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Thomas Smith
Thomas Smith

Atlas Of Adult Congenital Heart Surgery 1st Edi... ^HOT^

This atlas comprehensively covers surgical techniques for congenital heart surgery. As the population with congenital heart defects increases more and more operations will be required to treat the residual defects, new defects, and replacement strategies such as valve replacements. Chapters are devoted to specific conditions and feature detailed descriptions of how to perform a variety of appropriate reparative surgical techniques; involving complex anatomy, reoperative surgery, and unique techniques to this speciality, enabling the reader to develop a deep understanding of how to successfully resolve situations such as left ventricular outflow tract obstruction, anomalous pulmonary venous return, and anomalous origin of the coronary arteries.

Atlas of Adult Congenital Heart Surgery 1st Edi...


Atlas of Adult Congenital Heart Surgery provides a foundational resource for practising and trainee cardiac surgeons, nurses, and healthcare associates seeking specialist training and insight to the resolution of congenital heart diseases in adults.

There are several causes of valvular heart disease, including congenital conditions (being born with it), infections, degenerative conditions (wearing out with age), and conditions linked to other types of heart disease.

The UI Adult Congenital Heart Disease Clinic (ACHD) provides comprehensive, specialized care for adults living with congenital heart disease. Since 1982, our clinic has provided a smooth transition for children to adult cardiology care with continuity of staff and facilities. Our patients require lifelong cardiac care by specialists who understand the complicated, unique anatomy of their hearts, and know the latest method for follow-up and treatment. Our specialists are familiar with the complex problems adults may face such as the need for surgical revision, catheterization and intervention, rhythm disturbances, and exercise limitations.

The embryological abnormalities that cause congenital heart defects may also have a direct impact on the conduction system. The AV node and the His bundle may only be displaced, or there may be accessory or duplicated AV connections with the possibility of reentrant arrhythmias.

6. Triedman JK, Alexander MA, Love BA, et al. Influence of patient factors and ablative technologies on outcomes of radiofrequency ablation of intra-atrial tachycardia in patients with congenital heart disease. J Am Coll Cardiol. 2002;39:1827-1835.

9. Philip F, Muhammad KI, Agarwal S, et al. Pulmonary vein isolation for the treatment of drug-refractory atrial fibrillation in adults with congenital heart disease. Congenit Heart Dis. 2012;7:392-399.

Houston Methodist Hospital is ranked best in Texas and No. 13 in the nation among 800 hospitals by U.S. News & World Report for cardiology and heart surgery. Learn more.With specialized clinics and programs, innovative research and more than 100 clinical trials underway, our heart and vascular clinicians are investigating more effective ways of diagnosing and treating heart and vascular disease.

Named after Dr. Michael E. DeBakey, a world-renowned pioneer in cardiovascular surgery, Houston Methodist DeBakey Heart & Vascular Center combines experienced doctors specializing in specific heart and vascular conditions with the most advanced cardiac imaging and treatment options available. With multiple locations across the Greater Houston area, our experts are committed to preventing heart and vascular disease, as well as managing the complications that can accompany these conditions.

According to the NHS, CHD patients require regular monitoring, and an adult with CHD might need a variety of treatment and medications including transcatheter intervention, cardiac surgery, invasive electrophysiology and pacing procedures, advanced heart failure management, palliative care and transplantation.

As such, the majority of CHD patients require ongoing follow up and treatment. And, it is vital that all adults with congenital heart defects, whatever the level of complexity, are seen by an expert from a specialist centre at least once. View the Congenital Heart Disease Standards And Specifications.

While the development of pulmonary arterial hypertension is not uncommon in adult congenital heart disease patients, other forms of pulmonary hypertension (PH) may also be present. A good understanding of PH classification is therefore vital for clinicians managing adult patients with congenital heart disease. This paper reviews both the general classification of PH and more detailed approaches to classifying pulmonary arterial hypertension in association with congenital heart disease.

PH in association with increased left heart filling pressures may develop for a variety of reasons due to CHD, including congenital left heart valvular disease, congenital left ventricular outflow tract obstruction and congenital pulmonary vein stenosis. PH-LHD may also develop in patients with CHD due to comorbid acquired heart disease, including acquired valvular disease and systolic or diastolic dysfunction unrelated to the CHD.

Congenital heart disease is the most common group of congenital pathology. Over the past few decades, advances in surgical treatment have resulted in a rising population of adult patients with repaired complex congenital heart disease. Although the quality of life has greatly improved, a significant proportion of morbidities encountered in clinical practice is now seen in adults rather than in children. These patients often have significant haemodynamic pathophysiology necessitating repeat intervention. CT and MRI are excellent imaging modalities, which help elucidate potential complications that may need urgent management. Although imaging should be performed in specialised centres, occasionally patients may present acutely to emergency departments in hospitals with little experience in managing potentially complex patients. The purpose of this article is to provide an introductory overview to the radiologist who may not be familiar with complex congenital heart disease in adult patients. This educational review has three main sections: (1) a brief overview of the post-operative anatomy and surgical management of the most common complex conditions followed by (2) a discussion on CT/MRI protocols and (3) a review of the various complications and their CT/MRI findings.

The second set of ACHD patients who present acutely make up 90% of cases. These are ACHD patients who underwent surgery in childhood and normally have an extensive past surgical history, which is usually documented. The majority of these patients have complex ACHD, and the numbers are increasing as technological and surgical advances afford better survival rates. These patients have significantly altered haemodynamics and a neo-formed cardiovascular circulation due to the complex interventions performed [5]. Their clinical presentation may be due to an indirect consequence of their altered physiology or a disease-specific post-operative complication presenting in adulthood. Common symptoms and clinical findings include chest pain, shortness of breath, arrhythmias and exercise intolerance [5]. As the number of repaired complex ACHD patients continues to rise, it is exceedingly important to obtain as much clinically relevant past surgical history in order to accurately interpret images. In the acute setting, this may not be possible and a good grasp of the post-operative anatomy of repaired complex ACHD and the common complications that may occur becomes essential.

TOF is the most common type of cyanotic congenital heart disease with an adult prevalence of 28,000 in the US [6]. The classic constellation of findings includes subpulmonary infundibular stenosis, overriding aorta, ventricular septal defect (VSD), and right ventricular (RV) hypertrophy. The severity of the defects ranges from minimal overriding of the aorta and trivial pulmonary stenosis to almost complete override of the aorta and pulmonary atresia. The anterocephalad deviation of the outlet septum and hypertrophy of the septoparietal trabeculations are important features, which distinguish TOF from pulmonary stenosis and a VSD [7, 8].

Single ventricle defects can be defined as any anomaly in which there is an abnormal mixture of systemic and pulmonary venous blood associated with atresia or significant hypoplasia of a cardiac chamber. This broad category of congenital heart disease includes hypoplastic left heart, double inlet/outlet ventricular defects, tricuspid atresia, and pulmonary atresia with an intact ventricular septum. Generally, there are several stages of operations performed sequentially during childhood with the objectives of providing continuous systemic outflow, unimpeded venous inflow, and adequate pulmonary blood flow [18].

Pulmonary arterial hypertension (PAH) is defined as a mean pulmonary arterial pressure of 25 mmHg or greater. It is estimated that the prevalence of PAH in ACHD is approximately 10%. Of the five main classifications of PAH, ACHD is classified as Type I (pulmonary arterial hypertension secondary to congenital heart disease) [51].

In patients who have had an arterial switch procedure, the most common complications are supravalvular and branch pulmonary artery stenosis (left more common than right) due to post-surgical manipulation of the pulmonary trunk to anastomose it to the former aortic root. There is also a considerable risk of coronary ostial stenosis and resultant ischaemia due to coronary artery translocation during surgery. Neo-aortic root dilatation may result in significant aortic regurgitation. Assessment of ventricular function using standard 2D SSFP cine sequences through the heart and both ventricular outflow tracts in addition to stack images in the short axis allows for adequate visualisation of potential complications and regurgitant/stenotic jets. Specifically, SSFP cine MRI oblique axial stacks through the main pulmonary arteries can be useful in detecting stenotic areas, and 3D SSFP sequences or a dedicated CT coronary angiogram can assess for coronary ostial stenosis (Fig. 21) [38, 58]. Flow quantification using PC MRI in the through plane to assess for aortic regurgitation in the setting of neo-aortic root dilatation should be performed as well as in-plane imaging at any stenotic areas to assess for peak velocity [31, 37, 38]. In cases of post-Rastelli procedure for D-TGA with VSD and pulmonary stenosis, the main complications are related to the RV to pulmonary artery conduit as previously discussed. 041b061a72

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