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Bidirectional Glenn Procedure
The bidirectional Glenn (BDG) shunt (medical), shunt, or bidirectional cavopulmonary anastomosis, is a surgical technique used in pediatric cardiac surgery procedure used to temporarily improve blood oxygenation for patients with a congenital cardiac Hypoplastic left heart syndrome, defect resulting in a single functional ventricle. Creation of a bidirectional shunt reduces the amount of blood volume that the heart needs to pump at the time of surgical repair with the Fontan procedure. Uses Physiology The human circulatory system uses a low-resistance pulmonary circulation and high-resistance Circulatory system, systemic circulation to pump blood. In a single-ventricle heart, the sole functioning ventricle must pump blood to both the lungs and the organ systems. As a result, this is an abnormal parallel circuit where the pulmonary and systemic blood mixes such that both oxygenated and deoxygenated blood are pumped to the organs. The aim of the bidirectional Glenn shunt is to ...
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Double Inlet Left Ventricle
A double inlet left ventricle (DILV) or ''"single ventricle"'', is a congenital heart defect appearing in 5 in newborns, where both the left atrium and the right atrium feed into the left ventricle. The right ventricle is hypoplastic or does not exist. Both atria communicate with the ventricle by a single atrio-ventricular valve. There is a big shunt left-right with a quickly evolutive pulmonary hypertension. Without life-prolonging interventions, the condition is fatal, but with intervention, the newborn may survive. Even if there is no foetal sickness, the diagnosis can be made in utero by foetal echocardiography. Presentation Infants born with DILV cannot feed normally (breathlessness) and have difficulty gaining weight. The mixed blood in systemic circulation leads to hypoxia (lack of oxygen to the body and organs), so infants develop cyanosis and breathlessness early. Diagnosis Treatment * In the first few days, if there is no pulmonary valve stenosis, a pulmonary valve ...
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William Glenn
William Wallace Lumpkin Glenn (August 12, 1914 – March 10, 2003) was an American cardiac surgeon who co-created an early version of an artificial heart and was the developer of a technique for the treatment of congenital heart defects. Glenn was born on August 12, 1914, in Asheville, North Carolina. His father was a medical doctor and his mother an attorney. He was sent to attend the Sewanee Military Academy in Sewanee, Tennessee. He attended the University of South Carolina, graduating in 1934 with a Bachelor of Science degree. He attended Philadelphia's Jefferson Medical College, graduating with his medical degree in 1938. His internship was performed at Pennsylvania Hospital, while he performed his residency in surgery at Massachusetts General Hospital. During World War II, Glenn served as a field surgeon in the Army Medical Corps, serving in Europe where he established a field hospital in Normandy.Lavietes, Stuart"William Glenn, 88, Surgeon Who Invented Heart Proced ...
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Heart Transplantation
A heart transplant, or a cardiac transplant, is a surgical transplant procedure performed on patients with end-stage heart failure when other medical or surgical treatments have failed. , the most common procedure is to take a functioning heart from a recently deceased organ donor (brain death is the most common) and implant it into the patient. The patient's own heart is either removed and replaced with the donor heart ( orthotopic procedure) or, much less commonly, the recipient's diseased heart is left in place to support the donor heart (heterotopic, or "piggyback", transplant procedure). Approximately 5,000 heart transplants are performed each year worldwide, more than half of which are in the US. Post-operative survival periods average 15 years. Heart transplantation is not considered to be a cure for heart disease; rather it is a life-saving treatment intended to improve the quality and duration of life for a recipient. History American medical researcher Simon Fle ...
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ECMO
Extracorporeal membrane oxygenation (ECMO) is a form of extracorporeal life support, providing prolonged cardiac and respiratory support to people whose heart and lungs are unable to provide an adequate amount of oxygen, gas exchange or blood supply (perfusion) to sustain life. The technology for ECMO is largely derived from cardiopulmonary bypass, which provides shorter-term support with arrested native circulation. The device used is a membrane oxygenator, also known as an artificial lung. ECMO works by temporarily drawing blood from the body to allow artificial oxygenation of the red blood cells and removal of carbon dioxide. Generally, it is used either post-cardiopulmonary bypass or in late-stage treatment of a person with profound heart and/or lung failure, although it is now seeing use as a treatment for cardiac arrest in certain centers, allowing treatment of the underlying cause of arrest while circulation and oxygenation are supported. ECMO is also used to support pat ...
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Surgical Anastomosis
A surgical anastomosis is a surgical technique used to make a new connection between two body structures that carry fluid, such as blood vessels or bowel. For example, an Artery, arterial anastomosis is used in vascular bypass and a Colon (anatomy), colonic anastomosis is used to restore colonic continuity after the resection of Colorectal cancer#surgery, colon cancer. A surgical anastomosis can be created using suture sewn by hand, mechanical staplers and biological glues, depending on the circumstances. While an anastomosis may be end-to-end, equally it could be performed side-to-side or end-to-side depending on the circumstances of the required reconstruction or Coronary artery bypass surgery, bypass. The term reanastomosis is also used to describe a surgical reconnection usually reversing a prior surgery to disconnect an anatomical anastomosis, e.g. tubal reversal after tubal ligation. __TOC__ Medical uses * Blood vessels: Arteries and veins. Most vascular procedures, includi ...
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Pulmonary Artery
A pulmonary artery is an artery in the pulmonary circulation that carries deoxygenated blood from the right side of the heart to the lungs. The largest pulmonary artery is the ''main pulmonary artery'' or ''pulmonary trunk'' from the heart, and the smallest ones are the arterioles, which lead to the capillaries that surround the pulmonary alveoli. Structure The pulmonary arteries are blood vessels that carry systemic venous blood from the right ventricle of the heart to the microcirculation of the lungs. Unlike in other organs where arteries supply oxygenated blood, the blood carried by the pulmonary arteries is deoxygenated, as it is venous blood returning to the heart. The main pulmonary arteries emerge from the right side of the heart and then split into smaller arteries that progressively divide and become arterioles, eventually narrowing into the capillary microcirculation of the lungs where gas exchange occurs. Pulmonary trunk In order of blood flow, the pulmonary ...
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Atrium (heart)
The atrium (; : atria) is one of the two Heart#Chambers, upper chambers in the heart that receives blood from the circulatory system. The blood in the atria is pumped into the Ventricle (heart), heart ventricles through the atrioventricular valve, atrioventricular mitral valve, mitral and tricuspid valve, tricuspid heart valves. There are two atria in the human heart – the left atrium receives blood from the pulmonary circulation, and the right atrium receives blood from the venae cavae of the systemic circulation. During the cardiac cycle, the atria receive blood while relaxed in diastole, then contract in systole to move blood to the ventricles. Each atrium is roughly cube-shaped except for an ear-shaped projection called an atrial appendage, previously known as an auricle. All animals with a closed circulatory system have at least one atrium. The atrium was formerly called the 'auricle'. That term is still used to describe this chamber in some other animals, such as the ''Mo ...
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Superior Vena Cava
The superior vena cava (SVC) is the superior of the two venae cavae, the great venous trunks that return deoxygenated blood from the systemic circulation to the right atrium of the heart. It is a large-diameter (24 mm) short length vein that receives venous return from the upper half of the body, above the diaphragm. Venous return from the lower half, below the diaphragm, flows through the inferior vena cava. The SVC is located in the anterior right superior mediastinum. It is the typical site of central venous access via a central venous catheter or a peripherally inserted central catheter. Mentions of "the cava" without further specification usually refer to the SVC. Structure The superior vena cava is formed by the left and right brachiocephalic veins, which receive blood from the upper limbs, head and neck, behind the lower border of the first right costal cartilage. It passes vertically downwards behind the first intercostal space and receives the azygos vei ...
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AV Valve
A heart valve is a biological one-way valve that allows blood to flow in one direction through the chambers of the heart. A mammalian heart usually has four valves. Together, the valves determine the direction of blood flow through the heart. Heart valves are opened or closed by a difference in blood pressure on each side. The mammalian heart has two atrioventricular valves separating the upper atria from the lower ventricles: the mitral valve in the left heart, and the tricuspid valve in the right heart. The two semilunar valves are at the entrance of the arteries leaving the heart. These are the aortic valve at the aorta, and the pulmonary valve at the pulmonary artery. The heart also has a coronary sinus valve and an inferior vena cava valve, not discussed here. Structure The heart valves and the chambers are lined with endocardium. Heart valves separate the atria from the ventricles, or the ventricles from a blood vessel. Heart valves are situated around the fibrous rin ...
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Pulmonary Vascular Resistance
Vascular resistance is the resistance that must be overcome for blood to flow through the circulatory system. The resistance offered by the systemic circulation is known as the systemic vascular resistance or may sometimes be called by another term total peripheral resistance, while the resistance caused by the pulmonary circulation is known as the pulmonary vascular resistance. Vasoconstriction (i.e., decrease in the diameter of arteries and arterioles) increases resistance, whereas vasodilation (increase in diameter) decreases resistance. Blood flow and cardiac output are related to blood pressure and inversely related to vascular resistance. Measurement The measurement of vascular resistance is challenging in most situations. The standard method is by the use of a Pulmonary artery catheter. This is common in ICU settings but impractical is most other settings. Units for measuring Units for measuring vascular resistance are dyn·s·cm−5, pascal seconds per cubic metre (Pa ...
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Relative Contraindication
In medicine, a contraindication is a condition (a situation or factor) that serves as a reason not to take a certain medical treatment due to the harm that it would cause the patient. Contraindication is the opposite of indication, which is a reason to use a certain treatment. Absolute contraindications are contraindications for which there are no reasonable circumstances for undertaking a course of action (that is, overriding the prohibition). For example: * Children and teenagers with viral infections should not be given aspirin because of the risk of Reye syndrome. * A person with an anaphylactic food allergy should never eat the food to which they are allergic. * A person with hemochromatosis should not be administered iron preparations. * Some medications are so teratogenic that they are absolutely contraindicated in pregnancy; examples include thalidomide and isotretinoin. Relative contraindications are contraindications for circumstances in which the patient is at higher ...
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