Copyright â Springer - 2015
1: Cardiac Anatomy: Nomenclature and Abbreviations
1.1 Nomenclature of Cardiac Anatomy
1.1.2 Right Atrial Appendage (RAA)
1.1.4 Left Atrial Appendage (LAA)
1.1.5 Right Ventricle (RV)
1.1.6 Tricuspid Valve (TV)
1.1.7 Left Ventricle (LV)
1.1.10 Interatrial Septum (Atrial Septum)
1.1.9 The Posterior Cross of the Heart
1.1.11 Interventricular Septum (Ventricular Septum)
1.1.12 Atrioventricular Septum
1.1.14 Main Pulmonary Artery (Pulmonary Trunk)
1.2 Malformations of the Heart
1.2.1 Atrial Septal Defect (ASD)
1.2.1.1 Ostium Secundum Atrial Septal Defect
1.2.1.2 Ostium Primum Atrial Septal Defect
1.2.2 Atrioventricular Septal Defect
1.2.4 Left Ventricle Dysplasia
1.2.5 Tetralogy of Fallot (TOF)
1.2.6 Double-Outlet Right Ventricle (DORV)
1.2.6.1 Taussig-Bing Deformity
1.2.10 Pulmonary Artery Atresia (PAA)
1.2.11 Obstruction of the Right Outflow of the Ventricular Tract (ROVT)
1.2.12 Persistent Truncus Arteriosus
1.2.13 Aortopulmonary Window
1.2.7 Double-Outlet Left Ventricle (DOLV)
1.2.8 Complete Transposition of the Great Arteries
1.2.9 Corrective Transposition of the Great Arteries
1.3 Nomenclature and Acronyms
2: Position and Observation of the Heart and Surgical Approaches
2.1 Position of the Heart
2.2 Observation of the Heart
2.3 Surgical Approaches to the Heart
2.3.1.1 Median Sternotomy
2.3.1.2 Right Thoracotomy
2.3.1.4 Mini-Invasive Thoracotomy
2.3.2 Anatomical Surgical Features
3.1 General Considerations
3.1.2 Morphological Characteristics
3.1.3 Atrial Septum, Atrioventricular Septum, and Triangle of Koch
3.1.3.2 Atrioventricular Muscular Septum
4.1 General Considerations
4.1.2 Structural Characteristics
4.2 Right Ventricular Wall and Surgical Approaches
4.3 Right Ventricular Cavity Divisions
4.3.3.1 Infundibular Septum
4.4 Tricuspid Valve Device
4.4.1.2 Chordal and Papillary Muscles
4.4.2 Tricuspid Valve Surgery
5.1 Coronary Artery Anatomy
5.1.1 The Left Main Coronary Artery
5.1.2 The Right Coronary Artery
5.2 Coronary Artery Exposure in CABG
6: The Conduction System of the Heart
6.1 General Considerations
6.1.2 Atrioventricular Node
6.1.3 The Internodal Conduction Bundle
6.1.4 The Bundle of His and Its Branches
6.2 Specimen Demonstrations
7.1 Structure and Characteristics of the Left Atrium
7.1.2 Surgical Characteristics
7.2 Surgical Routes to Left Atrium
7.2.1 Through the Right Interatrial Groove
7.2.2 Through the Interatrial Septum
7.2.3 Through the Roof of the Left Atrium
7.3 Comparison of Different Surgical Routes and Related Risks
8.1 General Considerations
8.1.1 Wall of the Left Ventricle
8.1.2 Cavity of the Left Ventricle
8.1.2.2 Trabeculated Portion
8.2.2.2 Posterior Leaflet
8.2.3 Subvalvular Structure
8.3 Surgical Implications
8.3.1 Mitral Valvuloplasty
8.3.2 Mitral Valve Replacement
8.3.3 Procedure of Hypertrophic Subaortic Stenosis
8.3.4 Left Ventriculoplasty
9: The Cardiac Skeleton and the Aortic Root
9.1 General Considerations
9.1.1 The Cardiac Skeleton
9.2 Surgical Significance
9.2.1 Incision of the Aortic Root
9.2.2 Aortic Valve Plasty
9.2.3 Aortic Valve Replacement
9.2.4 Stenosis (Figs. 9.28, 9.29, 9.30, and 9.31)
9.2.4.1 Moderate Stenosis
9.2.5 Aortic Root Dilatation and Aneurysm
9.3 Specimen Demonstrations
10: General Considerations of Cardiac Embryology
10.1 General Considerations
10.2 Heart Chambers and Roots of Main Arteries
10.2.1 Formation of the Primitive Heart Tube
10.2.2 Segmentation of the Primitive Heart Tube
10.2.3 Looping of the Primitive Heart Tube
10.2.3.2 Caudal Direction
10.2.3.3 Ventral Direction
10.2.4 Rotation of the Proximal End of the Conotruncus
10.2.5 Merging and Connecting of the Primitive Heart Chambers
10.2.6 Septation of Heart Chambers and Main Artery Roots
10.2.6.1 Septation of the Conotruncus
10.2.6.2 Septation of the Ventricles
10.2.6.3 Septation of the Atrioventricular Foramen
10.2.6.4 Septation of the Atrium
10.3 Development of the Heart Chambers
10.3.1 Development of the Atria
10.3.1.1 Formation of the Right Atrium and the Auricles
10.3.1.2 Formation of the Left Atrium and Auricle
10.3.2 Development of the Ventricles and Valve Devices
10.3.2.2 Atrioventricular Valve Devices
10.4 Development of the Conducting System
10.5 Embryonic Development and the Classification of Cardiac Abnormalities
11: Atrial Septal Defect and Cor Triatriatum
11.1 Atrial Septal Defect
11.1.1 Formation of Atrial Septal Defect
11.1.2 Ostium Secundum Defect
11.1.2.1 Central-Type ASD
11.1.2.2 Inferior Vena Cava-Type ASD
11.1.2.3 Superior Vena Cava-Type ASD
11.1.3 Simple Ostium Primum Defect
11.1.4 Simple Left Ventricle-Right Atrium Shunt
11.2 Anatomical Characteristics of the Atrial Septum
11.3.1 Confirmation of Presence
11.3.3 Presence of Anomalous Pulmonary Venous Drainage
11.3.4.3 Ventricular Septal Defect
11.5 Specimen Demonstrations
11.5.1 Normal Atrial Septum and Patent Foramen Ovale
11.5.2 Surgical Specimen of Central-Type Ostium Secundum Defect
11.5.3 Atrial Septal Defect Associated with Ventricular Septal Defect
11.5.4 Lutembacher Syndrome
11.5.5 Postsurgical Ostium Primum Defect
12: Atrioventricular Septal Defect
12.1 General Consideration
12.2.1 Ostium Primum Atrial Septum Defect (ASD)
12.2.2 Ventricular Septum Defect (VSD)
12.2.3 Translocation of the Atrioventricular Node
12.3 Classification of Atrioventricular Defects
12.3.1 Partial Atrioventricular Septal Defect
12.3.2 Complete Atrioventricular Septal Defect
12.3.3 Transitional Atrioventricular Septal Defect
12.4.1 Special Considerations
12.4.2 Technical Difficulties and Risks
12.4.2.1 Residual Mitral Valve Regurgitation
12.4.2.2 Complete Atrioventricular Block
12.4.2.3 Left Ventricle Outflow Tract Obstruction
12.5 Specimen Demonstration
12.5.1 Partial Atrioventricular Septal Defect
12.5.2 Complete Atrioventricular Septal Defect
12.5.3 Postoperative Partial Atrioventricular Septal Defect
12.5.4 Complete Atrioventricular Septal Defect, Small Ventricular Septal Defect
12.5.5 Complete Atrioventricular Septal Defect With Typical Single-Patch Technique
12.5.6 Complete Atrioventricular Septal Defect, Small Ventricular Septal Defect
12.5.7 Repair of Complete Atrioventricular Septal Defect With Single-Patch Technique
12.5.8 Repair of Complete Atrioventricular Septal Defect With two-Patch Technique
12.5.9 Complete Atrioventricular Septal Defect, With Large Ventricular Septal Defect
12.5.10 Repair of Complete Atrioventricular Septal Defect With Two-Patch Technique
12.5.11 Partial Atrioventricular Septal Defect
12.5.12 Complete Atrioventricular Septal Defect With Primary Atrial Septal Defect
12.5.13 Complete Atrioventricular Septal Defect With Right Ventricular Outflow Tract Obstruction
12.5.14 Complete Atrioventricular Septal Defect With Double-ưOutlet Right Ventricle
13: Ventricular Septal Defect
13.1 Classification of VSDs
13.2 Anatomical Key Points of VSDs
13.3 Surgical Technique: Difficulties and Risks
13.4 Specimen Demonstrations
13.4.1 Suture Surpassing Conduction Bundle with a Patch
13.4.2 Lessons of Repair of Ventricular Septal Defect in Individual Cases
13.4.3 Repair Technique of Ventricular Septal Defect
14: Anomalous Pulmonary Venous Drainage
14.1 General Considerations
14.2.1 Systemic Venous Development
14.2.2 Pulmonary Venous Development
14.3 Anomalous Pulmonary Venous Connections
14.3.1 Partial Anomalous Pulmonary Venous Drainage (PAPVD)
14.3.2 Total Anomalous Pulmonary Venous Drainage
14.4 Specimen Demonstrations
14.4.1 Partial Anomalous Pulmonary Venous Drainage
15: Aortic Arch Coarctation and Interrupted Aortic Arch
15.1 General Considerations
15.2 Aortic Arch Coarctation
15.3 Interrupted Aortic Arch
15.4 Specimen Demonstrations
15.4.1 Aortic Arch Coarctation, Conduit Connected with the Aortic Arch and the Descending Aorta
15.4.2 Dysplasia of the Aortic Arch and the Ascending Aorta, with Concurrent Ventricular Septal Defect
15.4.3 Distal Aortic Arch Coarctation, with Concurrent Ventricular Septal Defect
15.4.4 Aortic Arch Coarctation, with Concurrent Ventricular Septal Defect and Pulmonary Artery Hypertension
15.4.5 Interrupted Aortic Arch, Conduit Connected with the Aortic Arch and the Descending Aorta
15.4.6 Interrupted Aortic Arch. The Ascending Aorta and Descending Aorta Are Directly Anastomosed
15.4.7 Interrupted Aortic Arch. The Ascending Aorta and Descending Aorta Are Directly Anastomosed
15.4.8 Interrupted Aortic Arch, with Concurrent Ventricular Septal Defect and Patent Ductus Arteriosus Connecting the Ascending Aorta to the Descending Aorta
16: Congenital Anomalies of the Tricuspid Valve
16.1 General Considerations
16.1.1 Tricuspid Stenosis and Tricuspid Atresia
16.1.1.1 Superior Vena Cava-Pulmonary Artery Anastomosis
16.1.1.2 Right Atrium-to-Right Ventricular Bypass
16.1.1.3 Right Atrium-Pulmonary Artery Anastomosis, Also Called Fontan Operation
16.1.1.4 Total Cavopulmonary Connection
16.1.2 Congenital Tricuspid Insufficiency
16.2 Specimen Demonstrations
16.2.1 Tricuspid Atresia, Right Atrium-Right Ventricle Artificial Vessel Bypass
16.2.2 Tricuspid Atresia. Bovine Pericardial Extracardiac Conduit from Right Atrium to Right Ventricle
16.2.3 Tricuspid Atresia. Autologous Pericardial Extracardiac Conduit from the Right Atrium to the Pulmonary Artery
16.2.4 Absent Tricuspid Papillary Muscle. Tricuspid Valvuloplasty
17: Right Ventricular Outflow Tract Obstruction
17.1 General Considerations
17.3 Types of Infundibulum Obstructions
17.3.1 Entrance Obstruction (Fig. 17.4)
17.3.2 Tube-Like Obstruction (Fig. 17.5)
17.3.3 Limited Stenosis Under the Pulmonary Valve (Fig. 17.6)
17.4 Specimen Demonstrations
18: Mitral Atresia and Hypoplastic Left Ventricle
18.1 General Considerations
18.3 Hypoplastic Left Ventricle
18.4 Specimen Demonstrations
18.4.1 Mitral Atresia Combined with Pulmonary Atresia
18.4.2 Hypoplastic Left Ventricle + Mitral Valve Malformation + Fine Aorta
18.4.3 Hypoplastic Left Ventricle Combined with Mitral Valve Malformation
19.1 General Considerations
19.6 Specimen Demonstrations
19.6.1 Single Ventricle, Double-Inlet Ventricle
19.6.2 Single Ventricle, Common Atrium
19.6.3 Double Inlets of Ventricle
19.6.4 Single Ventricle Combined with Main Pulmonary Artery Stenosis
20: Persistent Truncus Arteriosus
20.1 General Considerations
20.2 Specimen Demonstrations
21: Aortopulmonary Window
21.1 General Considerations
21.3 Specimen Demonstrations
22: Aneurysm of the Sinus of Valsalva
22.1 General Considerations
22.3 Specimen Demonstrations
23.1 General Considerations
23.1.1 Embryology and Pathology
23.2 Key Points in the Anatomy
23.2.1 Features of the VSD (Figs. 23.12a–j, 23.13a–d, and 23.7a–d)
23.2.2 Features of Pulmonary Artery Stenosis
23.3 Technical Risks with Repair of TOF
23.4 Specimen Demonstrations
23.4.1 Typical Postoperative Specimen of TOF Showing the Override of the Aortic Valve
23.4.2 TOF, the VSD Patch Removed to Show the Stitched Edge of the AV and the VSD
23.4.3 View of Intact VSD in TOF
23.4.4 Repair of TOF, Cut Across the VSD Patch
23.4.5 TOF with Distal Pulmonary Artery Stenosis and Patent Ductus Arteriosus (PDA)
23.4.6 Repair of TOF Without Expansion of RVOT
23.4.7 Oversized Transannular Patch in TOF
23.4.8 Enlarged RV After Expansion of RVOT
23.4.9 Oversized RVOT Patch
23.4.10 TOF with Pseudotruncus Arteriosus
23.4.11 Typical Repair of TOF
23.4.12 Fresh Specimen After Repair of TOF
23.4.13 Typical Repair of VSD in TOF
23.4.14 TOF with Atrial Septal Defect
23.4.15 Postoperative TOF, Subendocardial Hematoma, Thick Muscular Band in ROVT
23.4.16 Typical External View of Postoperative Specimen of TOF
23.4.17 ASD is Closed During the Repair of TOF
23.4.18 Wounded Tricuspid Valve After Repair of TOF
23.4.19 Incision of the RV Is Too Low
23.4.20 Residual Shunt of VSD After Repair of TOF
23.4.21 Residual Shunt of VSD After Repair of TOF
23.4.22 Repair of TOF and the Conduction Bundle
24: Double-Outlet Right Ventricle
24.1 General Considerations
24.1.2 Embryological Basis
24.1.4 Surgical Application
24.2 Specimen Demonstrations
24.2.1 DORV, AVSD, L-Malposition
24.2.2 A Typical DORV Is Seen
24.2.3 DORV, Dextrocardia, and Exterior Channel Surgery are Shown
24.2.4 DORV, Hypoplasia of Pulmonary Artery
24.2.5 DORV, Subaortic VSD
24.2.6 DORV, Subpulmonary VSD
24.2.9 DORV, Pulmonary Stenosis
24.2.10 DORV, Exterior Conduit
24.2.12 DORV, Subpulmonary VSD
24.2.13 DORV, Subaortic VSD
24.2.14 DORV, Doubly Committed VSD
24.2.15 DORV, Cut the VSD Patch
24.2.16 DORV + PS + VSD Correction, Exterior Conduit from Right Ventricle to Pulmonary Artery
24.2.17 DORV, Mirror Dextrocardia
24.2.18 DORV, Subpulmonary VSD, Intracardiac Channel
25: Complete Transposition of the Great Arteries
25.1 General Considerations
25.2 Specimen Demonstrations
25.2.1 Typical TGA, Without Pulmonary Malformation
25.2.2 TGA with VSD, Postoperation with RV-PA Bypass
25.2.3 TGA, Without VSD, Post Switch Operation
25.2.4 TGA with Secondary ASD
25.2.5 TGA with External Conduit
25.2.6 Arterial Ventricular Transposition, TGA + ASD + VSD
26: Corrected Transposition of the Great Arteries
26.1 General Considerations
26.2 Surgical Considerations
26.2.1 Cardiac Appearance and Course of the Coronary Artery
26.2.2 Atrioventricular Ring and the Membranous Septum
26.2.3 Complete Muscular Cone Inferior to the Aortic Valve
26.2.4 Anatomical Connection of the Pulmonary Artery Outflow
26.2.5 Course of the Conducting System
26.3 Specimen Demonstration
26.3.1 CTGA + VSD, Typical Type
26.3.2 Fresh Specimen of CTGA
26.3.3 CTGA + VSD: Analyzing the Adjacent Connection of RA-PV-MV
26.3.4 CTGA + VSD: With Hypotrophic Obstruction of Aortic Subvalvular Muscle
26.3.5 CTGA + VSD: Typical SLL
26.3.6 CTGA + VSD + PS Morphological Left Ventricle-Pulmonary Artery Exterior Canal
26.3.7 CTGA + AVSD + PS Morphological Left Ventricle-Pulmonary Artery Exterior Canal
26.3.8 TGA + VSD + PS: Several Surgical Correcting Approaches
27.1 General Considerations
27.2 Embryology and Pathology
27.3 Policy of Surgical Operation
27.3.1 Palliative Operation (Fig. 27.4)
27.3.2 One-Stage Radical Operation
27.4 Specimen Demonstrations
27.4.1 Pulmonary Atresia, Ascending Aorta-ưPulmonary Bypass
27.4.2 Pulmonary Atresia Accompanied with PD
27.4.3 Pulmonary Atresia, VSD
27.4.4 Pulmonary Atresia, VSD, PDA
27.4.5 Pulmonary Atresia Accompanied by VSD
27.4.6 Pulmonary Atresia Accompanied by Aortic Stenosis
27.4.7 Pulmonary Atresia, Paratactic Cardio-Auditory
27.4.8 Pulmonary Atresia, Intact Ventricular Septum
28: Double Outlet of Left Ventricle
28.1 General Considerations
28.2 Specimen Demonstrations
28.2.1 DOLV, Ventricle Normotopia
28.2.2 DOLV, Ventricle Inversus Viscerum, Outer Tunnel
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