for Tricuspid valve replacement in CCTGA : (Class I, Level of Evidence B)

❑ Symptomatic severe tricuspid regurgitaion accompanied by preserved or mildly systolic dysfunction of systemic ventricle

Indication for Tricuspid valve replacement in CCTGA : (Class 2a, Level of Evidence C)

❑ Asymptomatic severe tricuspid regurgitation accompanied by mildly dilated systemic ventricle

Indication for conduit intervention/replacement in CCTGA : (Class 2b, Level of Evidence B)

❑ Symptomatic subpulmonary left ventricle to pulmonary artery conduit dysfunction