1. CONGENITAL HEART DISEASES IIBy
Prof. Khaled KARARA
Professor of Cardiothoracic Surgery
Alexandria Faculty of Medicine

2. Ventricular septal defect (VSD)
Is the commonest congenital heart defect.
Types:
Perimembranous VSD: in the area of the membranous septum (commonest type).
Inlet VSD: beneath the septal leaflet of tricuspid valve.
Outlet VSD: beneath the pulmonary valve, superior to the crista supraventricularis.
Muscular VSD: in the muscular ventricular septum. May be multiple → Swiss cheese type.
NB: Types 1 & 4 may close spontaneously.

5. VSD (cont.)
Treatment: - Patch (Dacron or Gore-tex) closure through Rt atriotomy or ventriculotomy. - If the patient can not withstand open cardiac procedure → pulmonary artery banding to protect against pulmonary hypertension followed later by debanding and patch closure of the VSD.

6. Pulmonary Artery Banding

8. Atrial septal defect (ASD)
Types:
Secondum ASD: defect in fossa ovalis, is the commonest type.
Primum ASD: near the AV valves. It may be associated with cleft in anterior mitral leaflet.
Sinus venosus ASD: defect in the interatrial septum near the superior vena cava.
N.B. Patent foramen ovale (PFO) is a small intratrial communication at upper part of fossa ovalis; it is a remnant of the fetal foramen ovale, which normally closes at birth.

10. ASD (cont.)
Treatment:
Catheter device closure for selected cases of secondum defects and not suitable for primum and sinus venosus types.
Patch (autologous pericardium, or synthetic as Dacron or Gore-tex).
In presence of mitral reguge due to cleft in anterior mitral leaflet → interrupted sutures are used to approximate the defect to reduce the regurge.

11. Catheter device closure

13. Patent ductus arteriosus (PDA)
The ductus arteriosus closes within 2-3 weeks after birth to become the ligamentum arteriosum. Failure of ductus closure results in PDA connecting the beginning of the descending aorta and the beginning of the left main pulmonary artery.
Treatment:
In premature infants, indomethacin and ibuprofen may be effective in closure of PDA.
Device closure.
Surgical ligation, clipping or division and suturing. Approached through limited left thoracotomy. Take care of the Lt recurrent laryngeal nerve.
VATS (video-assisted thoracoscopic surgery) new option.

14. Device closure

15. PDA surgical ligation

16. Complications:
 Bleeding at the time of operation.
Recanalization or failure of proper occlusion.
Injury to the recurrent laryngeal nerve.
Chylothorax.