PowerPoint Slides for

Adult Congenital Heart Disease

An educational resource on developed at

Scientific Software Solutions, Inc.
with Allen D. Everett, MD of Johns Hopkins Heart Center.

Copyright 2006 by Scientific Software Solutions, Inc. All Rights Reserved.

 External
Normal
Heart
(Frontal View)
 Internal
Normal
Heart
(Frontal View)
Internal
Normal
Heart

(Basal view
from above)
External
Normal
Heart

(Showing
coronary
artery
branches)
Internal
Normal
Heart

(View from
right side)
 Total
Anomalous
Pulmonary
Venous
Return
PV – Pulmonary Veins
ASD – Atrial Septal Defect
Repair of Total Anomalous Pulmonary Venous Return
 Aortic
Stenosis
A - Supravalvar
B – Valvar
C - Subvalvar
 Repair of Aortic Stenosis

Ross Procedure Konno Procedure

 Repair of
Aortic
Stenosis
Conduit from Left
Ventricular Apex to
Descending Aorta
Aortic Stenosis - Balloon Valvuloplasty
 Aortopulmonary Window

(Above)
Dashed line shows area of
communication between
aorta and pulmonary artery.
Repair of Aortopulmonary Window
 Atrial
Septal
Defects

(View from
right side)
Atrial
Septal
Defect

Patch
Repair
Amplatzer Occlusion of Atrial Septal Defect

Clockwise from above:

Transcatheter delivery of
Amplatzer device, which is
positioned across the
atrial septal defect

Left: Amplatzer device in

place
Atrioventricular Canal Defect - Complete

Above: view of heart from above

showing joined mitral and tricuspid
valves

Right: ASD – atrial septal defect

VSD – ventricular septal defect
Repair of Atrioventricular Canal Defect - Complete
Coarctation
of the Aorta
SA – subclavian artery
COA – coarctation
AV - aortic valve
 Coarctation Repair
Excision with End to End Anastamosis
Coarctation - Subclavian Flap Repair
 Angioplasty
Aortic Coarctation Angioplasty

Illustrations showing (left) uninflated and (right) inflated angioplasty

balloon positioned within coarctation of the descending aorta
 Intravascular Stents
Coarctation of the Aorta

Left: uninflated angioplasty balloon and stent within coarctation

Middle: expansion of balloon and stent
Right: deflation of balloon leaving stent wide open
 Ebstein’s
Anomaly

ASD – atrial septal

defect

1 – atrialization of the
right ventricle
Repair of Ebstein’s Anomaly – Carpentier Procedure
 Eisenmenger
Complex
Ventricular Septal Defect
(VSD) in conjunction with
Pulmonary Vascular
Obstructive Disease
(PVOD)

Arrow – right to left shunt

 Hypertrophic
Cardiomyopathy
Repair of Hypertrophic Cardiomyopathy
Septal Myectomy
 Marfan’s
Syndrome
1 – enlarged ascending aorta
2 – stretched aortic valve
3 – mitral valve prolapse
SV – Sinuses of Valsalva
 Mitral Stenosis

LA – left atrium
LV – left ventricle Normal Heart
arrow – stenotic mitral valve
Mitral Stenosis – Valve Replacement
 Valvuloplasty
Mitral Balloon Valvuloplasty

Single (left picture) and double (right picture) Inoue valvuloplasty

balloon(s) inflated across stenotic mitral valve
Patent Ductus
Arteriosus
(PDA)
Patent Ductus Arteriosus
Division and Ligation
Occlusion of Intracardiac and Vascular Shunts
Coil embolization of PDA

Left, top: Catheter crosses the PDA

from the aortic side and delivers a coil.
Left, bottom: Withdrawal of catheter,
leaving coil in PDA
Pulmonary Atresia
with Intact
Ventricular Septum
1 – atrial septal defect
2 – atretic pulmonary valve
3 – patent ductus arteriosus
4 – hypoplastic right ventricle
5 – small tricuspid valve
Balloon Atrial Septostomy - Static

Rashkind-Miller catheter
Balloon Atrial Septostomy - Dynamic

Rashkind-Miller catheter
Illustration courtesy Edwards Lifesciences Corp.
Pulmonary
Stenosis
A – supravalvular
B – valvular
C - subvalvular
 Pulmonary
Stenosis Repair

Pulmonary valve
widened with insertion of
transannular patch
(shown in pink)
 Valvuloplasty
Pulmonary Balloon Valvuloplasty

Left: Arrow indicates stenotic pulmonary valve

 Single
Ventricle
Lesions
Single Ventricle Surgeries
 Single
Ventricle
Surgery

Pott’s Shunt
 Single Ventricle Surgeries

Superior Vena Cava to Direct Right Atrial to Pulmonary

Pulmonary Artery Anastomosis Artery Anastomosis (Fontan
(Glenn Shunt) Repair) for Tricuspid Atresia
 Tetralogy of Fallot

1 – ventricular septal defect (VSD), 2 –pulmonary stenosis

2a – infundibular stenosis, 3 – enlarged aorta overriding VSD
4 – right ventricular hypertrophy
Repair of Tetralogy of Fallot
 Repair of Tetralogy of Fallot

Subclavian Artery to Pulmonary Ascending Aorta to Right

Artery Anastomosis (Blalock- Pulmonart Artery Anastomosis
Taussig Shunt) (Waterston-Cooley Shunt)
Transposition
of the Great
Arteries –
D Type
Jatene Arterial
Switch
Operation
Transposition
of the Great
Arteries –
L Type

MV – mitral valve
TV – tricuspid valve
Atrial Switch Operation –Mustard Repair
(view of heart from right side)

Pericardium baffle shown in pink. Oxygenated blood shown as red

arrows. Oxygen-poor blood (blue arrows) flows behind baffle.
 Truncus
Arteriosus

1 – Type 1 Truncus

2 – abnormal valve
(4 leaflets)

3 – ventricular septal
defect (VSD)
 Repair of Truncus Arteriosus

TA – truncus arteriosus, VSD – ventricular septal defect

Right (upper arrow) – light blue valved conduit
Ventricular
Septal
Defects

(View from right

side)
Ventricular Septal Defect
Patch Repair

(View from right side)

Occlusion of Intracardiac and Vascular Shunts
Ventricular Septal Defect Occlusion

Above: Echocardiogram of muscular VSD

Upper right: Fluoro image of CardioSEAL
device occlusion of a VSD. Transesophageal
echo probe (TEE) and pigtail catheter in place.
Lower right: Amplatzer muscular ventricular
septal occluder Illustration courtesy AGA Medical Group
Occlusion of Intracardiac and Vascular Shunts
VSD Occlusion with CardioSEAL Device
Fontan Procedure – Lateral Tunnel
Occlusion of Intracardiac and Vascular Shunts
Fontan Fenestration Occlusion with Amplatzer Device
Fontan Procedure – Extracardiac
 Cardiac
Conduction
System
Normal Electrocardiogram Interval
Atrioventricular
Bundle
Branches

RBB – right bundle

branch

LBB – left bundle

branch
 Complete
Heart Block
Orthodromic
Reciprocating
Tachycardia
(ORT)
 Wolff
Parkinson
White
(WPW)

Atrioventricular
Reciprocating
Tachycardia
 Congenital Cardiac Interventions
Transseptal Puncture and Blade Septostomy

Transseptal perforation, Blade septostomy,

using Brockenbrough needle using Park Blade
Percutaneous
Vascular
Access
Sites
 Commonly Used Catheters

Pigtail angiographic catheter

End-hole catheters

Side-hole Berman angiographic catheter