pre operative evaluation of single ventricle disease
TRANSCRIPT
![Page 1: Pre operative evaluation of Single ventricle Disease](https://reader031.vdocuments.us/reader031/viewer/2022030318/5a6d2ed17f8b9ad1418b4f79/html5/thumbnails/1.jpg)
PRE OPERATIVE EVALUATION OF SINGLE VENTRICLEDr. Shahreen KabirFCPS (Paediatrics)Paediatric Cardiac ProgrammeNational Heart Foundation, Dhaka
![Page 2: Pre operative evaluation of Single ventricle Disease](https://reader031.vdocuments.us/reader031/viewer/2022030318/5a6d2ed17f8b9ad1418b4f79/html5/thumbnails/2.jpg)
Single Ventricle (or Univentricular heart) is considered a
cardiac malformation in which both atria connect to only one
ventricular chamber by either two separate AV Valve ( Double
Inlet) or a common AV Valve ( common inlet).
k
Ref- Congenital Heart Defect A.F Conro
![Page 3: Pre operative evaluation of Single ventricle Disease](https://reader031.vdocuments.us/reader031/viewer/2022030318/5a6d2ed17f8b9ad1418b4f79/html5/thumbnails/3.jpg)
Single Ventricle - congenital cardiac
malformations that lack two completely well
developed ventricles, and in which functionally there
is only a single ventricular chamber that supports
both pulmonary and systemic circulations.
![Page 4: Pre operative evaluation of Single ventricle Disease](https://reader031.vdocuments.us/reader031/viewer/2022030318/5a6d2ed17f8b9ad1418b4f79/html5/thumbnails/4.jpg)
Single Ventricle
PhysiologicalAnatomical
![Page 5: Pre operative evaluation of Single ventricle Disease](https://reader031.vdocuments.us/reader031/viewer/2022030318/5a6d2ed17f8b9ad1418b4f79/html5/thumbnails/5.jpg)
Single Ventricle:
Tricuspid Atresia
HLHS
DILV, DIRV
Unbalanced AV Canal Defect
DORV
![Page 6: Pre operative evaluation of Single ventricle Disease](https://reader031.vdocuments.us/reader031/viewer/2022030318/5a6d2ed17f8b9ad1418b4f79/html5/thumbnails/6.jpg)
Tricuspid Atresia
![Page 7: Pre operative evaluation of Single ventricle Disease](https://reader031.vdocuments.us/reader031/viewer/2022030318/5a6d2ed17f8b9ad1418b4f79/html5/thumbnails/7.jpg)
HLHS
![Page 8: Pre operative evaluation of Single ventricle Disease](https://reader031.vdocuments.us/reader031/viewer/2022030318/5a6d2ed17f8b9ad1418b4f79/html5/thumbnails/8.jpg)
DILV
![Page 9: Pre operative evaluation of Single ventricle Disease](https://reader031.vdocuments.us/reader031/viewer/2022030318/5a6d2ed17f8b9ad1418b4f79/html5/thumbnails/9.jpg)
DORV
![Page 10: Pre operative evaluation of Single ventricle Disease](https://reader031.vdocuments.us/reader031/viewer/2022030318/5a6d2ed17f8b9ad1418b4f79/html5/thumbnails/10.jpg)
Unbalanced AV CANAL DEFECT
![Page 11: Pre operative evaluation of Single ventricle Disease](https://reader031.vdocuments.us/reader031/viewer/2022030318/5a6d2ed17f8b9ad1418b4f79/html5/thumbnails/11.jpg)
Univentricluar Atrioventricular Connection
![Page 12: Pre operative evaluation of Single ventricle Disease](https://reader031.vdocuments.us/reader031/viewer/2022030318/5a6d2ed17f8b9ad1418b4f79/html5/thumbnails/12.jpg)
Presentation of Single Ventricle Dis:
Cyanosis
Irritability
Respiratory Distress
Feeding Difficulties
Not growing well
End organ failure ( CNS, Renal, etc)
Without PSWith PS
![Page 13: Pre operative evaluation of Single ventricle Disease](https://reader031.vdocuments.us/reader031/viewer/2022030318/5a6d2ed17f8b9ad1418b4f79/html5/thumbnails/13.jpg)
Physical Assessment
Vitals:
SpO2
Pulse, feeble in HLHS and Co arc
BP
Perfusion
Periphery for warmth
Cyanosis
Clubbing
Polycythemia
FTT
![Page 14: Pre operative evaluation of Single ventricle Disease](https://reader031.vdocuments.us/reader031/viewer/2022030318/5a6d2ed17f8b9ad1418b4f79/html5/thumbnails/14.jpg)
Respiratory- findings of collapse, consolidation
Precordium- findings depends upon the basic disease, presence and absence of PS
![Page 15: Pre operative evaluation of Single ventricle Disease](https://reader031.vdocuments.us/reader031/viewer/2022030318/5a6d2ed17f8b9ad1418b4f79/html5/thumbnails/15.jpg)
The Stages of Palliation:
Stage I : MBT/ PA Banding
Stage II: BD Glenn
Stage III: FONTAN
![Page 16: Pre operative evaluation of Single ventricle Disease](https://reader031.vdocuments.us/reader031/viewer/2022030318/5a6d2ed17f8b9ad1418b4f79/html5/thumbnails/16.jpg)
The 10 Commandements of FONTAN procedure
1. Minimum age, 4 years
2. Sinus rhythm
3. Normal caval drainage
4. Right atrium of normal volume
5. Mean pulmonary artery pressure ≤ 15 mm Hg
6. Pulmonary arterial resistance < 4 Wood/m2
7. Pulmonary-artery-to-aorta-diameter ratio ≥ 0.75
8. Normal ventricular functions (ejection fraction > 0.6)
9. Competent left atrioventricular valve
10. No impairing effects of previous shunts
![Page 17: Pre operative evaluation of Single ventricle Disease](https://reader031.vdocuments.us/reader031/viewer/2022030318/5a6d2ed17f8b9ad1418b4f79/html5/thumbnails/17.jpg)
Cardiovascular Workup
Chest X-ray-
Normal
Heart size (depends if the pt is in failure or not)
Pulmonary Vascularity or
![Page 18: Pre operative evaluation of Single ventricle Disease](https://reader031.vdocuments.us/reader031/viewer/2022030318/5a6d2ed17f8b9ad1418b4f79/html5/thumbnails/18.jpg)
Tricuspid Atresia
![Page 19: Pre operative evaluation of Single ventricle Disease](https://reader031.vdocuments.us/reader031/viewer/2022030318/5a6d2ed17f8b9ad1418b4f79/html5/thumbnails/19.jpg)
HLHS
![Page 20: Pre operative evaluation of Single ventricle Disease](https://reader031.vdocuments.us/reader031/viewer/2022030318/5a6d2ed17f8b9ad1418b4f79/html5/thumbnails/20.jpg)
ECG- acc to disease
Arrhythmia
LAD w LVH, 1st degree AV Block ( Tric Atr)
RAD, RVH, Tall P wave( HLHS)
![Page 21: Pre operative evaluation of Single ventricle Disease](https://reader031.vdocuments.us/reader031/viewer/2022030318/5a6d2ed17f8b9ad1418b4f79/html5/thumbnails/21.jpg)
Echocardiographic Evaluation
Basic diagnosis
Basic Anatomy
Atrial Volume
IAS mixing or restrictive?
SVC, IVC size, their draining, ratio.
AV valve morphology, allignment, regurgitation
MV, TV ratio
![Page 22: Pre operative evaluation of Single ventricle Disease](https://reader031.vdocuments.us/reader031/viewer/2022030318/5a6d2ed17f8b9ad1418b4f79/html5/thumbnails/22.jpg)
Ventricles, LV or RV morphology, rudimentary one
VSD size
LV EF, LV EDP
PA size, branching, anatomy.
PAH or PS
![Page 23: Pre operative evaluation of Single ventricle Disease](https://reader031.vdocuments.us/reader031/viewer/2022030318/5a6d2ed17f8b9ad1418b4f79/html5/thumbnails/23.jpg)
Pre FONTAN Cath:
PA Anatomy
PA Pressure ( <15mmHg is desirable)
PVR ( <4Wood Unit is desirable)
RV to PA gradient
Pulm Venous Return
LV EDP
Functioning of prev shunts
Any AVM
![Page 24: Pre operative evaluation of Single ventricle Disease](https://reader031.vdocuments.us/reader031/viewer/2022030318/5a6d2ed17f8b9ad1418b4f79/html5/thumbnails/24.jpg)
Before Proceeding to Fontan ( Stage III Palliation)
Improve clinical symptoms: cyanosis, CHF
Provide optimal pulmonary artery architecture and low PVR
Preserve systolic and diastolic ventricular function
Preserve atrio-ventricular valve function
Relieve systemic ventricular outflow tract obstruction
Provide anatomic setup for a definitive Fontan repair
Ideal saturation:
![Page 25: Pre operative evaluation of Single ventricle Disease](https://reader031.vdocuments.us/reader031/viewer/2022030318/5a6d2ed17f8b9ad1418b4f79/html5/thumbnails/25.jpg)
Age 3 to 4 mo
Mean PA pressure <15mmHg
PVR < 4 Wood units
Surgically repairable PA hypoplasia or discrete
stenosis present
Target SpO2: 78~85%
![Page 26: Pre operative evaluation of Single ventricle Disease](https://reader031.vdocuments.us/reader031/viewer/2022030318/5a6d2ed17f8b9ad1418b4f79/html5/thumbnails/26.jpg)
TAKE HOME MESSAGE
Meticulous pre operative assessment should be done before patient selection.
LOW PVR
GOOD LV FUNCTION
NO AV VALVE REGURG
![Page 27: Pre operative evaluation of Single ventricle Disease](https://reader031.vdocuments.us/reader031/viewer/2022030318/5a6d2ed17f8b9ad1418b4f79/html5/thumbnails/27.jpg)
THANKS FOR PATIENT HEARING!