Surgery of Conotruncal Anomalies 1st Edition by Francois Lacour Gayet, Edward Bove, Viktor Hraška, Victor Morell, Thomas Spray 3319230573 9783319230573

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ISBN-10 :  3319230573 

ISBN-13 : 9783319230573

Author:  Francois Lacour-Gayet, Edward L. Bove, Viktor Hraška, Victor O. Morell, Thomas L. Spray 

This book addresses the most technically demanding but life-changing techniques in the treatment of conotruncal heart defects, as many repairs are performed on small infants. Each chapter reviews surgical anatomy (the anatomical classification that the surgeon is using), preoperative evaluation (the surgeon’s check list before doing the surgery), and surgical techniques (clear drawings and videos, minimal text). It is an essential reference book for newly qualified surgeons when performing these complex cases. Conotruncal heart defects (CTHDs) are a group of complex congenital anomalies of the cardiovascular system that are a major cause of symptomatic cardiac disease at birth. They may account for up to 30% of all congenital cardiac anomalies. In many instances, patients with CTHD are symptomatic in the first days or weeks of life, with severe cyanosis or heart failure, requiring surgery in the neonatal period or in infancy. Most CHTD are today diagnosed in utero by fetal ultrasound. CHTDs are usually defined as malformations of the cardiac outflow tracts and presumably result in disturbance in the development of the cono-truncal apparatus of the embryonic heart, as well as of the primitive aortic arches. CTHDs include the following: truncus arteriosus, tetralogy of Fallot, double outlet right (or left) ventricle, transposition of the arteries, corrected transposition of the great arteries, interrupted aortic arch. The outcomes of CHTD surgery has considerably improved in the past 20 years, with quite fascinating innovations.

Surgery of Conotruncal Anomalies 1st Table of contents:

Chapter 1: Definition of Conotruncal Anomalies
What Really Are The Conotruncal Malformations?
What Are Normally Related Great Arteries and How Did they Get That Way?
Spiral Versus Straight Great Arteries
What About TGA {S,D,L}? [15]Where Is the Subaortic Conal free Wall? And Where Is the Subpulmonary Conal Free Wall?
Great Arterial Switch Procedures
Morphogenetic Movement of the Great Arteries
Cardiovascular Evolution
Infundibulo-Arterial (IA) Situs Concordance and Discordance
Conclusions
References
Chapter 2: Development and Maldevelopment of the Ventricular Outflow Tracts
Introduction
Early Development of the Heart Tube
Expansion of the Atrioventricular Canal
Normal Development of the Outflow Tract
Remodelling of the Distal Outflow Tract
Remodelling of the Intermediate Component of the Outflow Tract
Development of the Proximal Outflow Tract
Maldevelopment of the Outflow Tract
Malformations of the Distal Outflow Tract
Anomalous Development of the Intermediate Part of the Outflow Tract
Abnormal Development of the Proximal Outflow Tract
Conclusions
References
Chapter 3: Anatomy of Conotruncal Anomalies
Introduction
Cardiac Neural Crest Defects
Tetralogy of Fallot
Anatomic Features of Tetralogy of Fallot
The Pulmonary Outflow Tract Obstruction
The Ventricular Septal Defect
The Overriding of the Aorta
The Right Ventricular Hypertrophy
Associated Lesions
Absent Pulmonary Valve
Complete Atrioventricular Canal
Anomalies of the Pulmonary Branches
Right Aortic Arch
Coronary Abnormalities
Significant Systemic-to-Pulmonary Collateral Arteries
Aortic Coarctation
Tetralogy of Fallot with Pulmonary Atresia
Intracardiac Anatomy
The Pulmonary Arterial Supply
Common Arterial Trunk
Main Anatomic Types
The Ventricular Septal Defect
The Truncal Valve
The Coronary Arteries
Interrupted Aortic Arch
Main Anatomic Types
The Ventricular Septal Defect
Associated Anomalies
Right Aortic Arch
Bicuspid Aortic Valve
Aortopulmonary Window
Common Arterial Trunk
Other Outflow Tract Defects
Common AV Canal
Double Outlet Right Ventricle
The Ventricular Septal Defect
Committed VSDs
Non-committed VSDs
The Position of the Great Arteries
The Conal or Infundibular Morphology
The Taussig-Bing Anomaly
The Associated Anomalies
Obstruction of the Outflow Tracts
Anomalies of the AV Valves
The Mitral Valve
The Tricuspid Valve
Ventricular Hypoplasia
Coronary Arteries
DORV with Subaortic or Doubly Committed VSD
DORV with Subpulmonary VSD
Double Outlet Left Ventricle
The VSD
Subaortic VSD
Subpulmonary VSD
Doubly Committed VSD
Non-committed VSD
The Great Vessels
The Conal or Infundibular Morphology
Associated Anomalies
Subpulmonary Stenosis
Subaortic Stenosis
Other Associated Anomalies
Laterality Defects
Transposition of the Great Arteries
Main Anatomic Features
Position of the Great Arteries
Conus
Coronary Artery Pattern
Associated Lesions
Ventricular Septal Defect
Obstruction of the Outflow Tracts
Left Ventricular Outflow Tract Obstruction (LVOTO)
Right Ventricular Outflow Tract Obstruction (RVOTO)
Juxtaposition of the Atrial Appendages
Anomalies of the Atrioventricular Valves
Mitral Valve
Tricuspid Valve
Common Atrioventricular Canal
Anomalous Pulmonary Venous Connections
Congenitally Corrected TGA
Associated Anomalies
The Right Ventricle and the Tricuspid Valve
The Ventricular Septal Defect
Left Ventricular Outflow Tract Obstruction
The Left Ventricle and the Mitral Valve
Position of the Great Arteries
Conclusion
References
Chapter 4: Outcomes Data of Surgery for Conotruncal Anomalies from the Congenital EACTS and STS
Databases
STS and EACTS/ECHSA Congenital Heart Surgery Databases
Risk Adjustment Models in Congenital Heart Surgery
Results from STS and EACTS/ECHSA Databases
Conclusion
References
Chapter 5: Tetralogy of Fallot: Transventricular Repair, Including Pulmonary Atresia Without MAPCAs
Anatomy
Anatomy of TOF
Anatomy of Pulmonary Atresia-TOF
Diagnosis and Imaging
Check List Prior to Surgery
Surgery: Transventricular Repair of Tetralogy of Fallot
Indications
Surgical Technique
“Classic” Transannular Patch Repair of TOF Without Pulmonary Atresia
Valve-Sparing Repair of TOF Without Pulmonary Atresia
Repair of TOF with Abnormal Coronary Arteries
Surgery: Transventricular Repair of Pulmonary Atresia-­Tetralogy of Fallot without MAPCAS
Indications
Surgical Technique
Conduit Repair of Tetralogy of Fallot with Pulmonary Atresia
Transannular Patch for Tetralogy of Fallot with Pulmonary Atresia
Outcomes
References
Chapter 6: Transatrial Repair of Tetralogy of Fallot
Introduction
Anatomy
Diagnosis and Imaging
Checklist for Surgical Repair
Surgical Approach
Results
References
Chapter 7: Tetralogy of Fallot: Management of the Pulmonary Valve
Introduction
History
Anatomy
Preoperative Evaluation and Assessment
Surgical Strategy
Current Management Patterns (STS Data) and Long-Term Outcomes
References
Chapter 8: Pulmonary Atresia, Ventricular Septal Defect and Major Aorto-Pulmonary Collateral Arteri
Background
Rehabilitation Strategy
Unifocalisation
Anatomical Classification of the Pulmonary Arterial Supply
Central Pulmonary Arteries
Near-Normal Intra-Pulmonary Pulmonary Arteries or Pulmonary Lobar Branches
Multiple, Small Diminutive MAPCAs
Dual Pulmonary Blood Supply
Diagnosis and Imaging
Checklist Before Surgery
Surgical Techniques
Timing of Surgery
Rehabilitation of Native Pulmonary Arteries
Unifocalisation
Outcomes
Survival
Palliation Without Complete Repair
Right Ventricle Pressure After Complete Repair
References
Chapter 9: Tetralogy of Fallot with Complete Atrioventricular Canal
Introduction
History
Anatomo-Pathology
Embryology
Morphology
Diagnosis and Imaging
Presentation
Imaging
Surgery
Palliation by Modified BT Shunt
Surgical Repair
VSD Patch Closure (Fig. 9.1)
Common AV Valve Management
Ostium Primum Closure
RVOT Reconstruction
Post-repair Evaluation
Outcomes
Conclusion
References
Chapter 10: Tetralogy of Fallot with Absent Pulmonary Valve Syndrome
Introduction
Anatomy
Diagnostic – Imaging
Clinical Presentation
Chest X-ray
Echocardiography
Cardiac Catherization
Bronchoscopy
CT Scan, MRI
Check List
Decision Making & Management Strategy
Decision-Making
Medical Management
Surgical Management
Traditional Approach to Decompression of the Airways
Alternative Approach of Decompression of the Airways
Outcomes
Summary
References
Chapter 11: Fallot: Palliation with BT Shunt
Introduction
Diagnosis and Imaging
Check List Prior to BT Shunt
Surgery
Indications for BT Shunt
Surgical Technique
Outcomes
References
Chapter 12: Redo Fallot: Surgery for Pulmonary Valve Implantation
Introduction
Diagnosis and Imaging
Pre-operative Checklist
Indications and Timing for Pulmonary Valve Replacement (Table 12.1)
Surgical Techniques for Pulmonary Valve Replacement
Sizing and Choice of Prostheses for PVR
Surgical Ablation for Ventricular Tachycardia during Redo Surgery for Tetralogy of Fallot
Indications for Electrophysiologic (EP) Study and Ablation
Surgical Techniques for Cryoablation of RVOT pathway
Tetralogy of Fallot with Pulmonary Atresia
Redo Surgery in Patients with Right Ventricle to Pulmonary Artery Conduit
The Role of Percutaneous Pulmonary Valve Replacement
Surgical Outcomes after Pulmonary Valve Replacement with or without Ablation Surgery
Tricuspid Regurgitation in Late Survivors
References
Chapter 13: Transcatheter Pulmonary Valvulation
Introduction
Devices
The Melody Valve (Me V) (Fig. 13.1)
The Edward Sapien Valve (ESV) (Fig. 13.2)
Indications for TPVI
Suitability for TPVI
RVOT Substrate
RVOT Size
RVOT Shape
Patient Body Weight
Impact of RVOT Expansion on Coronary Flow
Techniques for TPVI (Fig. 13.3)
Procedural Complications
Contained and Non-contained Conduit Rupture
Pulmonary Artery Dissection
Valve Embolization and Malposition
Coronary Artery Compression
Hammock Effect
Early and Mid-term Results
MeV Implants
ESV Implants
Specific Applications: TPVI in Native RVOT
Adverse Events During Follow Up
Stent Fractures
Recurrent Stenosis
Infective Endocarditis
Long Term Prospects
Sudden Cardiac Death and TPVI
Right Ventricular Function and TPVI
Exercise Performance and TPVI
Quality of Life and TPVI
Future Perspectives
References
Chapter 14: Arterial Switch in TGA-IVS: Coronary Transfer
Introduction
Classification of Coronary Arteries
Normal Course, Two Ostia (60 %) (Fig. 14.1)
Looping Courses, Two Ostia (29.5 %) (Fig. 14.2)
Posterior Looping Course (20 %) (Fig. 14.2, Top)
Double Looping Course (9 %) (Complex Fig. 14.2, Medium)
Anterior Looping Course (0.5 %) (Complex Fig. 14.2, Bottom)
Intramural Course, Two Ostia (5 %) (Complex Fig. 14.3)
Single Ostium. Miscellaneous Course. (5.5 %) (Complex Fig. 14.4)
Diagnosis. Imaging
Indication
Surgical Technique
Cardio-Pulmonary Bypass and Myocardial Protection
Uniform Coronary Transfer Technique Described in Normal Coronary Anatomy
Surgical Technique I: Normal Coronary Arteries Course (Fig. 14.5)
Surgical Technique II. Normal Coronary Arteries Course (Fig. 14.6)
Surgical Technique III. Normal Coronary Arteries Course (Fig. 14.7)
Surgical Technique IV. Normal Coronary Arteries Course (Fig. 14.8)
Surgical Technique V. Special Features (Fig. 14.9)
Surgical Technique VI. Pulmonary Trunk Reconstruction (Fig. 14.11)
Surgical Technique VII. Normal Coronary Arteries. Final Result (Fig. 14.12)
Surgical Technique VIII. Complex Coronary Transfer (Fig. 14.13)
Surgical Technique VIII Posterior Loop. Two Ostia (Fig. 14.14)
Surgical Technique VIII. Anterior Loop. Two Ostia (Fig. 14.15, Bottom)
Surgical Technique VIII. Double Loop. Two Ostia (Fig. 14.15, Top)
Surgical Technique IX. Intra Mural Coronary Arteries. Two Ostia (Fig. 14.16)
Surgical Technique X. Single Ostium. Miscellaneous Course (Fig. 14.17)
Outcome
References
Chapter 15: Arterial Switch for TGA or DORV and VSD, with and Without Aortic Arch Obstruction
Background
Anatomic Classification
TGA- VSD
Taussig-Bing (Figs. 15.2, 15.3, and 15.4)
Aortic Arch Obstruction (AAO)
Other Associated Lesions
Imaging and Diagnosis
Check List
Surgical Techniques
Palliative Procedures
One Stage Anatomical Repair of TGA-VSD and Taussig Bing
Cardio-Pulmonary Bypass (CPB) and Myocardial Protection
ASO in TGA – VSD
ASO in Taussig Bing
ASO in Taussig Bing with Aortic Arch Obstruction (Figs. 15.5 and 15.6)
Management of TGA/DORV with Multiple VSD
The Case of TGA-IVS Associated with AAO
Kawashima Operation
Outcomes
References
Chapter 16: TGA-IVS and TGA-VSD Seen Late
Part 1: Surgery of Transposition of the Great Arteries with Intact Ventricular Septum Seen Late
Introduction and Definition
Morphological and Pathophysiological Features of the Regressing LV
“Late” TGA-IVS Patients with Favorable LV Morphology
“Late” TGA-IVS Patients with Regressed LV Morphology
Diagnosis and Imaging
Surgical Indications
Primary ASO
LV Retraining
Timing of Second Stage ASO
Check List Prior to Surgery for Late TGA-IVS Patients
ASO Surgical Technique
One Stage ASO
Two Stage ASO
LV Retraining Procedure (Pulmonary Artery Banding and Modified B-T Shunt)
Second Stage ASO
Outcomes
Outcomes of One Stage ASO
Outcomes of Two-Stage ASO
Long-Term Outcome of Second-Stage ASO
Impact of Age >3 months at Retraining
Part 2: TGA-VSD Seen Late
Introduction and Definition
Morphological and Pathophysiological Features Of TGA-VSD beyond 6 Months of Age
Great Vessels
Pulmonary Vascular Obstructive Disease (PVOD)
Main Clinical Manifestation
Physiopathology Based on Age >6 Months at Surgery
ASO Within 6 Months of Age
ASO Beyond 6 Months of Age
Diagnosis and Imaging
Imaging and Pulmonary Vascular Resistance Evaluation
Surgical Indication
Indication for Pulmonary Artery Banding
Indication for Palliative Arterial Switch
Indication for Neo-aortic Sinotubular Junction Reconstruction
Check List Prior to Surgery for Late TGA-VSD >6 Months
Surgical Technique
VSD Patch Fenestration
Neo-aortic Sinotubular Junction Reconstruction
Medications to Reduce Pulmonary Pressure
Outcomes
Outcomes of ASO
Neo-aortic Regurgitation
Outcomes of Palliative ASO
References
Chapter 17: TGA-VSD and LVOTO: Rastelli Procedure
Introduction
Anatomy
Diagnosis and Imaging
Check List
Indications and Surgical Technique in the Current Area
Indications
Surgical Technique
Outcomes
Comments
References
Chapter 18: TGA-VSD-LVOT Obstruction: REV (Réparation à l’Etage Ventriculaire) Procedure
Introduction
Classification
Imaging
Check-List
Feasibility of Biventricular Repair
Feasibility of REV Procedure
Preference Card
Indications
Selection of Patients
Contra-indications
Inadequate Pulmonary Vascular Bed
Optimal Age
Surgical Technique
Initiation of Cardiopulmonary Bypass
Cardiac Incisions
Resection of the Conal Septum (Fig. 18.2)
Construction of the Intracardiac Tunnel
Reconstruction of the Right Ventricular Outflow Tract
Outcomes
Early Outcome
Late Outcome
References
Chapter 19: Transposition of the Great Arteries with VSD and LVOTO. The Autograft Procedure fo
Background
Anatomic Classification Used
Diagnosis Imaging
Surgical Technique
Outcomes
Conclusion
References
Chapter 20: The Aortic Translocation (Nikaidoh) Procedure
Introduction
Diagnosis and Imaging
Anatomy, Indications and Check List Prior to Surgery
Surgical Technique
Technique in TGA-VSD-LVOTO
Technique in Corrected TGA-VSD-LVOTO
Outcomes
References
Chapter 21: Double Root Translocation Operation for Complete Transposition of Great Arteries with
Background
Anatomical Classification
Type of VSD
Classification of LVOTO (Pulmonary and Subpulmonary Stenosis)
Existence of Bilateral Conal Structure
Anomaly of Coronary Artery Patterns
Diagnosis and Imaging
Echocardiography
Cardiac Catheter Imaging (Figs. 21.1 and 21.2)
Cardiovascular Computer Tomography (CT) and Magnetic Resonance Imaging (MRI)
Check List Prior to DRT
Indications
Surgical Techniques
DRT for TGA-VSD-LVOTO
DRT Procedure for DORV
Technical Highlights
Outcomes
References
Chapter 22: Transposition of the Great Arteries with Ventricular Septal Defect and Left Ventricl
Introduction
Anatomical Classification and Definitions
Anatomic and Hemodynamic Diagnosis
Check List Prior to Surgery
The Surgical Technique
Outcomes
Early Mortality
Long Term Results
Comments
Limitations for the Procedure
Conclusions
References
Chapter 23: Bi-ventricular Repair of Double Outlet Right Ventricle
Introduction
Surgical Anatomy of DORV
Anatomical Definitions
Morphology of DORV
Lev-Bharati Classification
Associated Lesions
Functional Classification
DORV-VSD Types. They account for 25 % of DORV (Fig. 23.1) and Include Two Different Forms: DORV
DORV- Subaortic VSD (Fig. 23.2)
DORV Doubly Committed VSD (Fig. 23.3)
DORV-Fallot Type (Fig. 23.4)
DORV-TGA Type. Taussig-Bing (Fig. 23.5)
DORV-Non-committed VSD (Figs. 23.6 and 23.7)
DORV-CAVSD-PS-Heterotaxy (Figs. 23.9, 23.10, and 23.11)
Diagnosis-Imaging of DORV
Echocardiography
Catheterization-Angiography
CT Scan. MRI. 3D Echo
3D Printing and 3D Computed Reconstruction
Prenatal Diagnosis and Chromosomic Anomalies
DORV Pre-operative Checklist
Surgical Techniques of DORV Biventricular Repair
Repair of DORV-VSD Type
DORV Subaortic VSD
DORV Doubly Committed VSD
Repair of DORV-Fallot Type (Fig. 23.4)
Repair of DORV-TGA Type (Taussig-Bing) (Fig. 23.5)
Repair of DORV-Non-committed VSD (Figs. 23.7, 23.8, and 23.12)
Repair of DORV-nc-VSD Without Pulmonary Obstruction
Tunellisation of the VSD to the Aorta
Tunnelization of the VSD to the PA Followed by an Arterial Switch
Repair of DORV-nc-VSD with Pulmonary Obstruction
Tunnelization of the VSD to the Aorta and RVOT Reconstruction
R.E.V. Operation and Rastelli Procedure
Tunnelization to the PA and Arterial Switch
Double Root Translocation (see Chap. 21)
Repair of DORV-AVSD-PS-Heterotaxy
Limitations of DORV Bi-ventricular Repair and Fontan Indication
Contra-indication to Biventricular Repair
Univentricular Repair in Complex DORV
Outcomes
Mortality
Follow Up and Reoperation
Bibliography
Chapter 24: Biventricular Repair of Double Outlet Right Ventricle with Complete Atrioventricular S
Introduction
Anatomy
Diagnosis and Imaging
Checklist for Surgical Repair
Surgical Approach
Results
References
Chapter 25: Double Outlet Left Ventricle
Definition of DOLV
Morphology and Classification of DOLV
Morphogenesis of VA Connections
Ventricular Septal Defect of DOLV
Classification of DOLV
Surgery of Abnormal VA Connections
Case Presentation
Outcomes
References
Chapter 26: Corrected TGA-VSD: The Double Switch Procedure
Introduction
Anatomy
Imaging and Diagnosis
Pre-operative Check List
Surgical Technique
PA Banding Palliation
Double Switch Technique
Outcomes
References
Chapter 27: Anatomic Correction of Corrected Transposition of the Great Arteries with Ventricula
Introduction
Anatomy
Ventricular Septal Defect
Conduction System
Coronaries
Diagnosis and Imaging
Clinical Signs and Symptoms
Chest X-ray
Echocardiography
Cardiac Catherization
Additional Diagnostic Studies
Checklist Prior to Surgery
Decision-Making and Management Strategy
Decision-Making
Medical Management
Surgical Management
Modified Senning Operation
Modified ½ Mustard Operation
Arterial Switch Operation
Rastelli Operation
Aortic Translocation
Outcomes
Issues Related to the Senning Procedure
Issues Related to the 1½ Mustard Procedure
Issues Related to the Rastelli Procedure
Issues Related to the Aortic Translocation Procedure
Summary
References
Chapter 28: Corrected TGA-VSD-LVOTO: Rastelli + Atrial Switch + Damus-Kaye-Stansel Operation
Background
Anatomic Classification
Diagnosis-Imaging
Check List
Surgical Techniques
Procedures for Senning Atrial Switch
Procedures for Left Ventricular Outflow Tract: Intra-ventricular Rerouting
Procedures for Left Ventricular Outflow Tract: Additional DKS Anastomosis
Procedures for Right Ventricular Outflow Tract
Outcomes
References
Chapter 29: Physiologic Repair of Congenitally Corrected Transposition of the Great Arteries
Introduction
Background
Anatomy
Pathophysiology
Diagnosis and Imaging
Surgical Option
Complications of Anatomic Repair
Complete Heart Block
Systemic Venous Baffle Obstruction
Pulmonary Venous Baffle Obstruction
Residual VSD
Physiological Repair
Surgical Options for Tricuspid Valve Regurgitation
TV Replacement in ccTGA
Surgical Techniques of TV Repair
Pulmonary Artery Banding (PAB)
The Failing Systemic Morphologic Right Ventricle
Mechanisms of Failure
Bulging of the Interventricular Septum
Role of Ischemia
Surgical Options
Bidirectional Cavopulmonary Anastomosis
Fontan Procedure
Use of Ventricular-Assist Devices (Fig. 29.10)
Heart Transplantation
Physiological Repair of ccTGA-VSD
Physiologic Repair of ccTGA-VSD-LVOTO with VSD Patch Closure and LV to PA Conduit
Physiologic Repair of ccTGA-VSD-LVOTO with VSD Patch Closure Only
Outcomes
Outcomes of Physiologic Repair
Outcomes of Systemic Atrioventricular Valve Surgery
Follow Up and Conclusion
References
Chapter 30: Anatomically Corrected Malposition of the Great Arteries
Introduction
Anatomy
Definition of Anatomically Corrected Malposition
ACM {S,D,L}
ACM {S,L,D}
ACM {I,L,D}
ACM {I,D,L} [4]ACM {A,D,L}
ACM {A,L,D}
Associated Malformations
Surgery of Anatomically Corrected Malposition
Surgery of ACM with AV Concordance (ACM-AVC)
Surgery of ACM with AV Discordance (ACM-AVD)
Comment
Differential Diagnosis
Isolated Infundibulo-Arterial Inversion {S,D,I}
Double-Outlet Right Ventricle with L-Malposition of the Great Arteries
Left Juxtaposition of the Atrial Appendages (LJAA) and ACM
Associated Anomalies
Evolution of the Infundibuloarterial Segment
References
Chapter 31: Truncus Arteriosus
Introduction
Anatomy & Physiology
Anatomy
Classification Systems
Physiology
Imaging and Diagnosis
Pre-operative Checklist
Surgical Technique
General Principles
Cardiopulmonary Bypass
Separating the Pulmonary and Systemic Circulation
Ventricular Septal Defect Closure
Establish Right Ventricular to Pulmonary Artery Continuity
Alternative Technique
Truncal Valve Repair
Interrupted Aortic Arch (See Chap. 35)
Post-operative Care
Outcomes
References
Chapter 32: Common Arterial Trunk with Interrupted Aortic Arch
Introduction
Anatomy and Physiopathology
Diagnosis and Imaging
Pre-operative Check-List
Surgery
Indications
Palliative Procedure
5.3 One Stage Repair
Outcome
References
Chapter 33: Interrupted Aortic Arch
Introduction
Anatomy
Etiopathogenesis of IAA
Associated Anomalies
Diagnosis/Imaging
Preoperative Check List
Indications
Anatomy of the Aortic Arch
Size of the Ascending Aorta
Status of the PDA
Ventricular Septal Defect
Presence of Severe LVOTO
Hypoplasia of the Left Ventricle
Status of Pulmonary Valve and Artery
Presence of Major Associated Cardiac Anomalies
Associated DiGeorge Syndrome
General Factors
Risk Assessment
Surgical Treatment
Timing
Repair
Trans-Thoracic Off-Pump Arch Repair ± Pulmonary Artery Banding
Primary Repair
Median Sternotomy Approach
Management of Cardiopulmonary Bypass
Cardiac Repair
Relief of Subaortic Stenosis
VSD Patch Closure
Aortic Arch Repair Through Sternotomy
Management of Severe LVOTO
Yasui Operation (Fig. 33.9)
Norwood Operation
Ross-Konno Operation (Fig. 33.10)
Outcome
Early and Mid-term Survival
Reoperations [37]Arch Obstruction
LVOTO
Other Residual Intracardiac Lesions
Bronchial Compression [37]Pulmonary Artery Reintervention [37]Conclusion
References
Chapter 34: The Dilated Aortic Root in Adult Patients with Conotruncal Anomalies
Introduction
Aortic Dilatation in Tetralogy of Fallot
Aortic Dilatation in Truncus Arteriosus
Aortic Dilatation in Transposition of the Great Arteries
Aortic Dilatation in Double Outlet Right Ventricle
Norwood Procedure
Pregnancy Evaluation
References
Chapter 35: Single Ventricle Repair for  Conotruncal Anomalies
Discussion
References
Chapter 36: Genetics of Conotruncal Anomalies
Introduction
Overview of Early Heart Development
Second Heart Field Lineage
Cardiac Neural Crest Cell Lineage
Conotruncal Anomalies
Tetralogy of Fallot
Double Outlet Right Ventricle
Overriding Aorta
Transposition of the Great Arteries
Persistent Truncus Arteriosus
Chromosomal Disorders and Conotruncal Anomalies

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