PA-VSD Decision Tree

From Lofland GK. Progress in Pediatric Cardiology 2009;26:65-70

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Accessory Hemiazygos Vein

Accessory Hemiazygos Vein

Subclavian Steal - Mechansim

Arteries that form the basis for Subclavian Steal Syndrome

Oxygen Consumption (Lundell et al. Table)

Adapted from Lundell et al. Pediatr Cardiol 1996;17:207-13.

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Diabolo Stent

Diabolo stent placement technique (Fontan Fenestration)

O.Stumper et al. Heart 2003;89:1227-30.

Technique: 3-4 mm diameter loop is created using temporary epicardial pacing wires as follows: The needle ends are removed. 5 cm of the wire tips are bared of its insulation. The 2 bare wire ends are tied in a loop. This provides ~90 cm long wire. A secure double-knot over a 10-14 French dilator.

The loop is paced over a 15-25 mm Valvuloplasty balloon (?low pressure). J&J P308 or P188/JoMed 17 mm stents are options. The stent is gently dilated using 10-14 French dilator and then, mounted on the balloon - keeping the knotted-loop over the center of balloon.

Deliver using 11-14 Fr Mullin sheath.

 

Recommendations and Level of Evidence Classification

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EKG artifact

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This would have been reported as tachycardia if Channel III was not available! (Not sure what the reason for this artifact is. Recording was auto-triggered by the event monitor. Patient does not know; was probably sleeping).

Conduction system in VSD

Course of His bundle in VSD: Figure below shows the relationship for membranous VSD and inlet-muscular VSD (Note: Inlet-muscular VSD is different from inlet-VSD in AVSD.

Inlet-muscular VSD has a rim of myocardium separating the VSD margin from the tricuspid valve annulus; whereas, in inlet-VSD in AVSD, AV valve annulus itself if part of the VSD margin.

(See also separate posting for relevant images).

Image from Anderson RH, Wilcox BR. J Card Surgery. 1992;7:17-34.

Oxygen Consumption in Children - Normal values

From Jim Lock's Green book (2nd ed) 2000. page 60.
Also see earlier posting on this subject.

Cardiac Index in Children (Normal values)

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From Jim Lock's Green Book (Cath book) 2nd edition. 2000. page 58.

Data reportedly pooled from several previous publications (listed below) - Data from 140 patients of age range 12 day to 16 yrs.

1) Sproul & Simpson. Stroke volume and related hemodynamic data in normal children. Pediatr 1964;65:327-33.
2) James & Rowe. The pattern of response of pulmonary and systemic artery pressures in newborn and older infants to short periods of hypoxia. J Pediatr 1957;51:5-11.
3) Lucas R.V. Jr. et al. Maturation of pulmonary vascular bed. Am J Dis Child 1961;101:467-75.
4) Rowe and James. The normal pulmonary arterial pressure during the first year of life. J Pediatr 1957;51:1-4.
5) Kjellberg S.R. et al. Diagnosis of congenital heart disease. Chicago: Year book publishers. 1955.
6) Cummings GR. Hemodynamics of supine bicycle exercise in "normal" children. Am Heart J. 1977;93:617-22.
7) Lock, Einzig and Moller. Hemodynamic responses to exercise in normal children. Am J Cardiol. 1978;41:1278-84.