Cardiac Surgery: A Complete Guide

Preface
Contents
Part I: Perioperative Care and Cardiopulmonary Bypass
	1: Cardiac Catheterization
		History of Cardiac Catheterization
		Invasive Diagnostic Coronary Angiography
			Indications
			Pre-procedure Preparation
			Technical Aspects of the Procedure
				Access
				Pharmacology
				Catheter Selection and Manipulation
				Angiographic Views
			Post-procedure Care
				Sheath Removal and Closure Devices
				Coronary Angiogram Analysis
			Complications
		Right Heart Catheterization
			Indications
			Procedure
			Complications
			Interpreting Haemodynamics
				Right Atrium
				Right Ventricle
				Pulmonary Artery
				Pulmonary Capillary Wedge Pressure
		Conclusion
		References
	2: Fractional Flow Reserve
		Introduction
		Definitions
		How Was This Cut-Off Decided?
		FFR Compared to Other Non-invasive Diagnostic Techniques
		Limitations of Pressure Wire Measurements
		Intravascular Ultrasound and FFR
		Assessing Left Main Stem Stenosis Using FFR
		FFR Use Pre Coronary Artery Bypass Grafting
		Main Outcome Studies with FFR
			DEFER Trial [24]
			FAME Trial [9]
			FAME 2 Trial [10]
			COMPARE ACUTE Trial [27]
		Instantaneous Wave-Free Pressure Ratio (iFR)
		Conclusions
		References
	3: Echocardiography
		Introduction
		Essential Ultrasound Theory for Echocardiography
		Modalities of Echocardiography
		Assessment of Myocardial Function
			Left Ventricular Systolic Function
				Changes in Volumes/Dimensions
				Indices of Global Contractility
				Systolic Strain
				Regional Contractile Function
			Right Ventricular Systolic Function
			Diastolic Function
		Assessment of Valve Pathology
			Aortic Stenosis
			Aortic Regurgitation
			Mitral Stenosis
			Mitral Regurgitation
			Tricuspid Valve Assessment
			Pulmonary Valve Assessment
		Infective Endocarditis
			Echo Findings in Endocarditis
		Pericardial Disease
		Masses
		Contrast Echocardiography
		Stress Echocardiography
			Stress Echo for Coronary Artery Disease
			Stress Echo for Aortic Stenosis
			Stress Echo for Mitral Regurgitation
			Other Indications for Stress Echocardiography
		Transesophageal Echocardiography (TEE)
			Pre-operative TEE
			Intraoperative TEE
		Conclusions
		References
	4: Cardiac Computed Tomography and Magnetic Resonance Imaging
		Introduction
		Technology
			Computed Tomography (CT)
			Magnetic Resonance Imaging (MRI)
		Clinical Applications of CT and MRI
			Coronary Artery Disease
			Myocardial Ischaemia
			Myocardial Viability
			Heart Failure and Cardiomyopathies
			Valvular Heart Disease
			Congenital Heart Disease
			Pericardial Diseases
			Cardiac Tumours
			Aortic Diseases
			Post-surgical Patient
		Conclusion
		References
	5: Assessment of Myocardial Viability
		Introduction
		Assessment of Myocardial Viability
			Electrocardiogram (ECG)
			Baseline 2D Echocardiography
			Dobutamine Stress Echocardiography
			Single Photon Emission Computerized Tomography (SPECT)
			Positron Emission Tomography (PET)
			Cardiac Magnetic Resonance Imaging (CMR)
			Miscellaneous
		Choice of Viability Test
		Clinical Implications of Viability Status in Ischemic Cardiomyopathy
		Coronary Revascularization in Ischemic Cardiomyopathy
		Conclusions
		References
	6: Blood Conservation Strategies in Cardiac Surgery
		Introduction
		Pillar One: Optimization of Red Cell Mass and Erythropoiesis Prior to Surgery
		Pillar Two: Minimize Blood Loss
			Preoperative
			Intraoperative
			Postoperative
		Pillar Three: Maximize the Ability of the Patient to Cope with Haematological Irregularities During Recovery Period by Optimizing Tolerance to Anaemia
		Conclusion
		References
	7: Inotropes, Vasopressors and Vasodilators
		The Case for Inotropic Support in Cardiac Surgery
		What Are We Treating and What Are the Practical Dilemmas?
			Ventricular Dysfunction
			Circulatory Volume Status and Ventricular Preload
			Vascular Resistances and Vasoplegia
		Principles of Vasoactive Support
		Clinical Classification of Haemodynamically Active Pharmacological Agents
		Description and Clinical Utility of Inotropes and Vasoactive Agents
			Sympathomimetic Drugs
				Epinephrine (Adrenaline)
				Norepinephrine (Noradrenaline)
				Dopamine
				Dobutamine
			Phosphodiesterase-Type III Inhibitors
			Levosimendan
			Vasopressin
		Special Focus on the Pulmonary Circulation
			The Nitric Oxide (NO) Pathway
			Phosphodiesterase-Type V Inhibitors
			Prostacyclin Pathway
				Inhaled Epoprostenol
				Inhaled Iloprost
		Special Cardiac Surgical Settings
			Coronary Artery Bypass Graft Surgery
			Acute on Chronic Heart Failure
			LV Hypertrophy/Severe Diastolic Dysfunction
			Valvular Surgery
			Orthotopic Cardiac Transplantation
			Right Ventricular Dysfunction
		The Limits of Inotropic Support, Transition to Mechanical Circulatory Support
		Conclusion
		References
	8: Cardiac Pacing in Adults
		Introduction
		Anatomy and Physiology of the Conduction System
		Indications for Pacing and Defibrillators
		Basic Principles of Pacing
		Commonly Used Terms
			Threshold
			Sensitivity
		Implantation Techniques
		Common Complications and Problems with Devices
		Novel Device Approaches
			His Bundle Pacing
			Leadless Pacing
			Subcutaneous ICDs
			WiSE CRT
		Perioperative Management of Devices
		MRI and Pacing
		Pacing in the Peri- and Post-operative Setting
			Peri-operative and Post-operative Pacing in Cardiac Surgery
			Troubleshooting Temporary Epicardial Systems
			Transitioning to Permanent Pacing in the Post-operative Period
		Cardiothoracic Surgeon Involvement in Pacing Procedures
			Surgical Lead Implantation
			Lead Extraction
		Conclusion
		References
	9: Adult Cardiopulmonary Bypass
		Introduction
		Cannulation Strategies
		Key Elements of the Cardiopulmonary Bypass Machine
		Monitoring
		Temperature and pH Regulation
		Cardioplegia
		Pathophysiology of Cardiopulmonary Bypass
		Conclusions
		References
	10: Myocardial Protection in Adults
		Introduction
		Myocardial Injury After Cardiopulmonary Bypass
		Myocardial Protection
			Hypothermic Methods of Cardioplegic Protection
			Normothermic Methods of Cardioplegic Protection
		Cardioplegic Solutions
			Routes of Administration
			Cardioplegia Composition and Timing of Delivery
		Conclusion
		References
	11: Heparin-Induced Thrombocytopenia
		Introduction
		Pathogenesis
		Timing
		Clinical Picture
		Frequency
		Diagnosis
		Treatment
		Management of HIT in Cardiac Surgery
		Bivalirudin in Cardiac Surgery
		UFH and Platelet Inhibitors in Cardiac Surgery
		Plasmapheresis Before Cardiac Surgery
		HIT in Children
		Conclusion
		References
	12: Tissue Sealants in Cardiac Surgery
		Introduction
		Definitions and Classification of Topical Hemostatic Agents, Tissue Sealants, and Adhesives
		Clinical Use in Cardiovascular Surgery
		Fibrin Sealants
			Advantages
			Disadvantages
		Polyethylene Glycol Polymers
			Advantages
			Disadvantages
		Albumin and Glutaraldehyde
			Advantages
			Disadvantages
		Cyanoacrylates
			Advantages
			Disadvantages
		Thrombin Gelatin Matrix
			Advantages
			Disadvantages
		Cost Analysis at the Montreal Heart Institute
		Conclusion
		References
Part II: Coronary Artery Disease
	13: Conduits for Coronary Artery Bypass Surgery
		Introduction
		Internal Thoracic Artery
		The Radial Artery
		The Right Gastroepiploic Artery
		The Saphenous Vein
		Grafting Strategy and Conduit Choice
		References
	14: Endoscopic Saphenous Vein and Radial Artery Harvesting
		Introduction
		Evidence
			Graft Quality, Graft Occlusion and Major Cardiac-Related Events
			Wound and Neurological Complications and Patients’ Satisfaction
		Patient Selection
		Surgical Technique
			Surgical Equipment
		Endoscopic Radial Artery Harvesting
			First Step: Exposure of the Radial Artery
			Second Step: Endoscopic Harvesting
			Final Step: Radial Artery Retrieval
		Endoscopic Saphenous Vein Harvesting
			First Step: Exposure of the Great Saphenous Vein
			Second Step: Endoscopic Harvesting
			Final Step: Saphenous Vein Retrieval
		Conclusion
		References
	15: Conventional Coronary Artery Bypass Grafting
		Introduction
		History of Coronary Artery Bypass Surgery
		Indications for CABG
		Conduct of the Operation (Table 15.2)
			Incision
			Division of the Pericardium
			Cannulation
				Aortic
				Venous
			Initiation of Cardiopulmonary Bypass
			Target Identification and Preparation
			Arteriotomy
			Distal Anastomoses
			Graft Configurations
			Proximal Anastomoses
			De-Airing and Cross Clamp Removal
			Decannulation
			Sternal Closure
		Outcomes
			Hospital Mortality
			Hospital Morbidity
		Antiplatelet Therapy
		Conclusion
		References
			Additional Resources
			Online
			Books
	16: Off-Pump Coronary Artery Bypass Grafting
		Introduction
		Evolution
		Technique
		Anesthetic Considerations
		Indications
		Contraindications
		Outcomes
		Concerns
		Controversies
		Conclusion
		References
	17: Minimally Invasive Coronary Artery Bypass Grafting
		Introduction
		Published Literature
		Technique
		Conclusion
		References
	18: Totally Endoscopic Coronary Artery Bypass Grafting
		Introduction
		Arrested Heart TECAB
		Anesthetic Considerations
		Cardiopulmonary Bypass and Myocardial Protection
		Surgical Procedure
		Beating Heart TECAB
		Hybrid Revascularization
		Learning Curve
		Outcomes
		Conclusion
		References
	19: Redo Coronary Artery Bypass Grafting
		Introduction
		Recent Trends
		Indications
		Technical Considerations
			Sternal Re-entry
			Dissection of the Heart, Ascending Aorta and Grafts
			Alternative Approaches to Repeat Median Sternotomy
			Cardioprotection
			Grafting Pattern and Selection of Conduits
		Surgical Outcomes
		PCI vs CABG for Repeat Revascularization
		Off-Pump vs On-Pump Redo CABG
		Summary
		References
	20: Hybrid Coronary Revascularization
		Introduction
		Hybrid Coronary Revascularization
			Rationale for HCR
			Patient Selection
			Surgical Approaches
				MIDCAB
				Robotic Approaches
			Technique
		Timing of Interventions
		Results
		Conclusions
		References
	21: Bilateral Internal Mammary Artery Grafting
		Introduction
		Historical Aspects
		Rationale
		Technical Aspects
			Retroaortic In-Situ Right IMA Via Transverse Sinus to Circumflex Marginal Branches with In-Situ Left IMA to LAD
			Retrosternal Crossover In-Situ Right IMA to LAD with In-Situ Left IMA to Circumflex Marginal Branches
			Composite Left IMA-Right IMA T or Y Grafting
			Right Internal Mammary Artery for Grafting the Right Coronary System
		Clinical Outcomes
			Evidence from Observational Studies
			Evidence from Arterial Revascularization Trial
		Concerns
		Conclusion
		References
	22: Total and Multiple Arterial Revascularization
		Introduction and Rationale for Arterial Coronary Grafting
		Arterial Coronary Grafts
			Left Internal Thoracic Artery (LITA)
			Right Internal Thoracic Artery (RITA)
			Radial Artery (RA)
			Right Gastroepiploic Artery (RGEA)
			Other Arterial Grafts
		Deployment Strategies to Achieve Total Arterial or Multiple Arterial Coronary Bypass Grafting
			Bilateral Internal Thoracic Artery Grafts
			LITA and Left Radial Artery Graft
			LITA and Bilateral Radial Arteries
		Arterial Graft Patency Rates
		Clinical Results
			Perioperative Results
			Long-Term Results
			Three Versus Two Arterial Grafts
				Elderly
				Gender
				Diabetes
				Chronic Renal Disease
				Left Ventricular Dysfunction
				Reoperations
		Off-Pump and Anaortic Coronary Artery Bypass Grafting
		Contraindications and Limitations of Total Arterial or Multiple Arterial Coronary Bypass Grafting
		Role of Saphenous Vein Grafts
		Controversies in Total Arterial and Multiple Arterial Coronary Bypass Grafting
		Conclusion
		References
	23: Anastomotic Devices for Coronary Artery Surgery
		Introduction
		Proximal Anastomotic Devices
			Heartstring Proximal Seal System
			PAS-Port Proximal Anastomosis System
		Distal Anastomotic Devices
			C-Port Distal Anastomosis System
			Others
		Conclusions
		References
	24: Post-infarction Ventricular Septal Defect
		Epidemiology, Natural and Clinical History
		Therapeutic Strategies and Options
		Surgical Techniques
			General Considerations
			Apical Septal Defect
			Small Ventricular Septal Defect
			Medium or Large Septal Defects
			Concomitant Procedures
		Postoperative Results and Prognosis
		Conclusion
		References
	25: Ischemic Mitral Regurgitation
		Epidemiology
		Pathophysiology
		Diagnosis and Assessment of Ischemic Mitral Regurgitation
		Medical Therapy
		Indications for Surgical Intervention
		Mitral Valve Replacement
		Mitral Valve Repair
		Concomitant Coronary Bypass Grafting
		Percutaneous Therapy
			Leaflet Apposition Therapy (MitraClip)
			Therapies to Address Annular Dilation (Carillon, Cardioband, Mitralign)
			Transcatheter Mitral Valve Replacement
		Future Directions
		References
	26: Post-infarction Ventricular Aneurysms
		Introduction
		Incidence
		Pathophysiology
		Clinical Features
		Investigations
			Electrocardiogram
			Chest X-Ray
			Echocardiography
			Left Ventriculography
			Computed Tomography
			Magnetic Resonance Imaging
		Management
			Pseudoaneurysm
				Surgery
				Transcatheter Device Closure
			True Aneurysm
				Surgical Indications
				Surgical Techniques
				Plication
				Cooley Technique
				Stoney Technique
				Jatene Technique
				Dor Technique
				McCarthy Technique
		Outcomes
		Conclusion
		References
	27: Coronary Endarterectomy
		Introduction
		History
		Techniques
		Indications
		Anticoagulation Protocol
		Safety of Coronary Endarterectomy
		Unresolved Issues
			Single or Multi-vessel Coronary Endarterectomy
			Onlay-Patch Grafting Using the ITA
			Off-Pump Coronary Artery Bypass Grafting and Coronary Endarterectomy
		Alternative Procedures
		Conclusions
		References
	28: Transmyocardial Laser Revascularization
		Introduction
		Mechanism for Clinical Efficacy
		Devices
		Operative Technique
		Clinical Trials
			TMR as Sole Therapy
			TMR as an Adjunct to CABG
		Percutaneous Myocardial Laser Revascularization
		Conclusions
		References
	29: Gene Therapy for Coronary Artery Disease
		Introduction
		Clinical Gene Therapy—Past Lessons and Current Successes
		Gene Delivery Vectors
			Plasmids
			Viruses
			MicroRNA
		Routes of Administration
		Angiogenesis
		Cardiac Cellular Reprogramming
		Challenges in Cardiac Gene Therapy
		Conclusion
		References
	30: Combined Carotid and Coronary Artery Disease
		Introduction
		Should Routine Carotid Artery Screening Be Performed Prior to Surgery?
		Management of Concomitant Carotid and Coronary Artery Disease
			Combined Carotid Endarterectomy and Coronary Artery Bypass Grafting
			Staged Carotid Endarterectomy and Coronary Artery Bypass Grafting
			Role of Carotid Artery Stenting
		References
	31: Coronary Artery Aneurysms and Fistulas
		Coronary Artery Aneurysms
			Introduction
			Classification
			Risk Factors and Associations
			Pathogenesis
			Clinical Presentation
			Diagnosis
			Treatment
		Coronary Artery Fistulas
			Introduction
			Classification
			Epidemiology
			Pathophysiology
			Clinical Presentation
			Natural History
			Diagnosis
			Management Guidelines
			Treatment
		References
Part III: Valvular Heart Disease
	32: Mechanical Prosthetic Valves
		Introduction
		Current Indications and Patient Selection
		Current Mechanical Valves
			St. Jude Medical (St. Paul, MN)
			CryoLife (Kennesaw, GA)
			LivaNova (London, England)
			Medtronic (Minneapolis, MN)
		Future Directions
		Conclusions
		References
	33: Stented Bioprosthetic Valves
		Introduction
		Stented Aortic Bioprosthetic Valves
			Crown PRT™ Valve
			Trifecta™ Valve
			Magna Ease™ Valve
			Mosaic Ultra™ Valve
		Outcomes
			Hemodynamic Performance
			Durability
		Stented Mitral Bioprosthetic Valves
			PERIMOUNT Plus Mitral™ Valve
			Mosaic Mitral™ Valve
		Outcomes
			Hemodynamic Performance
			Durability
		Conclusions
		References
	34: Bentall and Mini-Bentall Procedure
		Introduction
		Mini-Bentall Procedure
			Mini-sternotomy
			Cardiopulmonary Bypass
			Aortic Root Exposure
			The “French Cuff” Technique
			Coronary Button Re-implantation
			Distal Anastomosis
			Hemi-Arch Replacement
			Closure
		Outcomes
		Conclusion
		References
	35: Aortic Valve-Sparing Root Replacement
		Introduction
		Natural History
		Pathophysiology
		Connective Tissue Disorders
		Indications and Patient Selection
		Remodeling of the Aortic Root and Other Annuloplasty Techniques
		The David Operation
		Results
		Conclusion
		References
	36: Aortic Valve Repair
		Introduction
		Aortic Root Anatomy
			Functional Aortic Annulus
		Indications for Aortic Valve Repair
		Assessment of Aortic Valve and the Repair-Oriented Classification
		Surgical Techniques
			Valve Exposure and Assessment
			Restoration of the Functional Aortic Annulus
			Subcommissural Annuloplasty
			Valve-Sparing Root Replacement: Reimplantation Technique
			Aortic Valve Annuloplasty
			Cusp Repair Techniques
		Bicuspid Valve Repair
		Outcomes
			Outcomes for Overall Population
			Outcomes for Aortic Valve-Sparing Root Replacement
			Outcomes for Bicuspid Aortic Valve Repair
		Conclusion
		References
	37: The Small Aortic Root
		Introduction
		Relevant Aortic Root Anatomy
		Aortic Root Sizing
		Mechanical Valves
		Bioprosthetic Valves
		Aortic Homograft
		Pulmonary Autograft
		Operations for Aortic Root Enlargement
		Conclusion
		References
	38: The Ross Procedure
		Introduction
		Historical Perspective
		Rationale
		Results Following the Ross Procedure
			Survival
			Hemodynamics
			Valve-Related Complications
			Reoperation
		Technical Considerations
		Conclusion
		References
	39: Bicuspid Aortic Valve and Aortopathy
		Introduction
		Anatomy
		Prevalence and Etiopathogenesis
		Clinical Presentation
		Diagnosis
		Clinical Course and Complications
			Valvular Complications
			Aortopathy
		Management
			Aortic Root and Ascending Aorta Surgery
				Indications in Patients with BAV Without Significant Aortic Valve Dysfunction
				Indications for Aortic Replacement in Patients with BAV and Aortic Valve Dysfunction
			Aortic Arch
		Postoperative Surveillance
		Summary
		References
	40: Mitral Valve Replacement
		Introduction
		Repair Versus Replacement
		Valve Selection
		Surgical Technique of Mitral Valve Replacement
		Postoperative Management
		Future Directions
		Conclusions
		References
	41: Techniques for Mitral Valve Repair
		Introduction
		Patient Selection and Pre-operative Work-Up
		Surgical Approaches
			Sternotomy
			Robotic Approach
			Anterolateral Right Mini-thoracotomy Approach
		Mitral Valve Repair Techniques
			Triangular Resection
			Quadrangular Resection with Sliding Repair
			Neochordae Implantation
			Annuloplasty
		Assessment of Repair
		Published Outcomes
		Conclusion
		References
	42: Mitral Valve Repair in Rheumatic Mitral Disease
		Introduction
		Problem and Burden of Rheumatic Valve Disease
		Mitral Valve Complex: Structure and Dynamics
		Rheumatic Mitral Valve Repair: Current Approaches and Strategy
			Commissure
			Mitral Leaflets
			Chordae and Papillary Muscles
			Annulus
		Associated Problems
			Tricuspid Regurgitation
			Associated Aortic Valve Disease
			Valvular Atrial Fibrillation
		The Technique of Rheumatic Mitral Valve Repair
			Exposure
			Valve Analysis
			Sequence of Rheumatic Mitral Repair
		Results
		Conclusion
		References
	43: Native Valve Endocarditis
		Introduction
		Relevant Anatomy
			The Decision to Operate
			Congestive Heart Failure
			Para-annular Extension
			Systemic Embolization
		General Surgical Principles in Endocarditis Surgery
		Reconstruction
			Mitral Valve
			Aortic Valve and the Aortomitral Curtain
		Conclusion
		References
	44: Prosthetic Valve Endocarditis
		Introduction
		Imaging
		Medical Management
		Surgical Management
			Prosthetic Aortic Valve Endocarditis
				Is There Any Advantage of a Homograft Versus Conventional Mechanical or Biological Prostheses?
				How Do We Approach an Aortic Perivalvular Abscess or Fistula?
				How Do We Approach an Aortic Root Abscess that Has Destroyed the Aorto-Mitral Continuity?
				What Is on the Horizon?
			Mitral and Tricuspid Prosthetic Valve Endocarditis
			Prosthetic Valve Endocarditis of Aortic Graft
		Conclusion
		References
	45: Tricuspid Valve Surgery
		Introduction
		Indications for Tricuspid Surgery
		Surgical Techniques for Tricuspid Valve Surgery
			General Considerations
			Tricuspid Valve Repair
				Annuloplasty Techniques
				Leaflet Repair Techniques
				Other Surgical Techniques
				Tricuspid Valve Replacement
		Results of Surgical Techniques
		Conclusion
		References
	46: Minimally Invasive Aortic Valve Surgery
		Introduction
		Definition, Surgical Approaches and Rationale for MIAVS
		Preoperative Anaesthetic Considerations
		Ministernotomy and Right Anterior Minithoracotomy
		Criticism
		MIAVR with Sutureless Valves
		Conclusions
		References
	47: Minimally Invasive Mitral Valve Surgery
		Introduction
		Brief History
		Definition
		Patient Selection
		Preoperative Screening
		Operative Management
			Surgical Setup
			MV Repair Techniques
				Triangular Resection
				Quadrangular Resection with Sliding Plasty
				Neochordae Implantation
				Alfieri Stitch
				Annuloplasty
		Short- and Long-Term Results
		Advantages, Disadvantages and Complications
		The Future
		References
	48: Transcatheter Aortic Valve Therapies
		Introduction
			History of Transcatheter Aortic Valve Implantation (TAVI)
			The Heart Team Approach
		Risk Assessment
		Latest Generation Transcatheter Valves
			SAPIEN 3
			Evolut R
		Access Routes
		Landmark TAVI Trials
			Prohibitive Risk
			High Risk
			Intermediate Risk
			Low Risk
		TAVI Indications and Guideline Recommendations
		Current Challenges
			Permanent Pacemaker
			Stroke
			Valve Thrombosis and Antithrombotic Management
		Conclusion
		References
	49: Transcatheter Pulmonary Valve Replacement
		Introduction
		Indications and Patient Selection
		Current Technologies
			Medtronic Melody Transcatheter Pulmonary Valve
			Edwards SAPIEN Transcatheter Heart Valve
		The Procedure and Technical Considerations
		Hemodynamic and Clinical Outcomes
		Complications
		The Future
		References
	50: Transcatheter Mitral Valve Therapies
		Introduction
		Current Transcatheter Management of Mitral Regurgitation
			Percutaneous Leaflet Repair
			Percutaneous Chordal Approach
			Percutaneous Mitral Annuloplasty
		Transcatheter MV Implantation
		Conclusion
		References
	51: Carcinoid Heart Disease
		Introduction
		Pathology and Pathophysiology
		Clinical Presentation and Indications for Surgery
		Perioperative Management
		Surgical Considerations
			Operative Approach
			Choice of Prosthetic Valves
			Left-Sided Heart Disease
			Postoperative Surveillance
		Outcomes of Valve Replacement for Carcinoid Heart Disease
			Perioperative Mortality
			Overall Survival and Functional Outcomes
		Conclusion
		References
Part IV: Thoracic Aorta
	52: Acute Type A Aortic Dissection
		Introduction
		Clinical Presentation
		Diagnostic Testing
		Pathology and Classification
		Surgical Technique
			Arch Repair Options
			Aortic Root Repair Options
			Conventional and Frozen Elephant Trunk and Related Techniques
		Complications and Surveillance
		Conclusion
		References
	53: Acute Type B Aortic Dissection
		Introduction
		Nomenclature
		Demographics, Etiology and Risk Factors
		Clinical Presentation and Diagnosis
		Management
			Uncomplicated Acute and Subacute Type B Dissection
			Complicated Acute Type B Aortic Dissection (ATBAD)
			Chronic Type B Aortic Dissection (CTBAD)
		Penetrating Aortic Ulcer and Intramural Hematoma
		Follow-Up
		Conclusions and Future
		References
	54: Chronic Type B Aortic Dissection
		Introduction
		Imaging
		Best Medical Treatment
		Indications for Intervention
		Invasive Treatment
			Open Surgical Repair
			Endovascular Repair
		Considerations
			False Lumen Deployment
			Stent Graft Induced New Entry (SINE)
			Adherence to Medical Therapy
			Level of Exercise
		Quality of Life (QOL)
		References
	55: Aortic Intramural Hematoma and Penetrating Aortic Ulcer
		Introduction
		Pathophysiology
		Epidemiology
		Clinical Features
		Diagnosis
		Treatment, Outcomes and Prognosis
			Medical Management
			Open Surgical Repair
			Endovascular Repair
		Conclusion
		References
	56: Descending Thoracic and Thoracoabdominal Aortic Aneurysms
		Introduction
		Etiology
		Epidemiology, Clinical Presentation and Natural History
		Diagnosis of DTAA and TAAA
		Treatment Options
			Medical
			Endovascular Treatment
			Open Surgical Treatment
			Preoperative Planning and Set-Up
			Cerebrospinal Fluid Drainage
			Incision
			Cardiopulmonary Bypass
				Cannulation Techniques
				Partial Cardiopulmonary Bypass (Distal Aortic Perfusion)
				Partial Left Heart Bypass (Distal Aortic Perfusion)
				Full Cardiopulmonary Bypass
				Deep Hypothermic Circulatory Arrest
			TAAA Repair Technique
		Outcomes After Open Repair of DTAA and TAAA
		Conclusions
		References
	57: Aortic Arch Aneurysms
		Introduction
		Anatomy
		Aortic Arch Pathology
		Clinical Presentation
		Imaging
		Treatment
			Criteria for Surgical Intervention
			Perfusion and Cerebral Protection
			Deep Hypothermic Circulatory Arrest (DHCA)
			Retrograde Cerebral Perfusion (RCP)
			Anterograde Cerebral Perfusion (ACP)
			Surgical Repair Techniques
		Conclusion
		References
	58: Hybrid Aortic Arch Repair
		Introduction
		Indications and Patient Selection
		Operative Technique
		Clinical Outcomes
		Conclusion
		References
	59: Endovascular Stent Grafting of Thoracic Aorta
		Introduction
		Preoperative Planning and Considerations
			Aortic Arch Landing Zones
			Cerebrospinal Fluid Drainage
			Neuromonitoring
			Vascular Access
		TEVAR for Descending Thoracic and Thoracic Abdominal Aneurysms
			Open Debranching and TEVAR (Hybrid Aortic Repair)
			Branched and Fenestrated Grafts for TEVAR
		TEVAR for Acute Thoracic Aortic Dissection
			Uncomplicated Type B Dissection
			Complicated Type B Dissection
			TEVAR in Blunt Traumatic Aortic Injury
		Complications After TEVAR
			Endoleaks
			Vascular Access Injury
			Neurologic Complications
			Retrograde Dissection
		Conclusions
		References
	60: Neuroprotective Strategies During Aortic Surgery
		Spinal Cord Injury Following Thoracoabdominal Aortic Surgery
			Pathophysiology
			Identifying Patients at High-Risk
			Protective Strategies
				Cerebrospinal Fluid Drainage
				Supporting Spinal Cord Perfusion Pressure (SCPP)
				Hypothermia
				Drugs
				Preconditioning and Postconditioning
			Monitoring
		Brain Injury Following Ascending Aorta and Arch Surgery
			Pathophysiology
			Identifying Patients at High Risk
			Protective Strategies
				Hypothermia
				Anterograde Cerebral Perfusion (ACP)
				Retrograde Cerebral Perfusion (RCP)
				Drugs
				Topical Head Cooling
				Acid-Base
				Hematocrit
			Monitoring
		References
	61: Sinus of Valsalva Aneurysms
		Introduction
		Embryology
		Pathogenesis
		Epidemiology
		Clinical Features
		Diagnostic Imaging
		Management
			Medical Management
			Percutaneous Closure
			Surgical Management
		Conclusion
		References
	62: Elephant Trunk Procedures
		Introduction
		Evolution of the Elephant Trunk
		Classification of Elephant Trunk Repairs
		Preoperative Evaluation
		Anesthetic Management
		Cardiopulmonary Perfusion and Brain Protection
		Operative Technique: First Stage Conventional Elephant Trunk
		Operative Technique: Second Stage Conventional Elephant Trunk
		Operative Technique: Frozen Elephant Trunk
		Postoperative Surveillance
		Outcomes
		Conclusion
		References
	63: Porcelain Ascending Aorta
		Introduction
		Definition and Diagnosis
		Pathogenesis and Associations
			Atheromatous Aortic Disease: A Disease of the Tunica Intima
			Non-atheromatous Aortic Disease: A Disease of the Tunica Media
		Prevalence
		PA and Cardiovascular Risk
		PA and Cardiac Surgery
		PA and TAVR
		References
	64: Cardiovascular Manifestations of Marfan and Loeys-Dietz Syndrome
		Introduction
		Proximal Aortic Disease in Marfan and Loeys-Dietz Syndrome
		Acute Aortic Dissection in Marfan Patients
		Interventions on the Distal Aorta After Type A Dissection
		Aortic Dissection in Patients with Loeys-Dietz Syndrome
		Mitral Valve Disease in Marfan and Loeys-Dietz Patients
		Cardiomyopathy in Marfan and Loeys-Dietz Patients
		Aneurysms of the Head and Neck Vessels in Loeys-Dietz Patients
		Conclusion
		References
Part V: Mechanical Circulatory Support and Transplantation
	65: Pharmacologic Support of the Failing Heart
		Introduction
		Heart Failure with Reduced Ejection Fraction (HFrEF)
			Drugs Which Prolong Survival
			Drugs Which Do Not Prolong Survival but Improve the Symptoms
		Heart Failure with Preserved Ejection Fraction (HFpEF)
		Advanced Heart Failure
		Acute Heart Failure (AHF)
		Conclusion
		References
	66: Cardiac Resynchronization Therapy for Heart Failure
		Introduction
		What Is CRT?
		How Does CRT Work?
		CRT Trials
		Indications and Patient Selection
		Technical Considerations
			Venous Access
			Cannulation of the Coronary Sinus
			Coronary Sinus Venogram
			LV Lead Position
			Post Implantation
			Device Programming
			Complications
		The Future
		References
	67: Intra-aortic Balloon Pump
		Introduction
		Mechanism of Action
		Indications for Use
		Contraindications for Use
		Technique of Insertion and Operation
			Femoral Artery Insertion
			Axillary Artery Insertion
		Complications
		Systemic Anticoagulation
		Common Problems and Troubleshooting Measures
			Poorly Synchronized Timing
				Early Balloon Inflation
				Late Balloon Inflation
				Early Balloon Deflation
				Late Balloon Deflation
				Poor Diastolic Augmentation Despite Appropriate Timing
			Limb Ischemia
			Console Problems
		Weaning from IABP
		Conclusion
		References
	68: Extracorporeal Life Support in the Adult
		Introduction
		Circuit Configurations and Components
		Respiratory Support
		Hypoxemic Respiratory Failure, Acute Respiratory Distress Syndrome, and Recent Clinical Trials
		Hypercapnic Respiratory Failure and Extracorporeal Carbon Dioxide Removal
		Bridge to Lung Transplantation and Primary Graft Dysfunction
		Cardiac Support
		Extracorporeal Cardiopulmonary Resuscitation
		Relative Contraindications and Complications
		Long-Term Outcomes
		Conclusion
		References
	69: Temporary Circulatory Support Devices
		Introduction
		Indications for Temporary MCS
		Patient Selection
		Options for Temporary MCS
			Impella®
			TandemHeart™
			CentriMag™
		Post-operative Management and Weaning
		Conclusions
		References
	70: Heart Transplantation
		Introduction
		Indications and Patient Selection
			Recipient Criteria
			Donor Criteria
		Organ Allocation
		Procedure and Technical Considerations
			Organ Retrieval
			Organ Implantation
		Haemodynamic and Clinical Outcomes
		Complications
			Primary Graft Dysfunction
			Acute Rejection
			Cardiac Allograft Vasculopathy
			Malignancy
		The Future
		References
	71: Heart-Lung Transplantation
		Introduction
		History
		Indications for Heart-Lung Transplantation
			Eisenmenger Syndrome
			Uncorrectable Congenital Heart Disease with Atresia or Hypoplasia of the Pulmonary Arteries
			Combined Cardiac and Pulmonary Disease
		Selection Criteria for Heart-Lung Transplantation
			Recipient Age
			Aortopulmonary Collaterals
			Previous Thoracic Surgery
		Technique of Heart-Lung Transplantation
			The Donor Procedure
			The Recipient Procedure
		Postoperative Management
			Immunosuppression
		Complications
			Acute Rejection
			Airway Complications
			Chronic Lung Allograft Dysfunction
			Cardiac Allograft Vasculopathy
			Graft-Versus-Host Disease
		Survival After Heart-Lung Transplantation
		References
	72: Immunosuppression in Cardiac Transplantation
		Introduction
		Goal of Immunosuppression
		Medications for Desensitization Prior to Transplantation
		Induction and Maintenance Therapies
			Induction Therapy
			Maintenance Therapy
		Specific Immunosuppression Medications
			Glucocorticoids
			Antiproliferatives
				Azathioprine
				Mycophenolic Acid
			Calcineurin Inhibitors
			Proliferation Signal Inhibitors
		Which Regimen Is Superior?
			Standard Triple Therapy
			Corticosteroid Withdrawal
			Renal Sparing
		Drug-Drug Interactions
		Medications for Rejection
			Rejection
			Endomyocardial Biopsy (EMBx) and Non-invasive Methods to Screen for Rejection
			Acute Cellular Rejection
			Antibody Mediated Rejection
			Cardiac Allograft Vasculopathy
		Future Directions
		References
	73: Complications of Heart Transplantation
		Introduction
		Background
		Early Complications
			Primary Graft Dysfunction (PGD) or Primary Graft Failure (PGF)
			Pulmonary Hypertension and Right Ventricular Dysfunction
			Rejection
			Non-cytomegalovirus Infections
			Cytomegalovirus Infections
			Surgical Complications
			Acute Kidney Injury (AKI) Requiring Haemofiltration
		Late Complications
			Renal Dysfunction
			Cardiac Allograft Vasculopathy (CAV)
			Malignancy
			Other Chronic Complications
		Conclusion
		References
Part VI: Miscellaneous Cardiovascular Disorders
	74: Cardiac Tumors
		Incidence
		Classification
		Clinical Symptoms
		Reactive Cardiac Masses and Pseudotumors
			Mural Thrombi
			Calcifying Amorphous Pseudotumor
			Mesothelial Pseudotumors
		Ectopias
			Cystic Tumor of the Atrioventricular Node
		Germ Cell Tumors of the Heart
		Benign Neoplasms
			Papillary Fibroelastoma
			Rhabdomyoma
			Adult Cellular Rhabdomyoma
			Lipomatous Hypertrophy of the Atrial Septum
			Cardiac Lipoma
			Cardiac Fibroma
			Cardiac Myxoma
		Malignant Tumors
			Primary Cardiac Sarcomas
				Angiosarcoma
				Undifferentiated Pleomorphic Sarcomas (Malignant Fibrous Histiocytoma)
				Leiomyosarcoma
				Rhabdomyosarcoma
			Cardiac Lymphoma
		Conclusion
		References
	75: Concomitant Coronary Artery Disease and Lung Cancer
		Introduction
		Concomitant or Staged Procedure
		Impact of Adhesions on Staged Procedure
		Use of Extracorporeal Circulation
		Off-Pump Coronary Artery Bypass Grafting
		Choice of Incision for Access
		Extent of Pulmonary Resection
		Conclusions
		References
	76: Trauma to the Heart and Great Vessels
		Introduction
		Initial Evaluation
		Evaluation and Management per Structure Injured
			Heart
				Surgical Approach
				Penetrating Cardiac Injury
				Coronary Artery Injury
				Blunt Cardiac Injury
			Aorta
				Penetrating Aortic Injury
				Blunt Aortic Injury
			Innominate Artery
				Penetrating Innominate Artery Injury
				Blunt Innominate Artery Injury
			Carotid Artery
				Penetrating Carotid Artery Injury
				Blunt Carotid Artery Injury
			Subclavian Artery
		Conclusion
		References
	77: Pericardial Diseases
		Anatomy and Functions of Pericardium
		Etiology of Pericardial Diseases
		Chronic Relapsing (Recurrent) Pericarditis
		Effusive Pericardial Disease
		Constrictive Pericardial Disease
		Pericardiectomy
			Indications
			Approaches
			Use of Cardiopulmonary Bypass
			Technique
			Special Considerations
			Results of Pericardiectomy
		Conclusion
		References
	78 Pulmonary Thromboendarterectomy
		Introduction
		Indications
		Operation Principles
		Technical Aspects
		Surgical Advancements
		Results
			Mortality Rate
			Other Post-operative Complications
		Conclusion
		References
	79: Surgical Management of Atrial Fibrillation
		Background
		Pathology
		Patients and Workup
		Procedures
		Surgical Rhythm Control
			The Cox-Maze Procedures
			Less Extensive Lesion Sets
			The Hybrid Approach
			Left Atrial Appendage Exclusion
		Conclusion
		References
	80: Hypertrophic Cardiomyopathy
		Introduction
		Surgical Treatment
			Preoperative Evaluation
			Operative Methods
		Postoperative Management
		Perioperative Results
		Long-Term Outcomes
		References
	81: Left Ventricular Volume Reduction
		Introduction
		Rationale for Left Ventricular Volume Reduction
		Volume-Related or Shape-Related Left Ventricular Reduction
		Secondary Mitral Regurgitation
		The STICH Trial
		Clinical Results
		Conclusions
		References
	82: Renal Failure After Cardiac Surgery
		Introduction
		Defining Cardiac Surgery Associated Acute Kidney Injury
		Pathogenesis of Cardiac Surgery Associated Acute Kidney Injury
		Risk Factors and Prediction of Cardiac Surgery Associated Acute Kidney Injury
		Renal Protective Strategies
			Preoperative Strategies
				Optimization of Renal Function
				Aspirin
				Statins
				Erythropoietin
			Intraoperative Strategies
				Anemia Correction
				Blood Glucose Control
				Blood Management Program
				Mini-CPB and Zero-Balanced Ultrafiltration
				Surgical Strategies
				Volatile Anesthesia
				Remote Ischemic Preconditioning
				Balanced Crystalloid Solutions
				Fenoldopam
				Natriuretic Peptide
				Sodium Bicarbonate
				Levosimendan
				Dexmedetomidine
				Vasopressin
			Postoperative Strategies
				KDIGO Bundle
				Early Use of RRT
				Extended Daily Dialysis
		Early Detection of Acute Kidney Injury
			The Role of Biomarkers
		Conclusion
		References
	83: Bleeding and Re-exploration After Cardiac Surgery
		Introduction
		Risk Factors for Bleeding Associated with Cardiac Surgery
		Medical Management of Postoperative Bleeding
		Surgical Methods to Manage Postoperative Bleeding
		Timing of Re-exploration
		Reoperation Versus Transfusion
		Intraoperative Approaches
		Conclusion
		References
	84: Sternal Wound Infections
		Introduction
		Clinical Presentation
		Pathogenesis
		Incidence and Risk Factors
		Treatment
			Negative-Pressure Wound Therapy
		Outcome of Treatment
		Late Sternal Wound Infections
		Preventive Measures
		Conclusion
		References
	85: Atrioventricular Disruption
		Introduction
		Types
		Pathogenesis and Risk Factors
		Strategies to Minimize the Risk of Atrioventricular Disruption
		Management
		Conclusion
		References
Part VII: Paediatric and Congenital Heart Disease
	86: Pediatric Cardiopulmonary Bypass and Hypothermic Circulatory Arrest
		Introduction
		Conduct of Cardiopulmonary Bypass
			Anticoagulation
			Arterial Cannulation
			Venous Cannulation
			Femoral Cannulation
			Initiation of Cardiopulmonary Bypass
			Blood Flow Through the Cardiopulmonary Bypass Circuit
			Pump Flow/Oxygen Delivery
			Goal-Directed-Perfusion
			Vents/Pump Suckers
			Weaning from CPB
		Deep Hypothermic Circulatory Arrest
		Adult Versus Pediatric Cardiopulmonary Bypass
		Modified Ultrafiltration
		Conclusion
		References
	87: Myocardial Protection in Children
		History of Cardioplegia
		Differences Between Pediatric and Adult Hearts
		Methods of Myocardial Protection
		Hypothermia
		Cardioplegia Administration Techniques
		Protection Strategies in Pediatric Myocardium
		References
	88: Pediatric Extracorporeal Membrane Oxygenation and Mechanical Circulatory Assist Devices
		Introduction
		Pediatric Extracorporeal Membrane Oxygenation
			Definition
			Types
			Indications and Contraindications
			ECMO Circuit
			Cannulation
			ECMO Management
			Complications
			Clinical Outcomes
			Translational Research for Optimization of Neonatal and Pediatric ECMO Circuitry
		Summary
		Pediatric Mechanical Circulatory Assist Devices
		Short-Term Pediatric MCS
			Devices
			Outcomes and Complications
		Long Term Pediatric MCS
		Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs)
			Devices and Patients
			Survival Post-VAD Implantation
			Adverse Events
		Summary
		References
	89: Palliative Operations for Congenital Heart Disease
		Introduction
		Procedures to Decrease Pulmonary Blood Flow
			Pulmonary Artery Banding
				Banding of Main Pulmonary Artery
					Indications
					Technique
					Complications
				Banding of Branch Pulmonary Arteries
		Procedures to Increase Pulmonary Blood Flow
			Systemic-Pulmonary Shunts
				Indications
			Classic Blalock-Taussig Shunt
			Modified Blalock-Taussig Shunt
			Potts Shunt
			Waterston Shunt
			Central Shunt
			Bidirectional Glenn Shunt
			Right Ventricle-to-Pulmonary Artery Shunt (Sano Shunt)
			Right Ventricular Outflow Tract Stenting
			Ductal Stenting
		Procedures to Enhance Mixing
			Indications
			Balloon Atrial Septostomy
			Blalock-Hanlon Operation
			Open Atrial Septectomy
			Palliative Atrial Switch Operation
		Other Miscellaneous Palliative Procedures
			Hybrid Palliation
				Indications
				Technique
				Complications
		Conclusion
		References
	90: Coronary Anomalies in Children
		Introduction
		Anomalous Origin of Coronary Arteries
			Anomalous Coronary Origin from the Pulmonary Artery
			Anomalous Aortic Origin
		Coronary Artery Fistula
		Conclusion
		References
	91: Congenital Valvar and Supravalvar Aortic Stenosis
		Congenital Aortic Valve Stenosis
			Introduction
			Anatomy
			Pathophysiology
			Clinical Features
			Diagnosis
				Electrocardiogram
				Chest Radiograph
				Echocardiogram
				Cardiac Magnetic Resonance
				Cardiopulmonary Exercise Testing
				Cardiac Catheterization
			Management of Critical Aortic Stenosis
				Medical Management
				Timing of Intervention
				Surgical Intervention
				Catheter Intervention
				Hybrid Approach
				Long-Term Outcomes
			Management of Non-critical Aortic Stenosis
				Medical Management
				Timing of Intervention
				Catheter Intervention
				Surgical Intervention
				Long-Term Outcomes
		Supravalvar Aortic Stenosis
			Introduction
			Anatomy
			Pathophysiology
			Clinical Features
			Investigations
				Electrocardiogram
				Chest Radiograph
				Echocardiogram
				Magnetic Resonance Imaging and Computed Tomography
				Cardiac Catheterization
			Management
			Long-Term Outcomes
		References
	92: Atrial Septal Defects
		Introduction
		Clinical Features
		Diagnosis
			Echocardiogram
				Transthoracic Echocardiogram (TTE)
				Transesophageal Echocardiogram (TEE)
				Intracardiac Echocardiogram (ICE)
			Cross Sectional Imaging
			Cardiac Catheterization
		Indications and Timing for ASD Closure
		Surgical Versus Transcatheter Management
			Surgical and Interventional Therapy Recommendations
			Surgical Techniques and Results
				Traditional Surgical Closure
				Minimally Invasive Cardiac Surgery
				Right Axillary Incision Approach
			Secundum ASD
			Primum ASD
			Sinus Venosus ASD
				Warden Procedure
		Postoperative Complications
			Outcomes of Transcatheter Closure and Comparison with Surgical Closure
			Catheter Closure of ASD Compared to Minimally Invasive Cardiac Surgery
			Early Complications of ASD Devices
			Late Complications of ASD Devices
		Conclusion
		References
	93: Isolated Ventricular Septal Defect
		Introduction
		Epidemiology
		Morphology
			The Right Ventricle (RV)
			The Left Ventricle (LV)
			Perimembranous Ventricular Septal Defects
			Muscular Ventricular Septal Defects
			Juxta-Arterial Defects
			Other
		Pathophysiology
		Clinical Features
			Small VSD
			Large Symptomatic VSD
		Investigations
			12-Lead Electrocardiography
			Chest X-Ray
			Echocardiography
		Medical Management
		Indications for Intervention
		Closure of VSDs in the Context of High Pulmonary Vascular Resistance
		Surgical Intervention
			Standard Closure of Perimembranous VSD
			Continuous Versus Interrupted Sutures
			Doubly Committed VSD
			Muscular VSDs
			Special Circumstances
				TV Apparatus Detachment
				Aortic Insufficiency
				Residual or Additional VSD
				Pulmonary Artery Banding
				New Approaches
		Hybrid Approach to VSD Closure
		Non-surgical Intervention
			Transcatheter Device Closure of Muscular VSDs
		Pacemaker Implantation After VSD Closure
		Late Effects of Surgical Closure of Isolated VSD
		Conclusion
		References
	94: Patent Ductus Arteriosus
		Introduction
		Embryology and Anatomy
		Normal Physiologic Postnatal Closure
		Patency with Pulmonary Overcirculation
		Patency Without Overcirculation
		Open Surgical Methods of Closure
		Catheter Methods of Closure
		Conclusion
		References
	95: Aortopulmonary Window
		Introduction
		Embryology
		Classification
		Associated Conditions
		Pathophysiology
		Clinical Features
			Symptoms
			Signs
		Diagnosis
		Natural History
		Management
			Medical and Interventional Therapy
			Surgical
				Indications
				Technique of Operation
			Postoperative Management
		Results
		Conclusion
		References
	96: Coarctation of the Aorta
		Introduction
		Morphology
		Pathophysiology and Clinical Presentation
			Fetal Presentation
			Neonatal Presentation
			Infant Presentation
			Childhood/Adolescent/Adult Presentation
		Diagnosis
			Echocardiography
			Computed Tomography Scanning
			Magnetic Resonance Imaging
			Catheterisation and Angiography
		Initial Management
		Definitive Treatment
		Surgery for Coarctation in Neonates and Infants
			Left Thoracotomy Without Cardiopulmonary Bypass
			Surgical Technique
			Specific Complications, Advantages, Disadvantages and Alternative Treatments
			Median Sternotomy with Cardiopulmonary Bypass
			Surgical Technique
			Specific Complications, Advantages, Disadvantages and Alternative Treatments
		Treatment of Coarctation in Older Children and Adults
		Outcomes in Contemporary Practice
		Long-Term Follow-Up
		References
	97: Pulmonary Valve Stenosis
		Introduction
		Anatomy and Spectrum of Lesions
		Pathophysiology
		Natural History
		Clinical Manifestations
			Symptoms
			Signs
		Diagnostic Evaluation
		Indications for Treatment
		Management
			Surgical Techniques
				Valvotomy and/or Valvectomy on Cardiopulmonary Bypass
				Off-Pump Closed Valvotomy
			Postoperative Management
		References
	98: Truncus Arteriosus
		Introduction
		Morphology
		Classification
		Natural History
		Pathophysiology
		Diagnosis
		Treatment
		Post-operative Management
		Outcomes
		Conclusion
		References
	99: Transposition of the Great Arteries
		Introduction
		Epidemiology
		Physiology
		Preoperative Imaging
		Preoperative Management
		Balloon Atrial Septostomy
		Prostaglandin E1
		Timing of Surgery
		Surgical Techniques
			Historical Perspective
			Arterial Switch Operation
			Presence of Outflow Tract Obstruction
		Long-Term Follow Up
		Conclusion
		References
	100: Congenitally Corrected Transposition of the Great Arteries
		Introduction
		Surgical Pathology
			Ventricular Septal Defect
			Left Ventricular Outflow Tract
			Atrioventricular Valves
			Coronary Arteries
			Conduction System
		Pathophysiology and Clinical Presentation
		Diagnosis
		Surgical Treatment
			ccTGA with Isolated Left Ventricular Outflow Tract Obstruction
			ccTGA with Pulmonary Stenosis/Atresia and Ventricular Septal Defect
			ccTGA with Tricuspid Valvar Insufficiency
			ccTGA with Isolated Ventricular Septal Defect
			Alternative Procedures
		Results
		Summary
		References
	101: Tetralogy of Fallot
		Introduction
		Anatomy and Morphology
		Pathophysiology
		Approach to Surgical Decision Making in the Modern Surgical Era: Pulmonary Valve Preservation and the Scope of the Problem
		Surgical Management
			VSD Closure and RVOT Muscle Bundle Resection
			Approach to the Pulmonary Valve
			Surgical Options for Valve-Sparing TOF Repair
			Mild-Moderate Pulmonary Stenosis and Mildly Dysplastic Valve
			Moderate Pulmonary Valve Stenosis or Dysplasia
				Commissurotomy and Intraoperative Balloon Pulmonary Valve Dilation
				Valve-Sparing Transannular Reconstruction
		Perioperative Management
		Postoperative Outcomes
			New York-Presbyterian Morgan Stanley Children’s Hospital/Columbia University Outcomes
		Conclusions and Perspective
		References
	102: Hypoplastic Left Heart Syndrome
		Introduction
		Morphology and Clinical Implications
		Neonatal Management and the Norwood Operation
			Norwood Operation
			Right Ventricle to Pulmonary Artery Conduit Versus the Blalock-Taussig Shunt
			The ‘Hybrid’ Norwood
			Outcomes
		Second and Third Stage Procedures
			Second Stage
			Third Stage
		Late Outcomes
		Transplantation
		Future
		References
	103: Congenital Aortic Arch Interruption and Hypoplasia
		Introduction
		Anatomy
		Clinical Features
		Diagnosis and Preoperative Management
		Surgical Management
		Postoperative Care
		Results
		Special Situations
			Hypoplastic Aortic Arch
			LVOT Obstruction
		Conclusion
		References
	104: Pulmonary Atresia with Intact Septum
		Introduction
		Anatomy
			Overview
			Right Ventricle and Tricuspid Valve
			Coronary Abnormalities
		Pathophysiology
			Blood Flow
			Right Ventricular Dependent Coronary Circulation
		Presentation and Diagnosis
		Surgical Management
			General Principles and Goals of Management
		Stages of Surgery
			Neonatal Management
			Management After the Neonatal Period
			Mild Right Ventricular Hypoplasia
			Moderate Right Ventricular Hypoplasia
			Severe Right Ventricular Hypoplasia
		Outcomes
		Conclusion
		References
	105: Complete Atrioventricular Septal Defect
		Introduction
		Anatomic Features and Nomenclature
		Diagnosis
		Indications and Timing for Repair
		General Strategy for Surgical Repair
		Technique of Nunn Repair
		Outcome of Surgery
		Conclusion
		References
	106: Double Outlet Right Ventricle
		Introduction
		Historical Perspective
		Definition
		Embryology
		Genetics
		Morphology
			Ventricular Septal Defect
			Subaortic VSD
			Subpulmonic VSD
			Non-committed VSD
			Doubly Committed VSD
		DORV Classification
		Associated Anomalies [1, 5, 18]
		Pathophysiology
			Ventricular Septal Defect and Great Artery Relation
			Patent Ductus Arteriosus
			Pulmonary Vascular Resistance
		Clinical Presentation
		Physical Signs
		Diagnosis
		Management
			Preoperative Management
			Postoperative Management
		Surgical Management
		Outcomes
		Conclusion
		References
	107: Neonatal Ebstein’s Anomaly
		Introduction
		Associated Anomalies and Arrhythmias
		Anatomy of Ebstein’s Anomaly
		Pathophysiology
		Diagnostic Evaluation
			Chest X-Ray
			Electrocardiography
			Echocardiography
			Catherization/Computed Tomography/Magnetic Resonance Imaging
		Treatment
			Medical
			Surgical Indications
			Surgical Procedures
		Outcomes
		Conclusion
		References
	108: Vascular Rings and Pulmonary Artery Sling
		Introduction
		Vascular Rings
			Natural History and Clinical Presentation
			Diagnostic Techniques
			Indications for Operation
			Operative Techniques
				Double Aortic Arch
				Right Aortic Arch
		Pulmonary Artery Sling
			Clinical Presentation
			Operative Techniques
				Pulmonary Artery Sling Repair
				Slide Tracheoplasty
		Rare Vascular Rings
		Conclusions
		References
	109: Congenital Left Ventricular Outflow Tract Obstruction
		Introduction
		Subvalvar Aortic Stenosis
			Overview
			Anatomy
			Pathophysiology
			Presentation, Diagnosis and Indications for Surgery
			Surgical Management
				Resection of Fibrous Shelf
				Modified Konno Operation
				Aortoventriculoplasty Procedures
				Konno Operation
				Ross-Konno Procedure
			Outcomes
		Supravalvar Aortic Stenosis
			Overview
			Anatomy
			Pathophysiology
			Presentation and Diagnosis
				Indications for Surgery
			Surgical Management
				Surgery for Localised SVAS
				Single-Patch (McGoon) Technique
				Two-Patch Repair (Inverted Y-Shaped) Doty Technique
				Three-Patch (Brom) Technique
				Sliding Aortoplasty: Three-Sinus Repair (Myers-Waldhausen)
				Surgery for Diffuse Supravalvar Aortic Stenosis
			Outcomes
		Conclusion
		References
	110: Pediatric Heart Transplantation
		Introduction and Historical Note
		Indications for Pediatric Heart Transplantation
			Cardiomyopathy
			Congenital Heart Disease
			Cardiac Tumors
		Recipient Evaluation
			Anatomic Considerations
			Pulmonary Vascular Resistance
		The Sensitized Patient
		The Pediatric Heart Donor
		The Transplant Operation
		Immunosuppression
			Pre-transplant Immunosuppression
			Maintenance Immunosuppression
		Complications of Heart Transplantation
			Allograft Rejection
				Acute Cellular Rejection
				Antibody-Mediated Rejection
				Treatment of Acute Rejection
				Outcomes
			Infection
			Malignancy
			Allograft Vasculopathy
		Survival
		Retransplantation
		Future Directions
		References
Review Questions
Answers
Index