Cyanosis surgery

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

Recommendation for surgery in cyanotic heart disease

[[ Recommendation for surgical repair of cyanotic congenital heart disease

Indications for repair of a scimitar vein in [[Anomalous pulmonary venous connection (Class I, Level of Evidence B ,Abnormal connection between pulmonary veins and systemic veins causing right heart volume overload such as ASD):

❑ 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

Indications for surgery in anomalous Pulmonary Venous Connections(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

Synchronized cardioversion : (Class I, Level of Evidence B)

❑ Highly effective in termination of AVRT ❑ In unstable hemodynamic or stable hemodynamic and ineffectiveness of vagal maneuver or adenosin is recommended ❑ Avoidance of complications associated antiarrhythmic drugs ❑ In the presence of PVC or PAC just after cardioversion, antiarrhythmic drugs is recommended for prevention of restarting AVRT ❑ In the presence of hemodynamically unstable and preexcited AF, synchronized cardioversion is recommended

Ibutilide or intravenous procainamide:(Class I, Level of Evidence C)

❑ effective in hemodynamic stable and preexcited AF by slowing conduction over the accessory pathway Contraindications: Compromised left ventricular function

Intravenous diltiazem,verapamil ,beta blockers : (Class 2a, Level of Evidence B-C)

❑ Effective for acute treatment of orthodromic AVRT with out pre-excitation on resting ECG during sinus rhythm(LOR=B) ❑ Intravenous diltiazem or verapamil effectively terminate 90% to 95% of AVRT with out pre-excitation on their resting sinus-rhythm ECG ❑ Hypotension may occur in 3% patients receiving Intravenous diltiazem or verapamil ❑ Intravenous beta blocker are effective for terminating AVRT with low risk of associated complications(LOR=C)

Intravenous betablockers,diltiazem,verapamil (Class 2b, Level of Evidence B):

❑ Acute termination of orthodromic AVRT with pre-excitation on resting ECG with out response to other treatment ❑ Complication is enhancing conduction over the accessory pathway if the AVRT converts to AF during administration of the medication

Intravenous digoxin,intravenous amiodarone,intravenous or oral beta blockers,diltiazem,verapamil : (Class 3, Harm, Level of Evidence B)

❑ Harmful in acute termination of peexcitated AF due to increased risk of ventricular fibrillation by these mechanisms: ❑ Increased conduction over the accessory pathway and slowing or blocking conduction over AV node ❑ Deceased refractory period of accessory pathway by digoxin ❑ Increased cathecolamin due to drug induced hypotension such as amiodarone, beta blocker, verapamil, diltiazem