P. Syamasundar Rao

By P. Syamasundar Rao

Part of the book: Congenital Heart Disease

By P. Syamasundar Rao

Part of the book: Atrial Septal Defect

By P. Syamasundar Rao

Part of the book: Atrial Septal Defect

By P. Syamasundar Rao

Since the first description of the Fontan operation in the early 1970s, a number of modifications have been introduced and currently staged, total cavopulmonary connection with fenestration has become the most commonly used multistage surgery in diverting the vena caval blood flow into the lungs. The existing ventricle, whether it is left or right, is utilized to supply systemic circuit. During Stage I, palliative surgery is performed, usually at presentation in the neonatal period/early infancy, on the basis of pathophysiology of the cardiac defect. During Stage II, a bidirectional Glenn procedure is undertaken in which the superior vena caval flow is diverted into the lungs at an approximate age of 6 months. During Stage IIIA, the blood flow from the inferior vena cava (IVC) is rerouted into the pulmonary arteries, typically by an extra-cardiac conduit along with a fenestration, generally around 2 years of age. During Stage IIIB, the fenestration is closed by transcatheter methodology 6–12 months after Stage IIIA. The evolution of Fontan concepts, the indications for Fontan surgery, and the results of old and current types of Fontan operation form the focus of this review.

Part of the book: Advances in Complex Valvular Disease

By P. Syamasundar Rao

Sudden death is associated with sports, while rare is a disastrous event. Sudden death in athletes often has a cardiac etiology. Hypertrophic cardiomyopathy and congenital coronary artery anomalies are the two most frequent causes. The existing recommendations are to perform a pre-spots participation screening consisting of full personal and family history and detailed physical examination. If abnormal findings in history or physical examination are found, additional investigations should be performed to define the nature of abnormalities. Employing an electrocardiogram, echocardiogram, or magnetic resonance imaging as a routine screening technique is not recommended in the US. The rationale of pre-participation screening is to allow as many athletes as feasible to take part in the sports.

Part of the book: Congenital Heart Defects

By Rakesh Donthula, Animisha Rudra and P. Syamasundar Rao

Atrioventricular septal defects (AVSD) are a group of malformations involving the atrioventricular (AV) septum and common AV junction. They are divided into complete, partial, intermediate and transitional AVSD. It is most commonly associated with Down Syndrome. All of them share a few common features. Complete AVSDs are also classified as balanced and unbalanced. Echocardiography is the primary imaging tool to diagnose these defects. Patients with complete and intermediate forms clinically present early and require surgical correction during infancy, whereas partial, and transitional forms become symptomatic in early childhood. Patients who are ineligible for complete surgical repair initially undergo palliative pulmonary artery banding. The surgical management of unbalanced AVSDs is complex. Most of these patients fall into either single ventricle, one and a half or bi-ventricular repair. Overall surgical outcomes for AVSDs are excellent. Left atrioventricular valve regurgitation is the most common reason for reoperation.

Part of the book: Congenital Heart Defects

By P. Syamasundar Rao

Part of the book: Congenital Heart Defects

By P. Syamasundar Rao

Part of the book: Aortic Valve Disease

By P. Syamasundar Rao

Transcatheter interventions that are useful in the management of valvar aortic stenosis will be reviewed. This chapter focuses on congenital aortic valve stenosis. The procedure of balloon aortic valvuloplasty (BAV) and the results were reviewed; BAV offers good relief of aortic valve obstruction and serves as substitute to surgery and is considered a favored option in the management of aortic stenosis in all age groups. However, BAV in elderly patients with calcific aortic stenosis offers only a temporary relief of aortic valve obstruction and BAV is not recommended for this subgroup of patients. Except for neonates, most patients are discharged home within 24-hours after BAV. While there is conclusive data for provision of pressure gradient relief both acutely and at follow-up as well as deferral of any surgery after BAV, the development of aortic insufficiency (AI) at long-term follow-up is a most important drawback. In neonates, severe AI may develop necessitating surgical intervention. Notwithstanding these drawbacks, BAV is presently believed to be a therapeutic procedure of option in the treatment of valvar aortic stenosis in pediatric and young adult patients. Methodical follow-up to identify reappearance of aortic obstruction and development of substantial AI is suggested.

Part of the book: Aortic Valve Disease