BOOK
Kirklin/Barratt-Boyes Cardiac Surgery E-Book
Nicholas T. Kouchoukos | Eugene H. Blackstone | Frank L. Hanley | James K Kirklin
(2012)
Additional Information
Book Details
Abstract
Now in its 4th edition, Kirklin/Barratt-Boyes Cardiac Surgery remains your indispensable source for definitive, state-of-the-art answers on every aspect of adult and pediatric cardiac surgery. This dynamic medical reference thoroughly and systematically covers the full range of new and classic surgical procedures—including the latest alternate and minimally invasive surgical techniques—and presents the up-to-date clinical evidence you need to make effective management decisions.
- Be certain with expert, dependable, accurate answers for every stage of your career from the most comprehensive, definitive text in the field!
- Get comprehensive coverage of all areas of cardiac surgery, including ischemic, valvular, and congenital heart disease; cardiac tumors; constrictive pericarditis; thoracic aortic surgery; cardiac transplantation; coronary artery disease; aortic valve disease; cardiac rhythm disturbances; heart failure and transplantation; disease of the thoracic aorta; tetralogy of Fallot; anesthesia; and postoperative care.
- Stay current with the latest advancements and practices. Comprehensive updates throughout include new information on endovascular management of thoracic aorta disease; new data on clinical outcomes; the most recent minimally invasive procedures; non-invasive CT angiography; new alternative surgical approaches to mitral valve surgery; and many other hot topics!
- Make the most well-informed decisions and achieve optimal outcomes by exploring each condition's natural history; diagnostic criteria; indications for surgery; operative techniques; and follow-up care.
- Reference information quickly thanks to a new, streamlined format.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| e9781416063919v1.pdf | 1 | ||
| Front cover | 1 | ||
| Expert Consult page | 2 | ||
| Kirklin/Barratt-Boyes Cardiac Surgery | 3 | ||
| Copyright page | 6 | ||
| Contributors | 7 | ||
| Acknowledgments | 9 | ||
| Preface to Fourth Edition | 11 | ||
| Table of Contents | 13 | ||
| I General Considerations | 15 | ||
| 1 Anatomy, Dimensions, and Terminology | 15 | ||
| Cardiac Chambers and Major Vessels | 16 | ||
| Right Atrium | 16 | ||
| Left Atrium | 16 | ||
| Right Ventricle | 18 | ||
| Left Ventricle | 20 | ||
| Myoarchitecture of the Ventricles | 21 | ||
| Great Arteries | 25 | ||
| Atrial Septum | 25 | ||
| Ventricular Septum | 25 | ||
| Muscular Septum | 25 | ||
| Membranous Septum | 25 | ||
| Atrioventricular Septum | 25 | ||
| Conduction System | 26 | ||
| Sinus Node | 26 | ||
| Internodal Pathways | 26 | ||
| Atrioventricular Node | 26 | ||
| Bundle of His and Bundle Branches | 27 | ||
| Cardiac Valves | 27 | ||
| Mitral Valve | 30 | ||
| Tricuspid Valve | 32 | ||
| Aortic Valve | 33 | ||
| Pulmonary Valve | 33 | ||
| Coronary Arteries | 34 | ||
| Left Main Coronary Artery | 35 | ||
| Left Anterior Descending Coronary Artery | 35 | ||
| Left Circumflex Coronary Artery | 37 | ||
| Right Coronary Artery | 37 | ||
| Coronary Arterial Supply to Specialized Areas of the Heart | 37 | ||
| Dimensions of Normal Cardiac and Great Artery Pathways | 39 | ||
| Dimensions of the Pathway | 39 | ||
| Normalization of Pathway Dimensions | 40 | ||
| Standardization of Dimensions | 40 | ||
| Dimensions of the Pulmonary Arteries | 43 | ||
| Relating Dimensions to Outcome | 43 | ||
| Dimensions of Normal Ventricles | 43 | ||
| Terminology and Classification of Heart Disease | 44 | ||
| Situs of the Thoracic Viscera and Atria | 44 | ||
| Situs of the Ventricles | 45 | ||
| Completeness of the Ventricles | 45 | ||
| Dominance of the Ventricles | 45 | ||
| Cardiac Connections | 45 | ||
| Cardiac and Arterial Positions | 46 | ||
| Atrioventricular Flow Pathways | 46 | ||
| Defects and Abnormalities | 46 | ||
| Conventional Diagnoses | 46 | ||
| Symbolic Convention of Van Praagh | 47 | ||
| 1A Morphogenesis | 47 | ||
| 1B Normal Pathway Dimensions from Autopsy Specimens | 47 | ||
| 1C Normal Pathway Dimensions from Cineangiography | 50 | ||
| 1D Normal Pathway Dimensions from Two-Dimensional Echocardiography | 53 | ||
| 1E Comparison of Pathway Dimensions from Different Measurement Modalities | 60 | ||
| Comparisons between Cineangiographic Dimensions and Those Obtained at Autopsy | 60 | ||
| Comparisons between Two-Dimensional Echocardiographic Dimensions and Those Obtained at Autopsy | 60 | ||
| Other Comparisons | 60 | ||
| 1F Comparison of Methods for Normalizing the Dimensions of Pulmonary Arteries | 62 | ||
| 1G Normal Ventricular Volume, Masses, and Dimensions from Different Measurement Modalities | 63 | ||
| 1H Illustrative Models of Congenital Heart Disease | 75 | ||
| References | 75 | ||
| A | 75 | ||
| B | 76 | ||
| C | 76 | ||
| D | 76 | ||
| E | 76 | ||
| F | 77 | ||
| G | 77 | ||
| H | 77 | ||
| J | 77 | ||
| K | 77 | ||
| L | 77 | ||
| M | 78 | ||
| N | 78 | ||
| O | 78 | ||
| P | 78 | ||
| R | 78 | ||
| S | 78 | ||
| T | 79 | ||
| U | 79 | ||
| V | 79 | ||
| W | 79 | ||
| Y | 80 | ||
| Z | 80 | ||
| 2 Hypothermia, Circulatory Arrest, and Cardiopulmonary Bypass | 81 | ||
| Section I Hypothermic Circulatory Arrest | 82 | ||
| Historical Note | 82 | ||
| Hypotheses | 83 | ||
| Oxygen Consumption During Hypothermia | 83 | ||
| Relationship between Oxygen Consumption and Body Temperature | 83 | ||
| Total Body Oxygen Consumption after Surface Cooling | 84 | ||
| Oxygen Consumption during Hypothermia in Tissue Slices and Isolated Organs | 84 | ||
| Other Phenomena During Hypothermia and Circulatory Arrest | 86 | ||
| No-Reflow Phenomenon | 86 | ||
| Changes in Plasma Volume | 86 | ||
| Damaging Effects of Circulatory Arrest During Hypothermia | 86 | ||
| Brain Function and Structure: Risk Factors for Damage | 86 | ||
| Temperature and Duration | 87 | ||
| Characteristics of the Cooling Process | 87 | ||
| Cerebral Blood Flow during Cooling and Rewarming | 88 | ||
| Biochemical Milieu | 88 | ||
| Electroencephalogram Before Arrest | 89 | ||
| Patient Age | 89 | ||
| Effects of Brain Damage | 90 | ||
| Evidence of Gross Neurologic Damage | 90 | ||
| Postoperative Intellectual Capacity | 91 | ||
| Spinal Cord Function | 92 | ||
| Renal Function and Structure | 92 | ||
| Experimental Studies | 92 | ||
| Studies in Humans | 93 | ||
| Liver Function | 93 | ||
| Safe Duration of Circulatory Arrest | 93 | ||
| Section II Whole-Body Perfusion during Cardiopulmonary Bypass | 94 | ||
| Historical Note | 94 | ||
| Uniqueness of Cardiopulmonary Bypass | 95 | ||
| Controlled Variables | 95 | ||
| Arterial Output to the Patient | 95 | ||
| Venous Input from the Patient | 96 | ||
| Vacuum-Assisted Venous Return | 96 | ||
| Siphon (Gravity) Drainage | 96 | ||
| Venous Pumping | 96 | ||
| Gas Exchange | 96 | ||
| Arterial Oxygen Levels | 97 | ||
| Arterial Carbon Dioxide Pressure | 97 | ||
| Heparin Levels | 98 | ||
| Perfusate | 99 | ||
| Diluent | 99 | ||
| Hemoglobin Concentration | 99 | ||
| Albumin Concentration | 100 | ||
| Other Additives | 100 | ||
| Changes during Cardiopulmonary Bypass | 101 | ||
| Total Systemic Blood Flow | 101 | ||
| Arterial Pressure Waveform | 102 | ||
| Systemic Venous Pressure | 102 | ||
| Pulmonary Venous Pressure | 103 | ||
| Temperature | 103 | ||
| Response Variables | 103 | ||
| Whole-Body (Nonspecific) Inflammatory Response to Use of a Pump-Oxygenator | 103 | ||
| Humoral Response | 104 | ||
| Cellular Response | 104 | ||
| Metabolic Response | 105 | ||
| Details of the Whole-Body Inflammatory Response | 105 | ||
| Neutrophil Activation | 105 | ||
| Platelet Response | 105 | ||
| Complement Activation | 107 | ||
| Kallikrein-Bradykinin Activation | 108 | ||
| Coagulation Cascade | 108 | ||
| Fibrinolytic Cascade | 108 | ||
| Arachidonic Acid Cascade | 109 | ||
| Cytokines | 109 | ||
| Other Mediators of Inflammation | 109 | ||
| Protein Denaturation | 109 | ||
| Oxygen Consumption | 109 | ||
| Total Body Oxygen Consumption | 109 | ||
| Cerebral Oxygen Consumption | 110 | ||
| Mixed Venous Oxygen Levels | 110 | ||
| Metabolic Acid-Base Status | 110 | ||
| Hemolysis | 110 | ||
| Systemic Vascular Resistance and Arterial Blood Pressure | 111 | ||
| Distribution of Blood Flow | 112 | ||
| Cerebral Blood Flow | 112 | ||
| Cutaneous Blood Flow | 112 | ||
| Venous Tone | 113 | ||
| Catecholamine Response | 113 | ||
| Adrenal Cortical Hormones | 113 | ||
| Vasopressin | 113 | ||
| Body Composition | 113 | ||
| Thermal Balance | 113 | ||
| Agents of Damage | 114 | ||
| Foreign Surfaces | 114 | ||
| Shear Stresses | 115 | ||
| Incorporation of Foreign Substances | 115 | ||
| Heparin | 115 | ||
| Protamine | 116 | ||
| Prevention of Undesirable Responses | 116 | ||
| Safe Duration of Total Cardiopulmonary Bypass | 116 | ||
| Section III Clinical Methodology of Cardiopulmonary Bypass | 117 | ||
| General Comments and Strategy | 117 | ||
| Positioning Monitoring Devices | 117 | ||
| Positioning Patient | 117 | ||
| Preparing Surgical Field | 117 | ||
| Incision | 117 | ||
| Primary Median Sternotomy | 117 | ||
| Alternative Primary Incisions | 118 | ||
| Secondary Median Sternotomy | 118 | ||
| Preparation For Cardiopulmonary Bypass | 119 | ||
| Siting and Purse-String Sutures for Aortic Cannulation | 119 | ||
| Siting and Purse-String Sutures for Venous Cannulation | 120 | ||
| Heparinization and Later Protamine Administration | 120 | ||
| Arterial Cannulation | 121 | ||
| Venous Cannulation | 121 | ||
| Commencing Cardiopulmonary Bypass and Left Heart Venting | 122 | ||
| Cardiopulmonary Bypass During Operation and Rewarming | 122 | ||
| De-Airing The Heart | 122 | ||
| Completing Cardiopulmonary Bypass | 123 | ||
| Positioning Chest Tubes | 124 | ||
| Completing Operation | 124 | ||
| Pump-Oxygenator | 124 | ||
| Components | 124 | ||
| Priming Volume | 125 | ||
| Miniaturized Cardiopulmonary Bypass Circuits | 125 | ||
| Special Situations and Controversies | 125 | ||
| One Versus Two Venous Cannulae | 125 | ||
| Cardiopulmonary Bypass Established by Peripheral Cannulation | 126 | ||
| Femoral Cannulation | 126 | ||
| Axillary Artery Cannulation | 126 | ||
| Other Sites | 126 | ||
| Indications | 126 | ||
| Blood Conservation | 126 | ||
| Left Superior Vena Cava | 127 | ||
| Other Systemic Venous Anomalies | 127 | ||
| Left Atrial Pressure Monitoring | 127 | ||
| Alternative Primary Incisions | 127 | ||
| Minimal Sternotomy and Thoracotomy | 127 | ||
| Right Anterolateral Thoracotomy | 129 | ||
| Left Thoracotomy | 129 | ||
| Port Access | 129 | ||
| Section IV Clinical Methodology of Hypothermic Circulatory Arrest and Its Alternatives | 129 | ||
| General Comments and Strategy | 129 | ||
| Adults | 129 | ||
| Neonates, Infants, and Children | 130 | ||
| Technique in Adults | 130 | ||
| Technique in Neonates, Infants, and Children | 130 | ||
| Hypothermic Circulatory Arrest | 130 | ||
| Preparation for Cardiopulmonary Bypass | 130 | ||
| Cannulation | 130 | ||
| Cardiopulmonary Bypass for Cooling | 131 | ||
| Circulatory Arrest | 131 | ||
| Cardiac Operation | 131 | ||
| Rewarming | 131 | ||
| Continuous Antegrade Cerebral Perfusion | 131 | ||
| Preparation for Cardiopulmonary Bypass | 131 | ||
| Cannulation | 131 | ||
| Cardiopulmonary Bypass and Cooling | 132 | ||
| Preparation for Cerebral Perfusion | 132 | ||
| Arch Reconstruction | 132 | ||
| Reestablishing Total Body Perfusion and Associated Intracardiac Repairs | 133 | ||
| Rewarming | 133 | ||
| 2A Equations | 133 | ||
| References | 134 | ||
| A | 134 | ||
| B | 134 | ||
| C | 136 | ||
| D | 136 | ||
| E | 137 | ||
| F | 137 | ||
| G | 138 | ||
| H | 139 | ||
| I | 140 | ||
| J | 140 | ||
| K | 140 | ||
| L | 141 | ||
| M | 141 | ||
| N | 142 | ||
| O | 142 | ||
| P | 142 | ||
| Q | 143 | ||
| R | 143 | ||
| S | 143 | ||
| T | 144 | ||
| U | 145 | ||
| V | 145 | ||
| W | 146 | ||
| Y | 146 | ||
| Z | 146 | ||
| 3 Myocardial Management during Cardiac Surgery with Cardiopulmonary Bypass | 147 | ||
| Historical Note | 148 | ||
| Need for Special Measures of Myocardial Management | 149 | ||
| Conditions during Cardiopulmonary Bypass | 149 | ||
| Vulnerability of the Diseased Heart | 150 | ||
| Surgical Requirements | 150 | ||
| Damage from Global Myocardial Ischemia | 150 | ||
| Myocardial Cell Stunning | 151 | ||
| Myocardial Cell Necrosis | 151 | ||
| Endothelial Cell Damage | 152 | ||
| Specialized Conduction Cell Damage | 153 | ||
| Damage from Reperfusion | 153 | ||
| Myocardial Cell Damage | 153 | ||
| Endothelial Cell Damage | 154 | ||
| Specialized Conduction Cell Damage | 154 | ||
| Advantageous Conditions During Ischemia | 154 | ||
| Advantageous Conditions During Reperfusion | 155 | ||
| Blood | 156 | ||
| Leukocyte Depletion | 156 | ||
| Substrate | 156 | ||
| Hydrogen Ion Concentration | 156 | ||
| Calcium | 156 | ||
| Potassium | 156 | ||
| Pressure | 156 | ||
| Flow and Resistance | 157 | ||
| Temperature | 157 | ||
| Suppression of Formation of Oxygen-Derived Free Radicals and Enhancement of Free Radical Scavengers | 157 | ||
| Duration | 157 | ||
| Adenosine | 157 | ||
| Ischemic Postconditioning | 158 | ||
| Methods of Myocardial Management During Cardiac Surgery | 158 | ||
| Continuous Normokalemic Coronary Perfusion | 158 | ||
| Empty Beating Heart | 158 | ||
| Perfusion of Individual Coronary Arteries | 158 | ||
| Hypothermic Fibrillating Heart | 159 | ||
| Moderately Hypothermic Intermittent Global Myocardial Ischemia | 159 | ||
| Profoundly Hypothermic Global Myocardial Ischemia | 159 | ||
| Drug-Mediated Myocardial Protection | 159 | ||
| Cold Cardioplegia (Multidose) | 160 | ||
| Cardioplegic Solution | 160 | ||
| Technique of Antegrade Infusion | 160 | ||
| Technique of Retrograde Infusion | 162 | ||
| Results of Cold Cardioplegia | 162 | ||
| Single-Dose Cold Cardioplegia in Neonates and Infants | 162 | ||
| Continuous Cardioplegia | 163 | ||
| Cold Perfusion | 163 | ||
| Warm Perfusion | 163 | ||
| Cold Cardioplegia, Controlled Aortic Root Reperfusion, and (When Needed) Warm Cardioplegic Induction | 163 | ||
| Circuitry | 163 | ||
| Technique for Elective Surgery | 163 | ||
| Technique for Energy-Depleted Hearts | 164 | ||
| Ancillary Measures for Preventing Myocardial Damage | 164 | ||
| Special Situations and Controversies | 164 | ||
| Species and Model Differences | 164 | ||
| Neonates and Infants | 164 | ||
| Ischemic Damage | 165 | ||
| Reperfusion Damage | 165 | ||
| Abnormal Immature Hearts | 165 | ||
| Methods of Myocardial Management | 165 | ||
| Aortic Valve Surgery | 166 | ||
| Coexisting Mild Aortic Regurgitation | 167 | ||
| Acute Occlusion of the Left Anterior Descending Coronary Artery | 167 | ||
| Large Noncoronary Collateral Flow | 167 | ||
| Active Rheumatic Pericarditis Necessitating Multiple Valve Surgery | 168 | ||
| Reoperative Surgery | 168 | ||
| References | 168 | ||
| A | 168 | ||
| B | 168 | ||
| C | 170 | ||
| D | 170 | ||
| E | 170 | ||
| F | 170 | ||
| G | 171 | ||
| H | 171 | ||
| I | 171 | ||
| J | 171 | ||
| K | 172 | ||
| L | 172 | ||
| M | 173 | ||
| N | 173 | ||
| O | 173 | ||
| P | 174 | ||
| Q | 174 | ||
| R | 174 | ||
| S | 175 | ||
| T | 175 | ||
| V | 175 | ||
| W | 176 | ||
| Y | 176 | ||
| Z | 176 | ||
| 4 Anesthesia for Cardiovascular Surgery | 177 | ||
| Section I Anesthetic Consultation for Adult Cardiovascular Surgery | 178 | ||
| Preoperative Preparation and Evaluation | 178 | ||
| Management of Preoperative Medications | 178 | ||
| Cardiovascular Medications | 178 | ||
| Statins | 178 | ||
| Medications Affecting Hemostasis | 178 | ||
| Aspirin | 178 | ||
| Clopidogrel | 179 | ||
| Combination Antiplatelet Therapy | 179 | ||
| Glycoprotein IIb/IIIa Inhibitors | 179 | ||
| Herbal Supplements | 180 | ||
| Monitoring | 180 | ||
| Cannulae | 180 | ||
| Transesophageal Echocardiography | 181 | ||
| Epiaortic Scanning | 183 | ||
| Cerebral Oximetry | 183 | ||
| Medications | 183 | ||
| Premedication | 183 | ||
| Induction Agents | 183 | ||
| Maintenance of Anesthesia | 183 | ||
| Opioids | 184 | ||
| Antifibrinolytic Drugs | 184 | ||
| Heparin Management | 184 | ||
| Monitoring | 184 | ||
| Heparin Resistance | 184 | ||
| Heparin-Induced Thrombocytopenia | 185 | ||
| Heparin Reversal | 185 | ||
| Weaning From Cardiopulmonary Bypass | 185 | ||
| Inotropic and Vasopressor Support | 185 | ||
| Specific Management Issues | 186 | ||
| Fast-Track Anesthesia | 186 | ||
| Perioperative Glucose Control | 186 | ||
| Blood Management | 186 | ||
| Reoperation | 187 | ||
| Off-Pump Coronary Artery Bypass Grafting | 187 | ||
| Heart Transplantation | 187 | ||
| Lung Transplantation | 188 | ||
| Descending Thoracic Artery Aneurysm | 188 | ||
| Transcatheter Aortic Valve Replacement | 189 | ||
| Ventricular Assist Devices | 189 | ||
| Conclusion | 189 | ||
| Section II Anesthesia for Neonates and Children | 189 | ||
| Infants and Children Undergoing Cardiopulmonary Bypass (open Procedures) | 189 | ||
| Laboratory Evaluation | 190 | ||
| Premedication | 190 | ||
| Physiologic Monitoring | 190 | ||
| Temperature | 190 | ||
| Intraoperative Echocardiography | 190 | ||
| Neurologic Monitoring | 190 | ||
| Near-Infrared Spectroscopy | 191 | ||
| Validation of NIRS | 191 | ||
| Clinical Applications | 191 | ||
| Outcomes after Heart Surgery and NIRS Monitoring | 191 | ||
| Anesthetic Agents | 192 | ||
| Intubation and Ventilation | 192 | ||
| Maintenance of Anesthesia | 193 | ||
| Infants and Children Undergoing Hypothermia With or Without Circulatory Arrest | 193 | ||
| Cardiopulmonary Bypass | 193 | ||
| Separation from Cardiopulmonary Bypass | 193 | ||
| Rationale for Specific Therapies | 194 | ||
| Right Ventricular (Pulmonary Ventricle) Dysfunction | 194 | ||
| Left Ventricular (Systemic Ventricle) Dysfunction | 194 | ||
| Management of Hypoplastic Left Heart Physiology | 194 | ||
| Rationale for Managing Fontan, Hemi-Fontan, and Bidirectional Glenn Procedures | 195 | ||
| Infants and Children Not Undergoing Cardiopulmonary Bypass (closed Procedures) | 195 | ||
| Palliative Procedures | 195 | ||
| Closure of Patent Ductus Arteriosus | 195 | ||
| Coarctation of the Aorta | 195 | ||
| One-Lung Ventilation in Children | 196 | ||
| Controversies in Pediatric Anesthesia | 196 | ||
| Effects of Anesthetic Medications on the Developing Brain | 196 | ||
| Blood Glucose Management in the Perioperative Period | 196 | ||
| 4A Intraoperative Insulin Management Protocol (Cleveland Clinic) | 197 | ||
| References | 198 | ||
| A | 198 | ||
| B | 198 | ||
| C | 198 | ||
| D | 199 | ||
| E | 199 | ||
| F | 199 | ||
| G | 199 | ||
| H | 199 | ||
| I | 200 | ||
| J | 200 | ||
| K | 200 | ||
| L | 200 | ||
| M | 200 | ||
| O | 201 | ||
| P | 201 | ||
| Q | 201 | ||
| R | 201 | ||
| S | 201 | ||
| T | 202 | ||
| V | 202 | ||
| W | 202 | ||
| Y | 202 | ||
| 5 Postoperative Care | 203 | ||
| Section I Subsystems during Early Convalescence after Cardiac Surgery | 205 | ||
| Cardiovascular Subsystem | 205 | ||
| Cardiac Reserve | 205 | ||
| Adequacy | 205 | ||
| Cardiac Index | 205 | ||
| Arterial Blood Pressure | 206 | ||
| Pedal Pulses | 206 | ||
| Skin Temperature | 206 | ||
| Whole Body Oxygen Consumption | 207 | ||
| Mixed Venous Oxygen Level | 207 | ||
| Urine Flow and Serum Potassium | 207 | ||
| Metabolic Acidosis | 208 | ||
| Cardiac Output and Its Determinants | 209 | ||
| Ventricular Preload | 209 | ||
| Ventricular Afterload | 209 | ||
| Myocardial Contractility | 210 | ||
| Relative Performance of Left and Right Ventricles | 211 | ||
| Heart Rate | 211 | ||
| Cardiac Rhythm | 211 | ||
| Causes of Acute Dysfunction (Low Cardiac Output) after Cardiac Surgery | 212 | ||
| Inadequate Operation | 212 | ||
| Myocardial Dysfunction | 212 | ||
| Reduced Preload | 212 | ||
| Hypovolemia. | 212 | ||
| Diastolic Dysfunction. | 212 | ||
| Acute Cardiac Tamponade. | 212 | ||
| Increased Ventricular Afterload | 212 | ||
| Risk Factors for Low Cardiac Output | 213 | ||
| Patient-Specific | 213 | ||
| Procedural | 213 | ||
| Course of Low Cardiac Output | 213 | ||
| Treatment of Low Cardiac Output | 214 | ||
| Noninvasive Methods | 214 | ||
| Intraaortic Balloon Pump | 215 | ||
| Temporary Ventricular Assistance | 216 | ||
| Temporary Ventricular Assist Devices. | 216 | ||
| Management. | 217 | ||
| Results. | 217 | ||
| Indications. | 217 | ||
| Cardiopulmonary Support and Extracorporeal Membrane Oxygenation | 217 | ||
| Management. | 218 | ||
| Results. | 218 | ||
| Indications. | 218 | ||
| Cardiac Arrhythmias | 218 | ||
| Ventricular Electrical Instability | 218 | ||
| Atrial Arrhythmias | 219 | ||
| Prevalence and Risk Factors for Atrial Fibrillation. | 219 | ||
| Prevention of Atrial Fibrillation. | 219 | ||
| Treatment of Atrial Fibrillation. | 219 | ||
| Atrial Flutter. | 220 | ||
| Paroxysmal Atrial Tachycardia. | 220 | ||
| Pulmonary Subsystem | 220 | ||
| Adequacy | 220 | ||
| During Intubation | 220 | ||
| Extubation | 221 | ||
| Causes of Dysfunction | 221 | ||
| Risk Factors for Acute Dysfunction | 222 | ||
| Patient-Specific | 222 | ||
| Procedural | 223 | ||
| Postoperative | 223 | ||
| Course of Dysfunction after Cardiac Surgery | 223 | ||
| Management and Treatment | 224 | ||
| General Measures | 224 | ||
| Prolonged Intubation | 224 | ||
| Reintubation | 225 | ||
| Pulmonary Hypertensive Crises | 225 | ||
| Description. | 225 | ||
| Incremental Risk Factors. | 225 | ||
| Prevention. | 226 | ||
| Renal Subsystem | 226 | ||
| Adequacy | 226 | ||
| Causes of Acute Dysfunction after Cardiac Surgery | 227 | ||
| Risk Factors for Acute Dysfunction | 227 | ||
| Patient-Specific | 227 | ||
| Procedural | 227 | ||
| Postoperative | 228 | ||
| Course of Dysfunction | 228 | ||
| Management and Treatment | 228 | ||
| Neuropsychological Subsystem | 229 | ||
| Generalized (Diffuse) Neuropsychological Function | 229 | ||
| Adequacy | 229 | ||
| Causes of Dysfunction | 229 | ||
| Risk Factors for Acute Dysfunction | 229 | ||
| e9781416063919v2 | 1251 | ||
| Front cover | 1251 | ||
| Expert Consult page | 1252 | ||
| Cardiac Surgery | 1255 | ||
| Copyright page | 1256 | ||
| Contributors | 1257 | ||
| Acknowledgments | 1259 | ||
| Preface to Fourth Edition | 1261 | ||
| Table of Contents | 1263 | ||
| VII Congenital Heart Disease | 1265 | ||
| 30 Atrial Septal Defect and Partial Anomalous Pulmonary Venous Connection | 1265 | ||
| Definition | 1266 | ||
| Historical Note | 1266 | ||
| Morphology | 1266 | ||
| Types of Atrial Septal Defect | 1266 | ||
| Fossa Ovalis Defect | 1266 | ||
| Posterior Defect | 1267 | ||
| Sinus Venosus Defect | 1267 | ||
| Coronary Sinus Defect | 1267 | ||
| Confluent Defect | 1267 | ||
| Ostium Primum Defect | 1267 | ||
| Types of Partial Anomalous Pulmonary Venous Connection | 1267 | ||
| Sinus Venosus Malformation | 1267 | ||
| Right Superior Pulmonary Vein to Superior Vena Cava | 1271 | ||
| Right Pulmonary Veins to Right Atrium | 1271 | ||
| Right Pulmonary Veins to Inferior Vena Cava (Scimitar Syndrome) | 1271 | ||
| Rare Connections of Right Pulmonary Veins | 1271 | ||
| Left Pulmonary Venous Connections | 1271 | ||
| Bilateral Partial Pulmonary Venous Connection | 1271 | ||
| Cardiac Chambers in Atrial Septal Defect and Related Conditions | 1271 | ||
| Mitral Valve and Atrial Septal Defects | 1272 | ||
| Mitral Prolapse | 1272 | ||
| Mitral Regurgitation | 1272 | ||
| Cleft Mitral Leaflets | 1272 | ||
| Lungs and Pulmonary Vasculature | 1272 | ||
| Associated Cardiac Conditions | 1272 | ||
| Related Conditions | 1272 | ||
| Clinical Features and Diagnostic Criteria | 1273 | ||
| Determinants of Interatrial Shunting | 1273 | ||
| Symptoms | 1273 | ||
| Signs | 1273 | ||
| Chest Radiography | 1273 | ||
| Electrocardiography | 1273 | ||
| Echocardiography | 1274 | ||
| Magnetic Resonance Imaging | 1274 | ||
| Cardiac Catheterization and Cineangiography | 1274 | ||
| Natural History | 1276 | ||
| Survival | 1276 | ||
| Pulmonary Hypertension | 1277 | ||
| Functional Status | 1277 | ||
| Spontaneous Closure | 1277 | ||
| Changes in Pulmonary/Systemic Blood Flow Over Time | 1278 | ||
| Right Ventricular Function | 1278 | ||
| Left Ventricular Function | 1278 | ||
| Atrioventricular Valvar Dysfunction | 1278 | ||
| Supraventricular Arrhythmias | 1278 | ||
| Systemic Arterial Hypertension | 1279 | ||
| Technique of Operation | 1279 | ||
| Fossa Ovalis Atrial Septal Defect | 1279 | ||
| Posterior Atrial Septal Defect | 1281 | ||
| Coronary Sinus Atrial Septal Defect | 1281 | ||
| Sinus Venosus Atrial Septal Defect | 1281 | ||
| Anomalous Connection of Right Pulmonary Veins to Right Atrium | 1282 | ||
| Anomalous Connection of Right Pulmonary Veins to Inferior Vena Cava (Scimitar Syndrome) | 1282 | ||
| Anomalous Connection of Left Pulmonary Veins to Brachiocephalic Vein | 1287 | ||
| Other Anomalous Pulmonary Venous Connections | 1287 | ||
| Treatment of Associated Mitral or Tricuspid Valve Disease | 1287 | ||
| Special Features of Postoperative Care | 1287 | ||
| Results | 1288 | ||
| Early (Hospital) Death | 1288 | ||
| Time-Related Survival | 1288 | ||
| Modes of Death | 1289 | ||
| Incremental Risk Factors for Death | 1289 | ||
| Pulmonary Vascular Disease | 1290 | ||
| Older Age at Operation | 1290 | ||
| Anatomic Type of Interatrial Communication | 1290 | ||
| Functional Status | 1290 | ||
| Hemodynamic Results | 1290 | ||
| Ventricular Function | 1290 | ||
| Arrhythmic Events | 1291 | ||
| Thromboembolism | 1292 | ||
| Reintervention | 1292 | ||
| Indications for Operation | 1292 | ||
| Special Situations and Controversies | 1292 | ||
| Closure of Atrial Septal Defects by Percutaneous Techniques | 1292 | ||
| Direct Suture versus Patch Repair | 1293 | ||
| Patch Material in Atrial Septum | 1293 | ||
| Complications after Repair of Sinus Venosus Malformation | 1293 | ||
| Pulmonary Venous Obstruction after Repair of Scimitar Syndrome | 1294 | ||
| Repair in Presence of Increased Pulmonary Vascular Resistance | 1294 | ||
| References | 1294 | ||
| A | 1294 | ||
| B | 1294 | ||
| C | 1294 | ||
| D | 1294 | ||
| E | 1295 | ||
| F | 1295 | ||
| G | 1295 | ||
| H | 1295 | ||
| J | 1295 | ||
| K | 1295 | ||
| L | 1295 | ||
| M | 1296 | ||
| N | 1296 | ||
| P | 1296 | ||
| R | 1296 | ||
| S | 1296 | ||
| T | 1297 | ||
| V | 1297 | ||
| W | 1297 | ||
| Y | 1297 | ||
| Z | 1297 | ||
| 31 Total Anomalous Pulmonary Venous Connection | 1298 | ||
| Definition | 1298 | ||
| Historical Note | 1298 | ||
| Morphology | 1299 | ||
| Pulmonary Venous Anatomy | 1299 | ||
| Cardiac Chamber and Septal Anatomy | 1299 | ||
| Pulmonary Vasculature | 1301 | ||
| Associated Conditions | 1301 | ||
| Clinical Features And Diagnostic Criteria | 1301 | ||
| Presentation | 1301 | ||
| Examination | 1301 | ||
| Chest Radiography | 1302 | ||
| Echocardiography | 1302 | ||
| Cardiac Catheterization and Cineangiography | 1302 | ||
| Magnetic Resonance Imaging and Computed Tomography | 1303 | ||
| Physiology of Common Mixing Chamber | 1303 | ||
| Natural History | 1304 | ||
| Technique Of Operation | 1304 | ||
| Total Anomalous Pulmonary Venous Connection to Left Brachiocephalic Vein | 1305 | ||
| Total Anomalous Pulmonary Venous Connection to Superior Vena Cava | 1305 | ||
| Total Anomalous Pulmonary Venous Connection to Coronary Sinus | 1310 | ||
| Total Anomalous Pulmonary Venous Connection to Right Atrium | 1313 | ||
| Total Anomalous Pulmonary Venous Connection to Infradiaphragmatic Vein | 1313 | ||
| Miscellaneous Types of Total Anomalous Pulmonary Venous Connection | 1313 | ||
| Mixed Total Anomalous Pulmonary Venous Connection | 1313 | ||
| Special Features Of Postoperative Care | 1313 | ||
| Results | 1316 | ||
| Survival | 1316 | ||
| Early (Hospital) Death | 1316 | ||
| Time-Related Survival | 1316 | ||
| Modes of Death | 1316 | ||
| Incremental Risk Factors for Death | 1316 | ||
| Functional Status | 1317 | ||
| Hemodynamic Result | 1317 | ||
| Cardiac Rhythm | 1317 | ||
| Reoperation and Development of Postoperative Pulmonary Venous Obstruction | 1317 | ||
| Anastomotic Stenosis | 1318 | ||
| Pulmonary Vein Stenosis | 1318 | ||
| Indications For Operation | 1319 | ||
| Special Situations And Controversies | 1319 | ||
| Pulmonary Vein Stenosis | 1319 | ||
| Delayed Operation | 1319 | ||
| Operative Exposure | 1319 | ||
| Surgical Enlargement of Left Atrium | 1320 | ||
| References | 1320 | ||
| A | 1320 | ||
| B | 1320 | ||
| C | 1320 | ||
| D | 1321 | ||
| E | 1321 | ||
| F | 1321 | ||
| G | 1321 | ||
| H | 1321 | ||
| I | 1321 | ||
| J | 1321 | ||
| K | 1322 | ||
| L | 1322 | ||
| M | 1322 | ||
| N | 1322 | ||
| O | 1322 | ||
| P | 1322 | ||
| R | 1322 | ||
| S | 1323 | ||
| T | 1323 | ||
| U | 1323 | ||
| V | 1323 | ||
| W | 1323 | ||
| Y | 1323 | ||
| 32 Cor Triatriatum | 1324 | ||
| Definition | 1324 | ||
| Historical Note | 1324 | ||
| Morphology | 1324 | ||
| Morphology of Classic Cor Triatriatum | 1324 | ||
| Relationship of Cor Triatriatum to Partial and Total Anomalous Pulmonary Venous Connection | 1324 | ||
| Relationship of Cor Triatriatum to a Left Superior Vena Cava | 1327 | ||
| Associated Anomalies | 1327 | ||
| Clinical Features and Diagnostic Criteria | 1327 | ||
| Natural History | 1327 | ||
| Technique Of Operation | 1327 | ||
| Classic Cor Triatriatum | 1327 | ||
| Atypical Cor Triatriatum | 1328 | ||
| Special Features Of Postoperative Care | 1329 | ||
| Results | 1329 | ||
| Early (Hospital) Death | 1329 | ||
| Time-Related Survival and Functional Status | 1329 | ||
| Indications For Operation | 1330 | ||
| References | 1331 | ||
| A | 1331 | ||
| B | 1331 | ||
| C | 1331 | ||
| G | 1331 | ||
| H | 1331 | ||
| J | 1331 | ||
| K | 1331 | ||
| L | 1331 | ||
| M | 1331 | ||
| N | 1331 | ||
| O | 1331 | ||
| P | 1331 | ||
| R | 1331 | ||
| S | 1331 | ||
| T | 1331 | ||
| V | 1331 | ||
| W | 1332 | ||
| 33 Unroofed Coronary Sinus Syndrome | 1333 | ||
| Definition | 1333 | ||
| Historical Note | 1333 | ||
| Morphology | 1333 | ||
| Completely Unroofed Coronary Sinus with Persistent Left Superior Vena Cava | 1333 | ||
| Completely Unroofed Coronary Sinus without Persistent Left Superior Vena Cava | 1334 | ||
| Partially Unroofed Midportion of Coronary Sinus | 1334 | ||
| Partially Unroofed Terminal Portion of Coronary Sinus | 1334 | ||
| Relationship of Unroofed Coronary Sinus Syndrome to Cor Triatriatum and Atrioventricular Septal Defect | 1334 | ||
| Atrial Isomerism | 1334 | ||
| Clinical Features And Diagnostic Criteria | 1334 | ||
| Natural History | 1335 | ||
| Technique Of Operation | 1335 | ||
| Isolated Completely Unroofed Coronary Sinus with Persistent Left Superior Vena Cava | 1335 | ||
| Intracardiac Repair | 1335 | ||
| Extracardiac Repair | 1335 | ||
| Partially Unroofed Midportion of Coronary Sinus | 1337 | ||
| Partially Unroofed Terminal Portion of Coronary Sinus | 1337 | ||
| Unroofed Coronary Sinus Syndrome with Left Superior Vena Cava and Atrioventricular Septal Defect | 1337 | ||
| Completely Unroofed Coronary Sinus Associated with Other Complex Cardiac Anomalies | 1337 | ||
| Results | 1337 | ||
| Early (Hospital) Death | 1337 | ||
| Time-Related Survival and Functional Status | 1339 | ||
| Indications For Operation | 1339 | ||
| Special Situations And Controversies | 1340 | ||
| Ligation of Left Superior Vena Cava | 1340 | ||
| References | 1341 | ||
| A | 1341 | ||
| C | 1341 | ||
| D | 1341 | ||
| F | 1342 | ||
| H | 1342 | ||
| K | 1342 | ||
| L | 1342 | ||
| M | 1342 | ||
| O | 1342 | ||
| Q | 1342 | ||
| R | 1342 | ||
| S | 1342 | ||
| T | 1342 | ||
| V | 1342 | ||
| W | 1342 | ||
| 34 Atrioventricular Septal Defect | 1343 | ||
| Definition | 1344 | ||
| Historical Note | 1344 | ||
| Morphology | 1344 | ||
| Surgical Treatment | 1344 | ||
| Morphology | 1345 | ||
| General Morphologic Characteristics | 1345 | ||
| Atrial Septal Deficiency and Interatrial Communications | 1349 | ||
| Partial Atrioventricular Septal Defect | 1349 | ||
| Common Atrium | 1349 | ||
| Absence of Interatrial Communication | 1349 | ||
| Ventricular Septal Deficiency and Interventricular Communications | 1350 | ||
| Partial Atrioventricular Septal Defect | 1350 | ||
| Complete Atrioventricular Septal Defect | 1350 | ||
| Atrioventricular Valves | 1350 | ||
| Two Atrioventricular Valve Orifices | 1350 | ||
| Common Atrioventricular Orifice | 1352 | ||
| Unusual Atrioventricular Combinations | 1354 | ||
| Accessory Orifice | 1354 | ||
| Single Papillary Muscle | 1355 | ||
| Ventricles | 1355 | ||
| Septal Malalignment | 1355 | ||
| Left Ventricular Outflow or Inflow Obstruction | 1356 | ||
| Conduction System | 1356 | ||
| Major Associated Cardiac Anomalies | 1356 | ||
| Patent Ductus Arteriosus | 1356 | ||
| Tetralogy of Fallot | 1356 | ||
| Double Outlet Right Ventricle | 1356 | ||
| Transposition of the Great Arteries | 1357 | ||
| Completely Unroofed Coronary Sinus with Left Superior Vena Cava | 1357 | ||
| Minor Associated Cardiac Anomalies | 1357 | ||
| Pulmonary Vascular Disease | 1357 | ||
| Down Syndrome | 1357 | ||
| Inlet Septal Type of Ventricular Septal Defect | 1357 | ||
| Clinical Features and Diagnostic Criteria | 1357 | ||
| Pathophysiology | 1357 | ||
| Atrioventricular Valve Regurgitation | 1358 | ||
| Symptoms and Physical Findings | 1358 | ||
| Chest Radiograph | 1358 | ||
| Electrocardiogram | 1358 | ||
| Two-Dimensional Echocardiogram | 1358 | ||
| Cardiac Catheterization and Cineangiogram | 1360 | ||
| Special Situations and Associated Defects | 1360 | ||
| Natural History | 1360 | ||
| Technique of Operation | 1366 | ||
| Repair of Complete Atrioventricular Septal Defect with Little or No Bridging of Left Superior and Left Inferior Leaflets: Rastelli Type A | 1367 | ||
| Two-Patch Technique | 1367 | ||
| Repair of Complete Atrioventricular Septal Defect with Bridging of Left Superior Leaflet: Rastelli Type B or C | 1371 | ||
| Repair of Complete Atrioventricular Septal Defect with Single-Patch Technique | 1371 | ||
| Repair of Complete Atrioventricular Septal Defect with Modified Single-Patch Technique | 1373 | ||
| Repair of Partial Atrioventricular Septal Defect with Little or No Left Atrioventricular Valve Regurgitation | 1373 | ||
| Repair of Atrioventricular Septal Defect with Small Interchordal Interventricular Communications (Intermediate Form) | 1374 | ||
| Repair of Atrioventricular Septal Defect with Common Atrium | 1374 | ||
| Repair of Complete or Partial Atrioventricular Septal Defect with Moderate or Severe Left Atrioventricular Valve Regurgitation | 1374 | ||
| Right Atrioventricular Valve | 1377 | ||
| Left Superior Leaflet–Right Superior Leaflet and Left Inferior Leaflet–Right Inferior Leaflet Commissures | 1377 | ||
| Replacement of Left Atrioventricular Valve | 1377 | ||
| Repair of Complete Atrioventricular Septal Defect with Tetralogy of Fallot | 1378 | ||
| Repair of Complete Atrioventricular Septal Defect with Double Outlet Right Ventricle | 1379 | ||
| Repair with Transposition of the Great Arteries | 1379 | ||
| Special Features of Postoperative Care | 1379 | ||
| Results | 1379 | ||
| Survival | 1379 | ||
| Early (Hospital) Death | 1379 | ||
| Time-Related Survival | 1380 | ||
| Incremental Risk Factors for Premature Death | 1380 | ||
| Earlier Date of Operation | 1380 | ||
| Higher New York Heart Association Functional Class | 1380 | ||
| Important Pre-Repair Atrioventricular Valve Regurgitation | 1380 | ||
| Interventricular Communication | 1380 | ||
| Accessory Valve Orifice | 1381 | ||
| Major Associated Cardiac Anomalies | 1381 | ||
| Young Age | 1381 | ||
| Down Syndrome | 1381 | ||
| Need for Reoperation | 1381 | ||
| Other Risk Factors | 1381 | ||
| Heart Block and Other Arrhythmias | 1381 | ||
| Functional Status | 1381 | ||
| Atrioventricular Valve Function | 1381 | ||
| Left Ventricular Outflow Tract Obstruction | 1382 | ||
| Residual Pulmonary Hypertension | 1382 | ||
| Indications for Operation | 1382 | ||
| Partial Atrioventricular Septal Defects | 1382 | ||
| Complete Atrioventricular Septal Defects | 1383 | ||
| Coexisting Cardiac Anomalies | 1383 | ||
| Special Situations and Controversies | 1383 | ||
| Pulmonary Trunk Banding | 1383 | ||
| Septal Patches | 1383 | ||
| Avoiding Heart Block | 1383 | ||
| Unbalanced Atrioventricular Septal Defects | 1383 | ||
| Late Reoperation | 1384 | ||
| References | 1384 | ||
| A | 1384 | ||
| B | 1385 | ||
| C | 1385 | ||
| D | 1386 | ||
| E | 1386 | ||
| F | 1386 | ||
| G | 1386 | ||
| H | 1386 | ||
| I | 1386 | ||
| J | 1386 | ||
| K | 1386 | ||
| L | 1387 | ||
| M | 1387 | ||
| N | 1387 | ||
| O | 1388 | ||
| P | 1388 | ||
| Q | 1388 | ||
| R | 1388 | ||
| S | 1388 | ||
| T | 1389 | ||
| U | 1389 | ||
| V | 1389 | ||
| W | 1389 | ||
| Y | 1389 | ||
| 35 Ventricular Septal Defect | 1390 | ||
| Section I Primary Ventricular Septal Defect | 1391 | ||
| Definition | 1391 | ||
| Historical Note | 1391 | ||
| Morphology | 1391 | ||
| Size | 1391 | ||
| Location in Septum and Relationship to Conduction System | 1392 | ||
| Perimembranous Ventricular Septal Defect | 1393 | ||
| Ventricular Septal Defect in Right Ventricular Outlet (Doubly Committed Subarterial Ventricular Septal Defect) | 1394 | ||
| Inlet Septal Ventricular Septal Defect | 1395 | ||
| Muscular Ventricular Septal Defect | 1397 | ||
| Confluent Ventricular Septal Defect | 1399 | ||
| Ventricular Septal Defect with Straddling or Overriding Tricuspid Valve | 1399 | ||
| Associated Lesions | 1399 | ||
| Pulmonary Vascular Disease | 1401 | ||
| Clinical Features And Diagnostic Criteria | 1402 | ||
| Clinical Findings | 1402 | ||
| Two-Dimensional Echocardiography | 1403 | ||
| Other Noninvasive Diagnostic Methods | 1403 | ||
| Cardiac Catheterization | 1403 | ||
| Angiography | 1404 | ||
| Natural History | 1404 | ||
| Spontaneous Closure | 1404 | ||
| Pulmonary Vascular Disease | 1409 | ||
| Infective Endocarditis | 1409 | ||
| Premature Death | 1409 | ||
| Clinical Course | 1410 | ||
| Development of Aortic Regurgitation | 1410 | ||
| Development of Infundibular Pulmonary Stenosis | 1410 | ||
| Technique Of Operation | 1410 | ||
| Repair of Perimembranous Ventricular Septal Defect | 1410 | ||
| Repair of Doubly Committed Subarterial Ventricular Septal Defect | 1412 | ||
| Repair of Inlet Septal Ventricular Septal Defect | 1412 | ||
| Repair of Muscular Ventricular Septal Defect | 1412 | ||
| Closure of Associated Patent Ductus Arteriosus | 1416 | ||
| Pulmonary Trunk Banding | 1416 | ||
| Pulmonary Trunk Debanding | 1416 | ||
| Special Features Of Postoperative Care | 1417 | ||
| Results | 1417 | ||
| Early (Hospital) Death | 1417 | ||
| Mode of Early Death | 1417 | ||
| Incremental Risk Factors for Hospital Death | 1417 | ||
| Survival | 1418 | ||
| Physical Development | 1418 | ||
| Conduction Disturbances | 1418 | ||
| Right Bundle Branch Block | 1418 | ||
| Right Bundle Branch Block and Left Anterior Hemiblock | 1418 | ||
| Ventricular Arrhythmias | 1419 | ||
| Permanent Heart Block | 1419 | ||
| Cardiac Function | 1419 | ||
| Residual Shunting | 1419 | ||
| Pulmonary Hyperinflation Syndrome | 1420 | ||
| Surgically Produced Aortic or Tricuspid Regurgitation | 1420 | ||
| Pulmonary Hypertension | 1420 | ||
| Surgical Cure | 1421 | ||
| Indications For Operation | 1421 | ||
| Special Situations And Controversies | 1422 | ||
| Ventricular Septal Defect and Patent Ductus Arteriosus | 1422 | ||
| Ventricular Septal Defect and Coarctation of Aorta | 1422 | ||
| Pulmonary Trunk Banding | 1423 | ||
| Right Atrial versus Right Ventricular Approach for Perimembranous Ventricular Septal Defect | 1424 | ||
| Closure of Ventricular Septal Defect Through Less Invasive Approaches | 1424 | ||
| Percutaneous Closure of Ventricular Septal Defects | 1424 | ||
| Closure of Ventricular Septal Defect When Pulmonary Resistance Is High | 1424 | ||
| Section II Ventricular Septal Defect and Aortic Regurgitation | 1424 | ||
| Definition | 1424 | ||
| Historical Note | 1424 | ||
| Morphology And Morphogenesis | 1425 | ||
| Mechanism of Aortic Regurgitation | 1425 | ||
| Clinical Features And Diagnostic Criteria | 1426 | ||
| Natural History | 1426 | ||
| Technique Of Operation | 1426 | ||
| Results | 1429 | ||
| Survival | 1429 | ||
| Heart Block | 1429 | ||
| Relief of Aortic Regurgitation | 1429 | ||
| Freedom from Aortic Valve Replacement | 1429 | ||
| Indications For Operation | 1430 | ||
| Special Situations And Controversies | 1430 | ||
| Section III Straddling and Overriding Tricuspid (or Mitral) Valve | 1430 | ||
| Definition | 1430 | ||
| Historical Note | 1430 | ||
| Morphology | 1431 | ||
| Morphologic Syndromes | 1431 | ||
| Conduction System | 1431 | ||
| Clinical Features And Diagnostic Criteria | 1431 | ||
| Technique Of Operation | 1432 | ||
| Section of Straddling Cords | 1432 | ||
| Slotting of Repair Patch | 1432 | ||
| Reattachment of Sectioned Tensor Apparatus | 1432 | ||
| Minor Septation | 1432 | ||
| Replacement of Straddling Atrioventricular Valve | 1432 | ||
| Fontan Operation | 1433 | ||
| Cardiac Transplantation | 1434 | ||
| Results | 1434 | ||
| Indications For Operation | 1435 | ||
| References | 1435 | ||
| A | 1435 | ||
| B | 1435 | ||
| C | 1436 | ||
| D | 1436 | ||
| E | 1436 | ||
| F | 1436 | ||
| G | 1437 | ||
| H | 1437 | ||
| J | 1437 | ||
| K | 1437 | ||
| L | 1438 | ||
| M | 1438 | ||
| N | 1439 | ||
| O | 1439 | ||
| P | 1439 | ||
| Q | 1439 | ||
| R | 1439 | ||
| S | 1440 | ||
| T | 1440 | ||
| U | 1441 | ||
| V | 1441 | ||
| W | 1441 | ||
| Y | 1441 | ||
| Z | 1441 | ||
| 36 Congenital Sinus of Valsalva Aneurysm and Aortico–Left Ventricular Tunnel | 1442 | ||
| Section I Unruptured and Ruptured Sinus of Valsalva Aneurysms | 1442 | ||
| Definition | 1442 | ||
| Historical Note | 1442 | ||
| Morphology | 1443 | ||
| Rupture | 1443 | ||
| Associated Cardiac Anomalies | 1446 | ||
| Ventricular Septal Defect | 1446 | ||
| Aortic Valve Abnormalities and Aortic Regurgitation | 1446 | ||
| Pulmonary Stenosis | 1447 | ||
| Other Anomalies | 1447 | ||
| Clinical Features And Diagnostic Criteria | 1447 | ||
| Natural History | 1448 | ||
| Technique Of Operation | 1448 | ||
| Ruptured Right Sinus of Valsalva Aneurysm, with Ventricular Septal Defect | 1448 | ||
| Ruptured Sinus of Valsalva Aneurysm into Right Atrium, without Ventricular Septal Defect | 1451 | ||
| Unruptured Sinus of Valsalva Aneurysm | 1451 | ||
| Special Features Of Postoperative Care | 1451 | ||
| Results | 1451 | ||
| Survival | 1451 | ||
| Risk Factors for Premature Late Death | 1451 | ||
| Functional Status | 1452 | ||
| Complications | 1452 | ||
| Indications For Operation | 1452 | ||
| Special Situations And Controversies | 1453 | ||
| Transcatheter Closure of Ruptured Sinus of Valsalva Aneurysm | 1453 | ||
| Section II Aortico–Left Ventricular Tunnel | 1453 | ||
| Definition | 1453 | ||
| Historical Note | 1453 | ||
| Morphology | 1453 | ||
| Clinical Features And Diagnostic Criteria | 1453 | ||
| Natural History | 1453 | ||
| Technique Of Operation | 1453 | ||
| Special Features Of Postoperative Care | 1454 | ||
| Results | 1454 | ||
| Indications For Operation | 1454 | ||
| References | 1454 | ||
| A | 1454 | ||
| B | 1454 | ||
| C | 1455 | ||
| D | 1455 | ||
| E | 1455 | ||
| F | 1455 | ||
| G | 1455 | ||
| H | 1455 | ||
| J | 1455 | ||
| K | 1455 | ||
| L | 1456 | ||
| M | 1456 | ||
| N | 1456 | ||
| O | 1456 | ||
| P | 1456 | ||
| R | 1456 | ||
| S | 1456 | ||
| T | 1456 | ||
| V | 1457 | ||
| W | 1457 | ||
| 37 Patent Ductus Arteriosus | 1458 | ||
| Definition | 1458 | ||
| Historical Note | 1458 | ||
| Morphology and Morphogenesis | 1459 | ||
| Morphology of Normal Ductal Closure | 1459 | ||
| Position and Absence | 1459 | ||
| Anatomic Details | 1459 | ||
| Isolated Patent Ductus Arteriosus | 1459 | ||
| Patent Ductus Arteriosus as a Coexisting Anomaly | 1459 | ||
| Histology | 1461 | ||
| Aneurysms of Ductus Arteriosus | 1461 | ||
| Clinical Features and Diagnostic Criteria | 1461 | ||
| Large Patent Ductus Arteriosus | 1461 | ||
| Moderate-Sized Patent Ductus Arteriosus | 1461 | ||
| Small Patent Ductus Arteriosus | 1462 | ||
| Special Investigations | 1462 | ||
| Natural History | 1462 | ||
| Spontaneous Closure | 1462 | ||
| Pulmonary Vascular Disease | 1462 | ||
| Rupture | 1462 | ||
| Death | 1462 | ||
| Modes of Death | 1463 | ||
| Technique of Operation | 1463 | ||
| Closure of Patent Ductus Arteriosus | 1463 | ||
| Posterolateral Thoracotomy | 1463 | ||
| Division | 1463 | ||
| Ligation | 1466 | ||
| Transaxillary Muscle-Sparing Lateral Thoracotomy | 1466 | ||
| Closure of Patent Ductus Arteriosus in Association with Repair of Intracardiac Lesions | 1466 | ||
| Closure of Patent Ductus Arteriosus in Older Adults | 1466 | ||
| Closure of Patent Ductus Arteriosus in Premature Infants | 1468 | ||
| Special Features of Postoperative Care | 1468 | ||
| Results | 1468 | ||
| Early (Hospital) Death | 1468 | ||
| Incremental Risk Factors for Early Death | 1468 | ||
| Time-Related Survival | 1469 | ||
| Symptomatic and Functional Status | 1469 | ||
| Physical Development | 1469 | ||
| Recurrence of Ductal Patency | 1469 | ||
| False Aneurysm | 1469 | ||
| Left Vocal Cord Paralysis | 1469 | ||
| Phrenic Nerve Paralysis | 1469 | ||
| Chylothorax | 1469 | ||
| Indications for Operation | 1469 | ||
| Special Situations and Controversies | 1470 | ||
| Patent Ductus Arteriosus in Preterm Infants | 1470 | ||
| Historical Note | 1470 | ||
| Clinical Features and Diagnostic Criteria | 1470 | ||
| Natural History | 1470 | ||
| Technique of Operation | 1470 | ||
| Special Features of Postoperative Care | 1470 | ||
| Early Results | 1470 | ||
| Late Results | 1470 | ||
| Indications for Operation | 1470 | ||
| Percutaneous (Catheter) Closure of Patent Ductus Arteriosus | 1471 | ||
| Thoracoscopic Closure of Patent Ductus Arteriosus | 1471 | ||
| References | 1471 | ||
| A | 1471 | ||
| B | 1471 | ||
| C | 1471 | ||
| D | 1472 | ||
| E | 1472 | ||
| F | 1472 | ||
| G | 1472 | ||
| H | 1472 | ||
| J | 1473 | ||
| K | 1473 | ||
| L | 1473 | ||
| M | 1473 | ||
| N | 1473 | ||
| O | 1473 | ||
| P | 1473 | ||
| R | 1474 | ||
| S | 1474 | ||
| T | 1474 | ||
| U | 1474 | ||
| V | 1474 | ||
| W | 1474 | ||
| Z | 1474 | ||
| 38 Ventricular Septal Defect with Pulmonary Stenosis or Atresia | 1475 | ||
| Section I Tetralogy of Fallot with Pulmonary Stenosis | 1478 | ||
| Definition | 1478 | ||
| Historical Note | 1478 | ||
| Morphology | 1478 | ||
| Developmental Considerations | 1478 | ||
| Right Ventricular Outflow Tract | 1479 | ||
| Infundibulum | 1479 | ||
| Pulmonary Valve | 1479 | ||
| Right Ventricular–Pulmonary Trunk Junction | 1482 | ||
| Pulmonary Trunk | 1482 | ||
| Pulmonary Trunk Bifurcation | 1482 | ||
| Right and Left Pulmonary Arteries | 1482 | ||
| Distal Pulmonary Arteries and Veins | 1483 | ||
| Dimensions of Right Ventricular Outflow Tract and Pulmonary Arteries | 1483 | ||
| Convenient Morphologic Categories of Right Ventricular Outflow Obstruction | 1484 | ||
| Iatrogenic Pulmonary Arterial Problems | 1484 | ||
| Collateral Pulmonary Arterial Blood Flow | 1485 | ||
| Ventricular Septal Defect | 1485 | ||
| Conduction System | 1488 | ||
| Aorta | 1488 | ||
| Aortic Arch and Ductus Arteriosus | 1488 | ||
| Right Ventricle | 1489 | ||
| Left Ventricle | 1489 | ||
| Coronary Arteries | 1490 | ||
| Major Associated Cardiac Anomalies | 1490 | ||
| Minor Associated Cardiac Anomalies | 1490 | ||
| Clinical Features and Diagnostic Criteria | 1490 | ||
| Clinical Presentation | 1490 | ||
| Physical Examination | 1490 | ||
| Laboratory Studies | 1491 | ||
| Chest Radiography | 1491 | ||
| Electrocardiography | 1491 | ||
| Echocardiography | 1491 | ||
| Cardiac Catheterization and Angiography | 1492 | ||
| Computed Tomography | 1493 | ||
| Magnetic Resonance Imaging | 1494 | ||
| Natural History | 1494 | ||
| Symptoms and Survival | 1495 | ||
| Pulmonary Artery Thromboses | 1495 | ||
| Pulmonary Vascular Disease | 1497 | ||
| Genetic History | 1497 | ||
| Technique of Operation | 1497 | ||
| General Plan and Details of Repair Common to All Approaches | 1497 | ||
| Surgical Evaluation | 1497 | ||
| Conceptual Approach to Surgery | 1497 | ||
| Approach | 1497 | ||
| Transanular Patch | 1497 | ||
| Right Coronary Artery Branches | 1498 | ||
| Anomalous Left Anterior Descending Coronary Artery | 1498 | ||
| Pulmonary Valve | 1498 | ||
| Atrial Septal Communications | 1498 | ||
| Tricuspid Valve | 1498 | ||
| Right Ventricular Muscle Bundles | 1498 | ||
| Preparations for Cardiopulmonary Bypass | 1499 | ||
| Technical Details of Repair | 1499 | ||
| Infundibular Dissection | 1499 | ||
| Pulmonary Valvotomy | 1502 | ||
| VSD Closure | 1503 | ||
| Decision and Technique for Transanular Patching | 1504 | ||
| Assessing Postrepair Right Ventricular Outflow Tract Obstruction | 1506 | ||
| Measuring Postrepair (Operating Room [OR]) PRV/LV | 1506 | ||
| Measuring Postrepair (OR) Right Ventricular Outflow Tract Pressure Gradient | 1508 | ||
| Management of Atrial Septum | 1508 | ||
| Repair of Uncomplicated Tetralogy of Fallot with Pulmonary Stenosis via Right Ventricle | 1508 | ||
| Repair of Uncomplicated Tetralogy of Fallot with Pulmonary Stenosis via Right Atrium | 1509 | ||
| Repair of Tetralogy of Fallot in Infancy | 1510 | ||
| Repair of Tetralogy of Fallot with Stenosis at Origin of Left Pulmonary Artery | 1510 | ||
| Repair of Tetralogy of Fallot with Stenosis at Origin of Right Pulmonary Artery | 1510 | ||
| Repair of Tetralogy of Fallot with Bifurcation Stenosis of Pulmonary Trunk | 1511 | ||
| Repair of Tetralogy of Fallot with Anomalous Origin of Left Anterior Descending Coronary Artery from Right Coronary Artery | 1512 | ||
| Repair of Tetralogy of Fallot after Blalock-Taussig Shunt or Polytetrafluoroethylene Interposition Shunt | 1514 | ||
| Repair of Tetralogy of Fallot after Waterston and Potts Shunts | 1515 | ||
| Technique of Shunting Operations | 1515 | ||
| Classic Right Blalock-Taussig Shunt | 1515 | ||
| Interposition Shunt between Left Subclavian and Left Pulmonary Artery | 1518 | ||
| Right-Sided Interposition Shunt Through Median Sternotomy | 1518 | ||
| Classic Left Blalock-Taussig Shunt (in Patients with Right Aortic Arch) | 1518 | ||
| Right-Sided Interposition Shunt (in Patients with Right Aortic Arch) | 1519 | ||
| Special Features of Postoperative Care | 1519 | ||
| Repair | 1519 | ||
| Systemic–Pulmonary Arterial Shunting | 1521 | ||
| Results | 1522 | ||
| Survival | 1522 | ||
| Early (Hospital) Death | 1522 | ||
| Time-Related Survival and the Question of “Cure” | 1522 | ||
| Modes of Death | 1524 | ||
| Incremental Risk Factors for Death | 1524 | ||
| Young Age at Repair | 1524 | ||
| Older Age at Repair | 1525 | ||
| Severity of Right Ventricle–Pulmonary Trunk Junction Hypoplasia | 1525 | ||
| Small Size of Right and Left Pulmonary Arteries | 1525 | ||
| Transanular Patch | 1526 | ||
| Postrepair PRV/LV | 1526 | ||
| Previous Palliative Operations | 1527 | ||
| Multiple Ventricular Septal Defects | 1527 | ||
| Coexisting Related Cardiac Anomalies | 1527 | ||
| Other Risk Factors | 1527 | ||
| Heart Block | 1527 | ||
| Junctional Ectopic Tachycardia | 1528 | ||
| Functional Status | 1528 | ||
| Right Ventricular Function | 1529 | ||
| Right Ventricular Aneurysms | 1530 | ||
| Residual Right Ventricular Outflow Obstruction | 1530 | ||
| Reoperation and Other Reinterventions for Right Ventricular Outflow Problems | 1531 | ||
| Left Ventricular Function | 1532 | ||
| Pulmonary Function | 1533 | ||
| Recurrent (Residual) Ventricular Septal Defects | 1533 | ||
| Sudden Death and Important Arrhythmic Events | 1533 | ||
| Infective Endocarditis | 1533 | ||
| Interim Results after Classic Shunting Operations | 1533 | ||
| Survival | 1533 | ||
| Interim Events | 1534 | ||
| Indications for Operation | 1534 | ||
| Special Situations and Controversies | 1535 | ||
| Timing and Type of Initial Surgery | 1535 | ||
| Rationale for Use of Postrepair PRV/LV | 1535 | ||
| Initial Palliative Operations | 1535 | ||
| Initial Palliation by β-Adrenergic Blockade | 1535 | ||
| Initial Palliation by Balloon Valvotomy | 1536 | ||
| Monocusp Valves Beneath Transanular Patches | 1536 | ||
| Timing of Pulmonary Valve Replacement for Pulmonary Regurgitation Late after Repair | 1536 | ||
| Percutaneous Pulmonary Valve Implantation | 1536 | ||
| Section II Tetralogy of Fallot with Pulmonary Atresia | 1536 | ||
| Definition | 1536 | ||
| Historical Note | 1536 | ||
| Morphology and Morphogenesis | 1537 | ||
| Tetralogy of Fallot with Congenital Pulmonary Atresia | 1537 | ||
| Right Ventricular Outflow Tract | 1537 | ||
| Pulmonary Trunk | 1537 | ||
| Right and Left Pulmonary Arteries | 1537 | ||
| Confluence of Right and Left Pulmonary Arteries | 1537 | ||
| Stenoses of Origins of Pulmonary Arteries | 1538 | ||
| Distribution (Arborization) of Pulmonary Arteries | 1538 | ||
| Stenoses of Pulmonary Arteries | 1539 | ||
| Size of Pulmonary Arteries | 1539 | ||
| Abnormal Hilar Branching Patterns | 1539 | ||
| Alternative Sources of Pulmonary Blood Flow | 1539 | ||
| Large Aortopulmonary Collateral Arteries | 1539 | ||
| Paramediastinal Collateral Arteries | 1541 | ||
| Bronchial Collateral Arteries | 1541 | ||
| Other Collaterals | 1541 | ||
| Acquired Collaterals | 1541 | ||
| Ductus Arteriosus | 1541 | ||
| Morphogenesis | 1541 | ||
| Tetralogy of Fallot with Acquired Pulmonary Atresia | 1541 | ||
| Clinical Features and Diagnostic Criteria | 1542 | ||
| Echocardiography | 1542 | ||
| Catheterization and Angiography | 1543 | ||
| Computed Tomographic Angiography | 1543 | ||
| Natural History | 1543 | ||
| Natural History of Pathophysiologic Subgroups | 1545 | ||
| Confluent and Normally Distributing Right and Left Pulmonary Arteries and Patent Ductus Arteriosus | 1545 | ||
| Confluent, Nonconfluent, or Absent Right and Left Pulmonary Arteries with Aortopulmonary Collaterals | 1545 | ||
| Pulmonary Arterial Disease | 1545 | ||
| Technique of Operation | 1546 | ||
| Repair of Tetralogy of Fallot with Acquired Pulmonary Atresia | 1546 | ||
| Repair of Tetralogy of Fallot with Pulmonary Atresia and Confluent and Normally Distributing Right and Left Pulmonary Arteries and Patent Ductus Arteriosus | 1546 | ||
| Repair of Tetralogy of Fallot with Pulmonary Atresia and Confluent, Nonconfluent, or Absent Right and Left Pulmonary Arteries and Aortopulmonary Collaterals | 1546 | ||
| One-Stage Unifocalization and Intracardiac Repair | 1546 | ||
| Assessing True Pulmonary Artery System | 1547 | ||
| Identifying and Assessing Collateral System | 1547 | ||
| Managing Sources of Pulmonary Blood Flow on Cardiopulmonary Bypass | 1547 | ||
| Completing Unifocalization | 1549 | ||
| Assessing Adequacy of Unifocalization | 1549 | ||
| Intracardiac Repair | 1552 | ||
| Establishing Right Ventricle–to–Pulmonary Artery Continuity | 1553 | ||
| Completing the Procedure | 1555 | ||
| Assessing Complete Repair | 1555 | ||
| Special Features of Postoperative Care | 1555 | ||
| Results | 1557 | ||
| After Repair | 1557 | ||
| Early (Hospital) Death | 1557 | ||
| Time-Related Survival | 1557 | ||
| Modes of Death | 1557 | ||
| Incremental Risk Factors for Death | 1557 | ||
| Pulmonary Artery Abnormalities | 1557 | ||
| Age (Size) | 1558 | ||
| Postrepair PRV/LV | 1558 | ||
| Duration of Cardiopulmonary Bypass | 1558 | ||
| Heart Block | 1558 | ||
| Functional Status | 1558 | ||
| Pulmonary Artery Pressure and Resistance | 1558 | ||
| Reintervention | 1558 | ||
| After Palliative Operations for Increasing Pulmonary Blood Flow | 1559 | ||
| Effect on Size of Pulmonary Arteries | 1559 |