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Mendero College Tiguma, Pagadian City

Submitted to: Ms. Kathleen B. Carpio BSN, RN Clinical Instructor

Submitted by: Princess D. Platero BSN-II

BlalockTaussig Shunt

Definition: The BlalockTaussig shunt (also referred to as a Blalock-Thomas-Taussig shunt) is a surgical procedure to give palliation to cyanotic heart defects which are common causes of blue baby syndrome. In modern surgery, this procedure is temporarily used to direct blood flow to the lungs and relieve cyanosis while the infant is waiting for corrective or palliative surgery. One branch of the subclavian artery or carotid artery is separated and connected with the pulmonary artery. The lung receives more blood with low oxygenation from the body. The first area of application was tetralogy of Fallot. The BlalockTaussig shunt may be used as the first step in the Fontan procedure. History: The original procedure was named for Alfred Blalock, surgeon, Baltimore(1899 1964), Helen B. Taussig, cardiologist, Baltimore/Boston (18981986) and Vivien Thomas (19101985) who was at that time Blalock's laboratory technician, developed the procedure. Management: y If at all possible, it is important that the patient be free of infection prior to going to surgery. This includes dental cavities, so a dental check-up and any dental

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work required should be completed within 6 weeks prior to surgery. A letter is required from the dentist clearing the patient for surgery. In addition, if the patient develops other signs and symptoms of an infection, such as a fever, runny nose, diarrhea, or vomiting, contact the surgeons office immediately. If the patient is taking aspirin, contact the cardiologist to ask when to discontinue taking the aspirin. Aspirin is generally discontinued 14 days prior to surgery to minimize the risk of excessive bleeding. However, there may be a medical reason to continue the aspirin, so it is important to check with the cardiologist. All patients whether they are admitted to the hospital or not - will be placed on NPO (nothing by mouth) status after midnight the night before surgery. Clear liquids may be allowed at the specific instructions of the anesthesiologist. Monitor the patientss vital signs and report immediately if there are any abnormalities. Once the surgical dressing is removed, the incision will remain open to air. The nurses will cleanse the incision with a Betadine solution twice a day. Watch out for bleeding (redness, swelling from incision) or infection basing on the signs manifested by the client after the procedure.

Modified Fontan Procedure

Definition: The Fontan procedure, or Fontan/Kreutzer procedure, is a palliative surgical procedure used in children with complex congenital heart defects. It involves diverting the venous blood from the right atrium to the pulmonary arteries without passing through the morphologic pulmonary ventricle. It was initially described in 1971 by Dr Fontan and Dr Kreutzer separately as a surgical treatment for tricuspid atresia. Indications: The Fontan procedure has more recently been used in pediatric situations where an infant only has a single effective ventricle, either due to heart valve defects (e.g. tricuspid or pulmonary atresia) or an abnormality of the pumping ability of the heart

(e.g. hypoplastic left heart syndrome, hypoplastic right heart syndrome), or has complex congenital heart disease where a bi-ventricular repair is impossible or inadvisable. Contraindication: After Fontan, blood must flow through the lungs without being pumped by the heart. Therefore children with high pulmonary vascular resistance may not tolerate a Fontan procedure. Often cardiac catheterization is performed to check the resistance before proceeding with the surgery. (This is also the reason a Fontan procedure cannot be done immediately after birth; the pulmonary vascular resistance is high in utero and takes months to drop.) Types: There are three different types of Fontan procedure.
  

Atriopulmonary connection (the original) Described by Fontan and Kreutzer. Intracardiac total cavopulmonary connection (lateral tunnel) Extracardiac total cavopulmonary connection

Atrial Septostomy or Rashkinds Procedure Definition: Atrial septostomy is a surgical procedure in which a small hole is created between the upper two chambers of the heart, the atria. This procedure is primarily used to treat dextro-Transposition of the great arteries or d-TGA (often imprecisely called transposition of the great arteries), a lifethreatening cyanotic congenital heart defect seen in infants. Atrial septostomy has also seen limited use as a surgical treatment for pulmonary hypertension. This technique was developed in 1966 by American surgeons William Rashkind and William Miller at the Children's Hospital of Philadelphia.

There are two types of this procedure: balloon atrial septostomy (also called endovascular atrial septostomy, Rashkind atrial balloon septostomy, or simply Rashkind's procedure) and blade atrial septostomy (also called static balloon atrial septostomy). Management: y
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Monitor the patients vital signs and report immediately if there are any abnormalities. Monitor incision for infection or bleeding.

Cardiac Catheterization Definition: Cardiac catheterization (also called cardiac cath or coronary angiogram) is an invasive imaging procedure that tests for heart disease by allowing your doctor to "see" how well your heart is functioning. During the test, a long, narrow tube, called a catheter, is inserted into a blood vessel in your arm or leg and guided to your heart with the aid of a special X-ray machine. Contrast dye is injected through the catheter so that X-ray movies of your valves, coronary arteries, and heart chambers can be created.

Cardiac catheterization is used to study the various functions of the heart. Using different techniques, the coronary arteries can be viewed by injecting dye or opened using balloon angioplasty. The oxygen concentration can be measured across the valves and walls (septa) of the heart and pressures within each chamber of the heart and across the valves can be measured. The technique can even be performed in small, newborn infants

Uses:

Evaluate or confirm the presence of heart disease (such as coronary artery disease, heart valve disease, or disease of the aorta). Evaluate heart muscle function. Determine the need for further treatment (such as an interventional procedure or bypass surgery). At many hospitals, several interventional, or therapeutic, procedures to open blocked arteries are performed after the diagnostic part of the cardiac catheterization is complete. Interventional procedures include balloon angioplasty, brachytherapy, atherectomy, rotoblation, cutting balloon, and stent placements.

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Risks are rare but can include:


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Bleeding around the point of puncture Abnormal heart rhythms Blood clots Infection Allergic reaction to the dye Stroke Heart attack Air embolism (introduction of air into a blood vessel, which can be life-threatening)

Management: y Before cardiac catheterization, most people will need to have a routine chest Xray, blood tests, electrocardiogram, and urinalysis performed within two weeks before having the test. A sterile dressing will be placed on the groin area to prevent infection You will need to lay flat and keep the leg straight for two to six hours to prevent bleeding. Your head can not be raised more than two pillows high (about 30 degrees). Do not raise your head off the pillows, as this can cause strain in your abdomen and groin. Do not try to sit or stand. The nurse will check your bandage regularly, but tell your nurse if you think you are bleeding (have a wet, warm sensation) or if your toes begin to tingle or feel numb. You may receive medication to relieve discomfort in the groin area after the anesthetic wears off. Assist the patient if the patient wants to move or sit down. Monitor the patients vital signs and report immediately if there are any abnormalities.

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