TY  - CHAP
M1  - Book, Section
TI  - The Anatomy of Congenital Cardiac Malformations
A1  - Anderson, Robert H.
A1  - Cook, Andrew C.
A2  - Yuh, David D.
A2  - Vricella, Luca A.
A2  - Yang, Stephen C.
A2  - Doty, John R.
PY  - 2014
T2  - Johns Hopkins Textbook of Cardiothoracic Surgery
AB  - The  results  of  the  surgical  treatment  of  congenital  cardiac  malformations  have  been  transformed  within  the  last  half-century.  Prior  to  the  development  of  cardiopulmonary  bypass,  it  was  impossible  to  even  contemplate  the  repair  of  major  malformations,  even  though  ingenious  surgeons  had  successfully  closed  simple  intracardiac  lesions  such  as  holes  between  the  atrial  chambers.  Even  when  it  proved  possible  for  the  surgeon  to  work  within  the  heart  in  the  setting  of  a  bloodless  operative  field,  the  results  of  operative  repair  were  far  from  perfect,  and  many  patients  died  subsequent  to  the  operative  procedure.  Nowadays,  it  is  unusual  for  any  patient  with  a  relatively  simple  defect  to  die,  and  even  those  with  “complex”  lesions  are  now  expected  to  survive.  There  have  been  many  reasons  for  these  truly  remarkable  advances,  but  without  question  one  has  been  the  knowledge  of  detailed  intracardiac  anatomy  accrued  within  recent  decades.  In  the  past,  it  was  often  thought  that,  in  the  setting  of  so-called  complex  malformations,  this  anatomy  was  difficult  to  understand.  It  is  now  recognized  that,  although  the  combination  of  given  lesions  can  truly  be  complex,  the  anatomy  itself  is  relatively  straightforward  provided  that  it  is  approached  in  straightforward  fashion  and  using  a  system  of  analysis  that  is  simple  and  logical.  To  achieve  success,  therefore,  the  pediatric  cardiac  surgeon  must  hone  not  only  the  surgical  skills  but  also  the  intellectual  rigor  needed  to  analyze  the  structure  of  the  congenitally  malformed  heart.  It  would  be  foolish  to  suggest  that  problems  do  not  still  exist  in  obtaining  the  necessary  morphologic  understanding,  but  these  problems  can  be  minimized  by  using  a  simple  philosophy  combined  with  use  of  words  in  their  vernacular  sense.  Too  many  of  the  problems  of  the  past  have  reflected  linguistic  rather  than  scientific  disagreements.  It  remains  appropriate  to  remember  the  aphorism  attributed  to  Rudolf  Virchow,  namely  that  “those  who  fail  to  learn  from  the  mistakes  of  the  past  are  condemned  to  repeat  them.”  In  this  chapter,  therefore,  we  describe  the  basics  of  cardiac  anatomy  that  permit  the  surgeon  to  diagnose  and  recognize  the  arrangement  of  the  cardiac  chambers  during  surgical  procedures  and  at  the  same  time  appreciate  the  likely  position  of  the  vital  conduction  tissues.  The  concomitant  advances  made  over  recent  years  in  diagnostic  techniques  are  now  such  that  the  basic  layout  of  the  heart  will  have  almost  certainly  been  established  prior  to  commencement  of  intracardiac  procedures.  Nonetheless,  even  in  the  most  complex  cases,  preliminary  diagnosis  demands  little  more,  in  terms  of  morphology,  than  the  distinction  of  a  right  atrium  from  a  left  atrium,  a  right  ventricle  from  a  left  ventricle,  and  an  aorta  from  a  pulmonary  trunk.  It  is  such  distinctions  that  provide  the  basis  for  simple  sequential  segmental  analysis.1  For  the  surgeon,  the  anatomy  of  holes  and  blockages  within  the  heart  and  great  vessels  are  of  equal  or  even  greater  significance.  This  morphology  is  addressed  elsewhere  in  the  appropriate  chapters  of  this  book;  therefore,  we  confine  ourselves  to  showing  how  the  anatomy  of  some  important  defects  differs  markedly  from  the  normal  arrangement.  Our  primary  concern,  however,  is  to  ...
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - accesssurgery.mhmedical.com/content.aspx?aid=1104594947
ER  -