chd surgery new
Post on 07-Apr-2018
229 Views
Preview:
TRANSCRIPT
-
8/6/2019 CHD Surgery New
1/32
CONGENITAL
HEART
DISEASE
Prepared By ,
Sonia Bhatia(F.Y. M.P.T)
-
8/6/2019 CHD Surgery New
2/32
Introduction
The primitive vascular tube apparent by the third weekof fetal life.
Over the next weeks it folds in on itself.
By 12 weeks it has fully developed.
-
8/6/2019 CHD Surgery New
3/32
Classification:
Acyanotic congenital heart disease.
Cyanotic congenital heart disease.
-
8/6/2019 CHD Surgery New
4/32
Acyanotic congenital heart diseases
Patent ductus arteriosus:
This anomaly 5 to 10 percent of congenital heart disease.
-
8/6/2019 CHD Surgery New
5/32
Etiology :
Apatent ductus arteriosus can be idiopathic.
Some common contributing factors in humans include:
Preterm Birth
Congenital Rubella Syndrome
Down Syndrome
-
8/6/2019 CHD Surgery New
6/32
Pathol
ogy:As the higher pressure in the aorta then in the pulmonary artery
Blood flow from aorta to pulmonary artery
Pulmonary blood flow increase to the lungs, the pulmonaryvessels dilated
More blood to left side of heart
Left ventricular hypertrophy
-
8/6/2019 CHD Surgery New
7/32
Signs and symptoms : Tachycardia Shortness of breath
Continuous machine-like murmur
Enlarged heart Left subclavicular thrill
Bounding pulse
Investigation: Electrocardiogram show left ventricular hypertrophy.
Cardiac catherisation
A
ortography
-
8/6/2019 CHD Surgery New
8/32
Operation:U
sually carried out in babies over 2-3 years of age.
Technique:
Operation performed through a left posterolateral thoracotomy through the 5th
intercostals space.
Lung retracted
Mediastinal pleura incised over aortic arch
So ductus arterious cleared
Ligation of patent ductus with multiple non-absorbable ligatures
Two transfixation ligatures one on either end of ductus and two in middleportion of the ductus.
Temporary aortic shunt, usually left atriofemoral by pass used totemporary occlusion of aorta above or below the ductus.
-
8/6/2019 CHD Surgery New
9/32
-
8/6/2019 CHD Surgery New
10/32
COARCTATAIONOF AORTA5% common of congenital heart disease.
Obstruction of the aorta in the region of the ductus arteriosus orligamentum arteriosum just distal to the left subclavian artery.
-
8/6/2019 CHD Surgery New
11/32
There are three types:Preductal coarctation:
The narrowing proximal to the ductus arteriosus.
Ductal coarctation: The narrowing occurs at the insertion of the ductus
arteriosus. This kind usually appears when the ductusarteriosus closes.
Postductal coarctation:
The narrowing is distal to the insertion of the ductusarteriosus.
-
8/6/2019 CHD Surgery New
12/32
Clinical features:
ypertension
Hypotension
Investigation:
Chest radiographs
Cardiac catheterisation
Aortography
-
8/6/2019 CHD Surgery New
13/32
TREATMENTOperative Technique:
The coarctation of aorta is excised and end-end anastomosis of theaorta is performed usually with a graft.
Left posterolateral thoracotomy through 4th intercostal space.
Mediastinal pleura incised, after which vagus nerve is retractedmedially.
Aorta mobilized both above and below constriction take care notdamage the intercostal vessels.
Proximal and distal aorta occluded with vascular clamps.
-
8/6/2019 CHD Surgery New
14/32
Coarctation of aorta excised
End to end anastomosis possible
Continuous sutures with prolene
After anastomosis, blood pressure measured proximal and distal toanastomosis
Difference blood pressure more than 4 to 5 mm Hg
Dacron patch inserted through short anterior arteriotomy
Widen the lumen of the aorta
Postoperatively antibiotics given for 3 to 4 days
Patients are discharge in 7 to 10 days
-
8/6/2019 CHD Surgery New
15/32
ATRIAL SEPTAL DEFECT
This defects allows blood to flow from left to right atrium, so that rightside of heart and lungs become overfilled, whereas left side heartreceives less blood.
Three types:1. Fossa ovalis defect (Secundum defect): Commonest and lies in centre of the septum. Failure of development of septum secundum.
Symptoms: FatiguePalpitationExertional dyspnoea
Signs: Soft systolic murmur sound.
-
8/6/2019 CHD Surgery New
16/32
Treatment:Incision:
Median sternotomy through 4th intercostal Space.
Direct suturing and closure of defect by continuoussuture with prolene.
If direct suturing is not possible, prosthetic patch of
knitted dacron may inserted with help of heart-lungmachine.
-
8/6/2019 CHD Surgery New
17/32
Atrioventricular septal defect (ostium primum defect):
4 to 5% of patients with atrial septal defect, associated withincomplete formation of mitral and tricuspid valves.
Treatment:
Incision.Operative procedure: Operative is usually between 4 to 6 years of age. Operation performed with help of heart-lung machine. Initially cleft in mitral valve is closed with interrupted sutures
placed from ventricular septum out to free margin of mitralorifice.
After cleft repair, septal defect repaired with patch ofpericardium inserted with interrupted sutures.
-
8/6/2019 CHD Surgery New
18/32
Anoma
lous drainage of pu
lmonary veins:
Right pulmonary veins usually enter the superior vena cava inferior topoint of entry of azygos vein or enter into the right atrium or intoinferior vena cava.
Left pulmonary vein may also enter the superior vena cava.
Treatment:
Anomalous veins can be corrected by insertion of prosthetic patch
Defect is closed
Pulmonary veins are enter the left atrium
-
8/6/2019 CHD Surgery New
19/32
VENTR
ICULAR S
EPTAL
DE
FEC
TCommon 20 to 30 % .Defect situated in muscular or membranous portions of theseptum.
Septum defect varies from 3 mm to more than 3 cm in size.Clinical features:
Large septal defect-Dyspnoea on exertionHaemoptysis
Physical examination:
Loud pansystolic murmur in 3rd and 4th intercostal space.Thrill is palpable.Rales due to pulmonary congestion.
-
8/6/2019 CHD Surgery New
20/32
-
8/6/2019 CHD Surgery New
21/32
-
8/6/2019 CHD Surgery New
22/32
Treatment :Operation :
Technique:
Operation performed through a median sternotomy with
help of extracorporeal circulation
Longitudinal ventriculotomy performed usually ininfundibular part of right Ventricle and near anterior
descending coronary artery
Defect usually closed with an oval patch of knitted dacron bymattress sutures posteriorly and continuous suture
anteriorly
-
8/6/2019 CHD Surgery New
23/32
Pulmonary Stenosis:
In this incomplete obstruction to the flow from the right ventricle.
Haemodynamics:
Pulmonary circulation is decreased
Work of right ventricle increased Right ventricular hypertrophy
Diminished cardiac output
Symptoms:
Exertional dyspnoea Fatigue
Systemic venous congestion
Hypoxaemia
Cardiac failure
-
8/6/2019 CHD Surgery New
24/32
-
8/6/2019 CHD Surgery New
25/32
Treatment :Incision :
Median sternotomy
Open procedure:
Valve exposed via anterior aspect of pulmonary artery thecommissures are cut.
If annulus is constricted it is cut through vertically anddacron inserted.
It may be necessary to replace the valve.
-
8/6/2019 CHD Surgery New
26/32
Aortic Stenosis :
Left ventricular outflow obstruction may be caused atthree levels :
Valvular Subvalvular
Supravalvular
The patients with valvular stenosis do notdevelop symptoms until the valve calcified around theage 40-50.
-
8/6/2019 CHD Surgery New
27/32
Haemodynamics:The narrowed valve orifice subjects the left ventricle to apressure overload.
Left ventricle hypertrophy develops.
Symptoms :
Mild asymptomatic
Severe FatigueSyncopeDyspnoea
-
8/6/2019 CHD Surgery New
28/32
Treatment :
Incision : Amedian sternotomy.Open procedures :
Valvular Stenosis :
Valvotomy is performed by entering the ascending aorta and
incising the commissures.
Subvalvular Stenosis :
It may approached through a low aortic incision and
through valvular excision will be undertaken.Supravalvular Stenosis :
Relieved by suturing an elliptical dacron into the verticalincision through the constricted portion of aorta.
-
8/6/2019 CHD Surgery New
29/32
Physiotherapy Treatment :
Pre-operative Treatment :
Infants with cardiac problem have pulmonary hypertension
associated with excessive secretion leading to repeated chestinfection.
So chest physiotherapy important that the lung field are clear aspossible prior to the surgery.
PercussionShaking and vibrationsPostural drainage
-
8/6/2019 CHD Surgery New
30/32
Post-operative Treatment :
Chest PT will begin when patients condition stabilized.
In some unit treatment will be on the day of operation , in others , dayafter.
Depends on the type of operation the patient may or may not beventilated.
Patients should be assessed and physiotherapy given as necessary.
Carefully watch the patients vital signs at all times.
Patients have small amount of secretions easily removed by suctionalone.
Early mobilization is important to stimulate deep breathing andcoughing.
Nasopharyngeal suction may be used in infants and children.
-
8/6/2019 CHD Surgery New
31/32
References :
1.) Textbook of surgery by, S.Das , 5th Edition.
2.) Bailey & LovesShort practice of surgery , 22nd Edition.
3.) DavidsonsPrinciples & practice of medicine , 20th Edition.
4.) Cashs Textbook ofChest , Heart and Vascular Disorders for Physiotherapists ,
4th Edition.
-
8/6/2019 CHD Surgery New
32/32
THANK YOU
top related