Congenital Heart Surgery

ADULT CONGENITAL HEART LESIONS

Adults with congenital heart disease require a

multi-disciplinary approach for optimal treatment.

Previous operations may have been palliative in

nature therefore, reconstruction and/or correction

of these residual defects frequently requires

innovative strategies combining the talents of a

cardiologist/interventionalist and a surgeon.
Telemanipulation of Intra-cardiac Anomalies:

A large Atrial Septal Defect in an adult female was

repaired utilizing robotic assisted telemanipulation.

Cardiolplegia was avoided and ventricular

fibrillation induced as a means of preventing left

ventricular output during the repair phase of the

operation. Autologous pericardial patch repair of

this defect was required. This Mom of two was

discharged within days with a superior cosmetic

result as compared to "conventional" techniques.
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Ventricular Septal Defect (VSD):

This peri-membranous ventricular septal defect

with over-ride required surgical closure.

Note that the aortic valve is in very close

proximity to the ventricular defect. Several

chordal arrays from the Tricuspid Valve have

been cut in order to unify the defect(s) and

allow superior exposure for successful surgical

closure. The entire procedure was performed

using cardioscopy and a minimally invasive

approach. Malalignment defects are found in

conal-truncal defects i.e. Double Outlet

Right Ventricle and Tetralogy of Fallot.

(right click on the picture for more info).

Adult Congenital Heart Surgery: (see above)

This movie demonstrates the repair of an ascending aortic aneurysm in association with a

Congenitally abnormal bicuspid Aortic Valve. A composite graft was inserted in concert

with re-implantation of the coronary arteries.

Adult Congenital Heart Surgery: (see below)

Picture 1: This JPEG demonstrates the intra-operative view of the heart in a patient

with Ebstein's anamaly (Note the size discrepency between the aorta and the giant

right atrium and ventricle).

Picture 2: This JPEG demonstrates the intra-operative view of an aortic

valve with subacute bacterial endocarditis. The patient was known to have

a coarctation of the aorta.

:

Picture 1: Picture 2:

Robotic Assisted Cardioscopy:

This illustration depicts a rigid cardioscope being

maneuvered by a robotic arm to allow improved

visualization, magnification, and illumination of the

critical heart structures via a mini-invasive incision.

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Patent Ductus Arteriosus:

Using a specially designed bronchial blocker,

thorascopic dissection of the patent ductus and

surrounding nerves was safely performed. Similar

techniques allow for the correction of vascular

rings without dis-figuring thoracotomy incisions.

("Double Click" on the picture for more info.)

Subaortic Fibromuscular Obstruction:

Using a 2.6mm cardioscope we were able to

do an extensive fibromyomectomy using a trans-aortic

approach to releave a severe left ventricular outflow

tract obstruction (LVOTO). Note the anterior medial

papillary muscle of the mitral valve cannot be seen until

the resection is completed. Only the anterior mitral valve

leaflet is seen in the pre-resection picture (bottom).

Pioneered cardioscopic techniques allow for agressive

mid-ventricular myomectomies - especially in teenagers

and adults.

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News placeholder Primum Atrial Septal Defect (partial endocardial

cushion defect):

Enlargement of the atrial septal defect (top) provides the

need exposure for the cleft closure of the left atrioventricular

valve (bottom). "Double Click" on the picture for more info.

Robotic Closure of Atrial Septal Communication:

The atrial (defect) communication is found within

the Fossa Ovalis and was primarily repaired by sewing

the septum Primum to the superior rim of the limbus

using a robotic video assisted technique.

Video Assisted Repair of a Restrictive

Peri-membranous Ventricular Septal

Defect (in children and adults)

The borders of the VSD are quite fibrotic. The

forceps are gently inserted into the defect. Note

how the septal leaflet of the Tricuspid Valve is

quite dysmorphic with rolled free edges.

Although the defect remains small and usually

hemodynamically insignificant (Qp:Qs<1.5:1)

other indications may be present for surgical

closure.

1) bout(s) of endocarditis

2) new onset of semilunar valve dysfunction

(aortic regurgitation)

3) slow but progressive chamber enlargment

(left ventricle) especially during and possibly

after pregnancy.