Double Inlet Left Ventricle

TSDA Congenital Curriculum for the Week of September 22, 2014
Week 10 of 32
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The Congenital Curriculum is based on a 32-week lesson plan, and you can expect to receive e-mail messages
every Thursday for the upcoming week, with the exception of holiday weekends. The weekly assignments are a
supplement to your program curriculum and include basic readings for congenital fellows, faculty, and others
interested in congenital heart surgery. TSDA hopes the Congenital Curriculum expands your current knowledge
base and enhances your learning experience.
Topic: Double Inlet Left Ventricle
I. Morphology
a. DILV morphology
i. l- ventricular looping
ii. d- ventricular looping
iii. Holmes Heart
b. Conduction system
c. Associated lesions
i. Coarctation/Aortic arch hypoplasia
II. Pathophysiology/Natural History
a. Functional Single Ventricle/Mixing lesion
i. Unobstructed pulmonary bloodflow
ii. Potential obstruction of VSD/bulboventricular foramen
b. Diagnosis/Determination of operability
i. Echocardiogram
ii. Cardiac Catheterization
1. PVR calculation/transpulmonary gradient calculation
2. Qp:Qs calculation
3. Aortopulmonary collaterals
4. LVEDP
5. PA angiography
iii. CT/MRI
III. Surgical repair
a. Indications/Timing
b. Conduct of Operation ( Including Cannulation, CPB, Myocardial Protection, Approach)
i. Neonatal Palliation
1. PA banding
2. PA disconnection and Shunt
3. Operations for restrictive VSD/BVF flow
a. Enlargement of VSD
b. Damus-Kaye-Stansel Procedure
ii. Bidirectional Glenn Shunt
iii. Fontan Procedure
c. Associated Technical Considerations
i. Site of VSD enlargement
d. Post-operative management
e. Outcomes
IV. Controversies
a. Choice of neonatal palliation
b. Additional source of pulmonary bloodflow at time of BDG shunt
c. Ventricular septation vs single ventricle palliation
d. Technique of Fontan procedure
i. Lateral tunnel vs Extracardiac conduit
ii. Fenestration vs No fenestration
Talk:
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Single Ventricle Syndromes - John Mayer (Children’s Hospital Boston)
Readings:
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Chapter 71, by Baue AE, Hammond GL, in Glenn’s Thoracic and Cardiovascular Surgery, 6th edition, Geha
AS, Graeme LH (eds)., 1996.
Congenital Heart Surgery Nomenclature and Database Project: single ventricle, by Jacobs ML and Mayer
JE, in The Annals of Thoracic Surgery, April 2000; 69:S197-S204.
The Anatomy of Hearts With Double Inlet Ventricle, by Cook AC, Anderson RH, in Cardiology in the Young,
2006;16 Suppl 1:22-26.
Morphologic Spectrum of Ventriculoarterial Connection in Double Inlet Left Ventricle: Implications for
Surgical Procedures, by Uemura H, Ho SY, Adachi I, Yagihara T, in The Annals of Thoracic Surgery,
2008;86:1321-7.
Comparison of Late Postoperative Cardiopulmonary Responses in the Fontan Versus Ventricular Septation
for Double-Inlet Left Ventricle Repair, by Ohuchi H, Watanabe K, Kishiki K, Nii M, Wakisaka Y, Yagihara T,
Echigo S, in the The American Journal of Cardiology, 2007;99:1757-61.
Long-Term Results of the Fontan Operation for Double-Inlet Left Ventricle, by Earing MG, Cetta F, Driscoll
DJ, Mair DD, Hodge DO, Dearani JA, Puge F, Danielson GK, O’Leary PW, in The American Journal of
Caridology, 2005;96:291-8.
Mid-Term Results for Double-Inlet Left Ventricle and Similar Morphologies: Timing of Damus-Kaye-Stansel,
by Clarke AJ, Kasahara S, Andrews DR, Cooper SG, Nicholson IA, Chard RB, Nunn GR, Winlaw DS, in
The Annals of Thoracic Surgery, 2004;78:650-7.
ADDITIONAL TSDA RESOURCES
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Visit TSRA Resources for Residents to view resources written by residents for residents, including TSRA
Review of Cardiothoracic Surgery; TSRA Primer of Cardiothoracic Surgery; TSRA Clinical Scenarios; and
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TSRA Journal Club.
The McGraw-Hill Companies, Inc., publishers of The Johns Hopkins Manual of Cardiothoracic Surgery, has
graciously made available sections of this important textbook to the TSDA Weekly Curricula subscribers.
TSDA will post three chapters for a three month period over the course of one year. Check back frequently
for new postings. The Johns Hopkins Manual of Cardiothoracic Surgery can be ordered at Amazon.com
Attention program directors, faculty, residents, and fellows: If you know of a congenital curriculum topic for
which you would like to create a talk, the TSDA Curriculum Committee encourages such contributions.
Instructions for creating a talk can be found on TSDA.org.
NEWS & INFORMATION
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Contact TSDA at [email protected] if you have comments or suggestions for the TSDA Congenital
Curriculum.
The next message will be sent on September 25 for the week of September 29.
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Phone: 312.202.5854 | Fax: 773.289.0871 | [email protected] | www.tsda.org
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