Left to Right Shunts - ECAB

Author: Desai> Nagaraj  

Publisher: Elsevier Health Sciences APAC‎

Publication year: 2012

E-ISBN: 9788131231746

P-ISBN(Paperback): 9788131217221

Subject: R654.3 vascular

Keyword: 内科学

Language: ENG

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Description

Patients born with cardiac defects need to be identified early and the severity of symptoms also needs to be identified. In children with larger defects or with more symptoms, early institution of treatment is warranted, since in absence of treatment, the disease progresses to pulmonary hypertension and a simple pathology gets complicated. Presence of congestive cardiac failure in infancy or of pulmonary artery hypertension is indication for early surgical treatment (prior to 6 months of age). Untreated ASD may at times allow the child to grow and reach adulthood, but can cause complications in adulthood also. These issues related to understanding of natural history of the shunts and its implications in management decisions need to be addressed in clear terms. Also the role and timing of surgical therapy need to be emphasized. This book is designed to address such questions with supportive clinical scenarios. Thus, it provides an excellent opportunity to widen one's perspective in this area.

Chapter

Introduction

Natural History of Left to Right Shunts

Atrial Septal Defect

Spontaneous Closure

Pulmonary Hypertension and Pulmonary Vaso-Occlusive Disease

Heart Failure

Atrial Arrhythmias

Repaired ASD

Patent Foramen Ovale

Mortality

Atrioventricular Septal Defect

Natural History of Ventricular Septal Defect

Spontaneous Closure

Pulmonary Vascular Disease

Infective Endocarditis

Mortality

Aortic Regurgitation

Infundibular Pulmonary Stenosis

Patent Ductus Arteriosus

Spontaneous Closure

Congestive Heart Failure

Pulmonary Hypertension

Endarteritis

Aneurysm of Ductus Arteriosus

Mortality

Hemodynamic Assessment of Congenital Heart Defects with Left to Right Shunts and Pulmonary Hypertension

Introduction

Objectives of the Review

Correlating Pre-Operative Hemodynamics with Lung Biopsy Findings and Clinical Outcomes

Clinical and Non-Invasive Correlates of Hemodynamic Changes in Left to Right Shunts

Accurate Hemodynamic Assessment in Shunt Lesions: Who Needs it Most?

Role of Clinical Examination, Ecg, Chest X-ray, Echocardiography and Arterial Blood Gas

Hemodynamic Assessment in the Catheterization Laboratory

Correct Sequence of Sampling and Pressure Measurement

Calculation of Flows and Resistances

Common Sources of Error with Invasive Hemodynamic Assessment

Role of Reversibility Testing for Estimation of Operability

Conclusion

Surgery in Congenital Heart Disease with Left to Right Shunts

Introduction

Timing of Surgical Intervention: Broad Principles

Predicting the Natural History of Congenital Heart Disease

Precise Anatomic Diagnosis

Hemodynamic Assessment

Clinical Evaluation

Natural History Information

Spontaneous Closure of Defects

Procedural Outcome

Guidelines for Individual Lesions

The Effect of Co-morbidities

Surgical Operations for Left to Right Shunts

Pulmonary Artery Banding

Technique

Patent Ductus Arteriosus

Atrial Septal Defects

Partial Anomalous and Hemianomalous Pulmonary Venous Connections

Ventricular Septal Defects

Atrio-ventricular Canal

Postoperative Features

Aorto-pulmonary Window

Conclusions

Summary

Forthcoming Books

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