Important surgical procedures in complex CHD

Important surgical procedures in complex CHD

Surgical procedures in simple congenital heart diseases like atrial septal defect, ventricular septal defect and patent ductus arteriosus, are often curative if undertaken in the appropriate time window. But in the case of complex congenital heart diseases, it is more often a palliation rather than cure.

Rastelli procedure is done in transposition with a ventricular septal defect (VSD) in which the VSD is closed by baffling the left ventricle to the aorta. Right ventricle is connected to the pulmonary artery using a conduit.

Norwood procedure is undertaken in hypoplastic left heart syndrome. The pulmonary artery along with its valve is used to create a neo aorta. A Blalock-Taussig shunt is created to provide flow to the pulmonary circulation.

Mustard procedure is an atrial based repair for transposition of great arteries. It was introduced earlier than the currently preferred arterial switch operation. It can now be considered in cases of transposition which has missed the time window for arterial switch. Intra atrial baffles are created to divert superior and inferior vena caval blood to the mitral valve and hence to the left ventricle and pulmonary artery. Pulmonary venous blood is baffled to reach the right ventricle and to the aorta through the tricuspid valve. This produces a physiological correction leaving the transposition as such.

Arterial switch operation or Jatene procedure, is the anatomical correction for transposition of great arteries which can be done in the neonatal period, within the first two weeks of life. Aorta and main pulmonary arteries are switched and the coronary arteries re-implanted. This procedure can be done only before the regression of the left ventricle which occurs if it faces the low resistance pulmonary circulation for a longer period after birth.