Acidemia A condition in which the blood is more acid and less Aortic arch The second part of the aorta, which continues on Acidosis An abnormal condition resulting from an increase in from the ascending aorta and curves to the left and poste- acids or from a depletion of alkali in the blood and body Aortic valve The valve in the heart between the left ventricle Acute A term used to describe a condition that appears sud- and the aorta. It has three flaps or cusps.
denly or one that has a short and relatively severe course.
Arrhythmia An abnormal rhythm of the heart.
Adrenalin A drug that is used to increase the blood pressure, Artery A blood vessel that carries blood from the heart to var- heart rate and force of contraction of the heart. This results ious parts of the body. Most arteries carry blood that is rich in an increase in cardiac output from the heart. Injection of in oxygen or well oxygenated. The main exception is the adrenalin, which is also known as epinephrine, may cause an irregularity of the heartbeat or an arrhythmia.
Arterial pressure The blood pressure in the arteries of the sys- Alkalinity An abnormal condition resulting from a decrease in acids or from an increase of alkali in the blood and bodytissues.
ASA physical class A classification system adopted by the American Society of Anesthesiologists (ASA) and used by Anaesthesia A field of medicine involving the administration anaesthetists to assess the pre-operative physical state or of drugs that produce a loss of consciousness or sensation.
condition of a patient. There are five categories, and adding The term also means a drug-induced state of lack of feel- the postscript ‘E’ indicates that the patient is to undergo ing. This may affect the entire body (as in general anaes- an emergency operation. The ASA Class does not correlate thesia), a region of the body (as in regional anaesthesia), or with the risk of the anaesthetic, but does roughly correlate a small amount of tissue (as in local anaesthesia).
with the risk of post-operative complications.
Anaesthetist A doctor who is specially trained to administer Ascending aorta The first part of the aorta, which arises from the left ventricle and gives off the right and left coronary Annulus A structure shaped like a ring. For example, in the arteries before continuing as the aortic arch.
heart, the base of the mitral valve is termed the annulus.
Aorta The large artery that takes blood from the left ventricle A P P E N D I X
Atresia The absence or closure of a normal body opening or tubu- Cannulation The act of insertion of cannulas into blood ves- lar structure.For example,in pulmonary atresia there is block- sels. This is a normal part of cardiopulmonary bypass.
age of the passage between the right ventricle and the lungs.
Cardiac arrest When the heart stops on its own or is stopped Atrial septal defect (ASD) An abnormal opening or hole in the from beating through drug or mechanical means.
septum between the right and left atria. Normally, the flow Cardiac catheterization Examination of the heart by the pas- of blood will be from left to right (left to right shunt). Blood sage of a thin tube or catheter into an artery or vein and up flow from right to left (right to left shunt) will be present to the heart. This is done to sample oxygen, measure pres- only if there are other complicating conditions leading to a sures and make X-ray videos of how the heart functions.
higher pressure on the right side, such as pulmonary steno-sis or tricuspid atresia, which impede or prevent the normal Cardiac output The volume of blood pumped by the heart flow of blood from the right ventricle to the lungs.
each minute. The amount of cardiac output equals the vol-ume of blood ejected with each heart beat (or stroke vol- Atrioventricular (AV) canal defect A defect in the heart in which there is a large hole in the centre of the heart. Thereare abnormal openings in the atrial and/or ventricular Cardiac surgery Surgery on, within and around the heart. This septa at the level of the atrioventricular valves. There are may be open or closed-heart surgery.
also often abnormalities of the mitral and/or tricuspid Cardiology The study of the heart and its functions in health valves. These defects are also known by the inclusive term ‘persistent common atrioventricular canal deformities’.
There are three variants, which may be classified as partial, Cardioplegia Intentional cardiac arrest or stopping of the intermediate and complete AV canal deformities.
heart (to allow cardiac surgery) by injection into (or perfu-sion of) the coronary arteries with a special salt or blood Atrioventricular (AV) valves The two valves that lie between solution. The solution may be cold or warm and may con- the atria and the ventricles. These valves are the tricuspid tain different chemicals and drugs. Repeated injections are (right) and the mitral (left) valves.
Atrium Either of the two upper chambers of the heart, in Cardiopulmonary Pertaining to the heart and lungs.
which blood collects before being pumped to the ventri-cles. (The plural is atria.) Cardiopulmonary bypass (CPB) Diversion of the venous blood going to the heart into a machine via a cannula. The machine then adds oxygen and removes (if necessary) carbon dioxide Azygous vein An unpaired vein in the chest, which serves to from the blood and pumps it via another cannula into the connect the superior and inferior vena cavas, as well as the arterial side of the circulation, bypassing the heart.
Cardiovascular Pertaining to the heart and blood vessels.
Bicuspid aortic valve An abnormality of the aortic valve in Cardioversion Correction of an abnormal heart rhythm and which there are only two cusps, instead of the normal restoration of normal rhythm by delivery of one or more mild electric shocks through the chest or directly onto the Blalock-Taussig shunt An operation performed in cases of heart. The machine used is called a cardioverter (or defib- congenital pulmonary stenosis. An anastomosis is created between the aorta (or one of its branches, such as the sub- Catheterization The act of insertion of a catheter into a vessel clavian artery) and one of the pulmonary arteries. This or tube, which could be an artery, a vein or a bladder.
allows some of the blood from the systemic circulation tobe shunted into the pulmonary circulation.
Central venous pressure The pressure in the right atrium and large veins of the chest. An estimate of this measurement Blood pressure (BP) The force or pressure exerted by the may be made by examining the large (jugular) vein in a heart in pumping blood through the arteries.
patient’s neck. The pressure may also be measured directly by inserting a special cannula into the jugular vein. Thismeasurement can give an estimate of the adequacy of the Cannula A tube inserted into a vessel to act as a channel for return of venous blood to the heart and how the right side the transport of fluid. Cannulas come in different styles Circulating nurse An operating-room nurse who does not Cross clamp (X-clamp) A special clamp that is applied to the ‘scrub in’ and does not wear sterile clothing (except to aorta to prevent the flow of blood through the aorta while relieve the scrub nurse). The circulating nurse helps pre- some type of surgical procedure is performed on the heart or pare the patient for the operation, may assist the anaes- thetist and carries out non-sterile surgical tasks, such as Cross-clamp time The length of time that the aorta is cross- opening packets of sutures, or obtaining equipment from clamped and blood does not flow through the aorta (or Closed-heart surgery Surgery carried out on and around the Cusp The flap or leaflet portion of any of the heart valves that heart, and without use of a heart-lung machine or stopping forms the movable part of the valve.
Cyanosis A bluish discolouration of the skin that indicates Coarctation of the aorta A constriction or narrowing of the that the hemoglobin in the blood has a reduced amount of main blood vessel (aorta) that carries blood from the heart oxygen. Peripheral cyanosis (for example, of the finger- to the body. The narrowing is situated somewhere along nails) occurs when there is a reduction in blood flow to the the vessel and restricts blood flow from the heart to the rest extremities. Central cyanosis (for example, of the tongue) of the body. Patients with coarctation generally have hyper- occurs when there is lung or heart disease, such as a right tension with high blood pressures in the arms and low to left shunt or inadequate breathing.
pressures in the legs. They may also have associated hyper-trophy of the left ventricle and a heart murmur, and may Definitive repair Surgical repair of a lesion, which corrects the Complete atrioventricular canal defect The most severe type Deoxygenated Having a reduced amount of oxygen, as in of the atrioventricular canal deformities. This lesion is characterized by direct communication between the right Descending aorta The part of the aorta that curves down from and left ventricles and absence of the openings to the the heart and extends down into the abdomen to where the aorta branches into the common iliac arteries.
Complete heart block Complete blockage of the heart’s nor- Diastolic Pertaining to diastole or the relaxation phase of the mal electrical current between the atria and ventricles. This condition almost always requires treatment with a pace-maker, after emergency treatment with drugs (and some- Digoxin A drug often used in the treatment of congestive times with external cardiac massage).
heart failure. Digoxin makes the heart muscle pump morestrongly, slows the rate or speed at which the heart beats Congenital Refers to conditions that are present at birth, and increases blood flow to the kidneys, which helps in the removal of excess fluid from the body. The same drug is Congestive heart failure (CHF) The inability of either the sometimes used to treat certain arrhythmias.
right or the left ventricle to pump all the blood that returns Distal Away from. (The opposite of proximal.) to it. As a result, blood backs up in the blood vessels lead-ing to that ventricle and the vessels become congested with Diuretic A drug that increases the production of urine by the blood. Failure of the right ventricle (or right heart failure) kidneys. As a result, a patient may excrete more water and leads to blood backing up in the liver and legs. Failure of the left ventricle (or left heart failure) leads to blood back- Double outlet (right) ventricle A condition in which both the pulmonary artery and the aorta connect to the right ventricle.
Coronary arteries The two arteries, right and left, which arise from Ductus arteriosus An arterial duct or vessel in the fetal heart the ascending aorta, curve down over the top of the heart and that connects the left pulmonary artery to the descending then branch out over the surface of the heart.The right coronary aorta. The ductus arteriosus allows blood to bypass the artery (RCA) supplies most of the right ventricle, while the left lungs in the fetal circulation and normally closes shortly coronary artery (LCA) supplies most of the left ventricle. These after birth. If it does not close, the condition is termed arteries supply the working heart muscle with oxygen.Blockage of an artery or one (or more) of its branches may lead to theheart being starved of oxygen, causing a myocardial infarction.
Dysplastic Any tissues that are abnormally developed.
Heart murmur An abnormal sound heard when the heart beats. This sound may result simply from increased blood flow in the heart—the murmur is termed physiological and Echocardiogram (ECHO) The use of ultrasound to produce is not considered serious. Other murmurs are caused by images of the inside of the heart and how it works.
blood flowing through abnormal openings in the heart(such as a patent foramen ovale) or through an abnormal ECMO See Extra-Corporeal Membrane Oxygenation heart valve (such as aortic stenosis).
Heart sounds Noises produced as the heart valves open and Electrocardiogram (ECG or EKG) A graphic record of the close in precise sequence, allowing blood to flow forward electrical impulses produced by the heart. This record into the next chamber and not backward. It is the closing shows the rate, rhythm and site of origin of these electrical of these valves that produces the heart sounds, as in the impulses, as well as if the patient has had damage to the Hemoglobin The special compound in red blood cells to Extra-Corporeal Membrane Oxygenation (ECMO) A method of providing life-support for a patient whose heart Hemorrhage Bleeding or loss of blood, which may be sudden and/or lungs have failed. ECMO is a form of long-term cardiopulmonary bypass. A cannula takes blood from thebody to a special membrane outside the body (or extracor- Heparin A drug used to decrease the ability of the blood to poreal), where oxygen is added and carbon dioxide is clot, resulting in an increase in (or prolongation of) the removed. The blood is then returned to the body through clotting time. In cardiopulmonary bypass, heparin is used to prevent clots from forming in the heart-lung machine.
Epinephrine A drug that is used to increase the blood pres- Hypertension An increase in blood pressure, either of the sys- sure, heart rate and force of contraction of the heart. This temic circulation or of the pulmonary circulation.
results in an increase in cardiac output from the heart.
Hypertrophy An increase in size or overgrowth of a tissue or Epinephrine, which is also known as adrenalin, may cause organ. In the heart, either the left or the right ventricle may an irregularity of the heartbeat or an arrhythmia.
hypertrophy in response to increased work of pumping Hypoplasia Underdevelopment of a tissue or organ. An example would be hypoplasia of the aortic arch,where blood flow to the Foramen ovale A natural opening in the septum between the two body is hampered by an underdeveloped and therefore restrict- atria that allows blood to bypass the lungs in the fetal circula- tion. Failure of the foramen ovale to close leads to a defect inthe septum known as a patent foramen ovale or PFO.
Hypoplastic Pertaining to hypoplasia or underdevelopment.
Heart block The interruption or blockage of the normal con- Hypoplastic aortic arch Underdevelopment of the aortic arch, duction of electrical impulses in the heart. Heart block is leading to restricted blood flow through the aorta.
classified as first degree, second degree or third degree Hypoplastic left-heart syndrome A complex group of con- (also known as complete heart block).
genital heart lesions, including hypoplasia or even com- Heart failure Inability of the heart to pump sufficient blood plete absence of the left ventricle and severe hypoplasia of (or cardiac output) to the body and/or the lungs. Heart fail- the aorta. There may also be a combination of aortic and ure can affect either the right ventricle or the left ventricle mitral valve stenosis or aortic and mitral valve atresia.
or both. As a result, blood backs up in the blood vessels Hypoplastic left ventricle Underdevelopment of the left ven- leading to that ventricle and the vessels become congested with blood. Failure of the right ventricle (or right heart fail-ure) leads to blood backing up in the liver and legs. Failure Hypothermia A reduction in the central or core temperature of of the left ventricle (or left heart failure) leads to blood the body below 36 degrees Celsius. In cardiac surgery, a backing up in the lungs. This may then lead to right heart patient may be made hypothermic, by infusing cold liquids failure. Sometimes the term congestive heart failure (CHF) into the circulation and/or packing ice around parts of the is used to describe left heart failure.
body. This is done in order that the flow of blood to thebrain and other tissues may be reduced, thus allowing the surgeon to safely repair the heart, without damage occur- Norwood operation or procedure A stage in the surgical ring in the organs that would otherwise be starved of oxy- treatment of hypoplastic left heart syndrome. In this oper- gen. With deep hypothermia, the patient (usually an ation, a pulmonary homograft is used to enlarge the rudi- infant) is intentionally cooled to about 16 to 20 degrees mentary aortic arch and then join it to the functioning pul- Celsius. This allows surgeons to be able to stop the heart for about 45–60 minutes and to operate without either the Open-heart surgery Surgery carried out on the heart that is heart moving or tubing or blood being in the very small opened or its major blood vessels, while the blood is diverted through a heart-lung machine.
Hypoxia A reduction in the amount of oxygen available for use Pacemaker An electrical device that can be used to replace the Hypoxic Pertaining to a reduction in the amount of oxygen.
heart’s defective natural pacemaker or conduction pathway.
Inferior vena cava (IVC) The major vein that carries the The artificial pacemaker emits a series of electrical dis- deoxygenated blood from the lower limbs and most of the charges from a battery and so controls the rate and rhythm organs of the pelvis and abdomen. The IVC returns this Palliative Reducing the severity or alleviating the symptoms of Interrupted aortic arch When the aorta does not develop a condition without curing the underlying abnormal con- completely in the area of the arch. As a result, the aorta is dition. Does not usually offer a good long-term outcome.
divided into two parts that are not connected to each other, Partial anomalous pulmonary venous return Oxygenated preventing blood flow through the aorta.
blood returning from the lungs is carried by one or more pul- monary veins emptying directly or indirectly through venouschannels into the right atrium instead of the left atrium. This Invasive A technique of studying the body in which instru- lesion functions in a manner similar to an atrial septal defect.
Patent ductus arteriosus (PDA) A condition in which the ductus arteriosus fails to close shortly after birth. This results in a significant right to left shunt of blood. Babieswith this condition often develop heart and lung failure.
Junctional ectopic tachycardia (JET) A very rapid heart beat Treatment with drugs (indomethacin) is possible, and sur- that can be fatal if not properly controlled.
Left-to-right shunt Abnormal direct passage of oxygen-rich Patent foramen ovale (PFO) A failure of the foramen ovale to blood from the left side of the heart to the right side, at the close, resulting in an opening in the septum between the level of the atria or the ventricles.
Left ventricular failure When the left ventricle is unable to Pediatrics (Paediatrics) The branch of medicine that deals pump all the blood out through the aorta. The blood then with the development and care of children, as well as the backs up within the left ventricle and then progressively into the left atrium and into the lungs. Fluid then builds upin the lungs.
Ligate To tie off, by application of a ligature or suture. For Perfusion The act of forcing liquid to flow through the vessels example, in cardiac surgery, the surgeon may ligate a patent of an organ. In heart surgery, the term perfusion refers specifically to use of the heart-lung machine for cardiopul-monary bypass.
Ligature A thread or suture that is tied tightly around a blood Perfusionist A person who is specially trained to operate a heart-lung machine for cardiopulmonary bypass. In Mitral valve The heart valve between the left atrium and the Canada, perfusionists are technicians, although in some left ventricle. This valve has two flaps or cusps and is one countries, doctors act as perfusionists.
Pulmonary artery (PA) The large artery that carries blood Neonate A newborn child aged from birth to six weeks.
from the right ventricle to the lungs.
Pulmonary artery stenosis Narrowing of the vessels involved and other equipment that will be used and then during the in pulmonary blood flow caused by an underdevelopment operation by handing the instruments to the surgeon.
of the area around the lung valve and along the pulmonary Septum A muscular wall that divides the two chambers on the arteries. This narrowing can be anywhere from just a block- right side of the heart from the two chambers on the left.
age at the valve to thickening below the valve. There can The atrial portion of the septum divides the top chambers, also be narrowing of the pulmonary artery above the valve, the right and left atria. The ventricular portion of the sep- and the vessel can narrow into both of the branches that go tum divides the bottom chambers, the right and left ven- Pulmonary atresia Absence of the normal opening from the Shunt A passage between two blood vessels or two chambers right ventricle into the pulmonary artery.
of the heart. A shunt may occur naturally (as in a left-to- Pulmonary blood flow The flow of blood from the right ven- right shunt though an ASD) or may be artificially formed tricle through the pulmonary arteries to the lungs and back (as in creation of a Blalock-Taussig shunt).
through the pulmonary veins to the left atrium.
Stenosis Narrowing or constriction of an opening, such as a Pulmonary circulation The circulation from the right side of the heart through the lungs to the left side of the heart.
Sternotomy Incision into or through the sternum or breast Pulmonary hypertension An increase in pressure in the blood vessels of the pulmonary circulation.
The pulmonary trunk The common stem of the pulmonary Stroke volume The volume of blood ejected by the heart with arteries, which arises from the upper surface of the right ventricle and then divides into the right and left pulmonaryarteries.
Subpulmonary stenosis Narrowing of the entrance to the pulmonary valve in the right ventricle.
Pulmonary valve The valve in the heart between the right ven- Superior vena cava (SVC) The major vein that receives the deoxygenated blood from the upper limbs and the head Pulmonary valve stenosis An abnormal narrowing of the pul- and neck. The SVC returns this blood to the right atrium.
monary valve. If the narrowing is mild and there are noother abnormalities, the patient may be symptom-free.
Moderate and severe stenosis will impair the flow of blood Systemic blood flow Blood flow to the body, as opposed to to the lungs, and right ventricular hypertrophy will develop in response to the increased work of pumping bloodthrough a narrowed opening.
Tachycardia An abnormally rapid beat. In an adult, a heart rate of more than 100 beats per minute is termed a tachycardia.
Pulmonary vein stenosis Narrowing of the pulmonary veins.
In a child, the definition of tachycardia depends on the age Pulse The wave of increased pressure produced in the blood of the child and from which part of the heart the increase vessels of the body each time the left ventricle contracts.
Regurgitation The abnormal backward flow of fluid. In the TAPVC See Total anomalous pulmonary venous connec- heart, regurgitation occurs when blood flows backward through a valve and into a chamber from which it was already pumped. This increases the work of the heart.
Right-to left-shunt The abnormal direct passage of oxygen- poor blood from the right side of the heart to the left side, Tetralogy of Fallot This congenital heart lesion has four major at the level of the atria or the ventricles. This blood does abnormalities. These are a hole or defect in the ventricular not pass through the lungs, with the result that there is a septum (VSD), displacement of the aorta overtop the ven- dilution or lessening of the amount of oxygen in the blood tricular septum, hypertrophy of the muscle of the right ventricle and obstruction to blood flow from the right ven-tricle or right ventricular outflow tract obstruction (which Scrub nurse An operating room nurse who ‘scrubs in’ and most often results from pulmonary stenosis). Babies with wears sterile clothing and gloves. This nurse helps the sur- Tetralogy of Fallot are often referred to as ‘Tet’ babies.
geon before the operation by preparing the instruments Tet spells Patients with Tetralogy of Fallot can suffer from Tet Tricuspid valve The valve of the heart between the right atri- spells or periods when they are extremely cyanotic. The um and the right ventricle. This valve is one of two atri- symptoms are most often brought on by activity. Tet spells usually indicate an urgent need for repair of the heart Ultrasound High-frequency sound vibrations that cannot be heard by a human ear and are used in medical diagnosis. In Thoracotomy Incision into the chest wall.
pediatric cardiology, one use of ultrasound includesechocardiography, which gives a picture of the heart and Total circulatory arrest (TCA) Complete stoppage of the cir- how it functions. In obstetrics, ultrasound is used to mon- culation of the heart, including complete stoppage of the itor the development and well-being of the fetus.
heart-lung machine. This allows the surgeon to work onthe heart without blood or perfusion cannula partially Valve A membranous fold in part of the body that prevents the obscuring the surgical site. This technique requires deep back-flow of blood or other fluids. In the heart, there are hypothermia so that the tissues of the body, especially the four valves that help propel the blood flow forward.
brain, are protected from the prolonged lack of oxygen.
Vascular Pertaining to the blood vessels.
Total anomalous pulmonary venous connection (TAPVC) Vein A blood vessel that carries blood from various parts of the All of the oxygenated blood returning from the lungs is body back toward the heart. Most veins carry blood that is carried abnormally to the right heart by one or more pul- low in oxygen or deoxygenated. The main exception is the monary veins emptying directly or indirectly through venous channels into the right atrium instead of the left. Aconnection between the right and left atria (or inter-atrial Vena cava The major vein of the body, which carries blood back connection) is necessary to allow oxygenated blood to to the right side of the heart. The superior vena cava (SVC) reach the left side of the heart for distribution to the rest of drains the top part of the body, while the inferior vena cava (IVC) drains blood from the lower part of the body.
Transesophageal echocardiography (TEE) A type of special- ized examination of the heart, which involves performing Venous return The blood that is carried in the veins from all echocardiography by placing the ultrasound probe in the parts of the body (including the heart itself) back to the patient’s esophagus, rather than against the chest wall.
When used during cardiac surgery, TEE allows the surgeonto evaluate the adequacy of the repair of the congenital Ventricle One of the two lower pumping chambers of the heart defects, the adequacy of function of the ventricles and the valves and the presence of any residual intracardiac Ventricular septal defect (VSD) An abnormal opening or hole in the septum between the two lower chambers or Transposition of the great arteries/vessels A congenital ventricles of the heart. Flow of blood is normally from left abnormality where the two major blood vessels are to right (left to right shunt), because of the higher pump- switched in their positions, so that the aorta arises from ing pressures produced by the left ventricle. If pulmonary the right ventricle and the pulmonary artery arises from the hypertension develops, the shunt may be reversed, with left ventricle. As a result, the pulmonary and systemic cir- blood flowing from right to left. This will result in oxygen- culations work independently, producing a severe lack of poor blood being delivered to the systemic side of the cir- oxygen after birth. Survival of the infant is possible only if culation, and the patient will appear cyanosed.
there is a connection between the two circulations, such as an ASD, a VSD or a patent ductus arteriosus.
Tricuspid atresia Congenital absence of the normal valvular opening between the right atrium and the right ventricle.
There is also a small right ventricle, a large left ventricle anddecreased pulmonary circulation. Blood from the right atri-um passes through an atrial septal defect into the left atri-um, where it mixes with oxygenated blood returning fromthe lungs, then flows into the left ventricle and out into thesystemic circulation. Blood reaches the lungs through anatrial septal defect and a ventricular septal defect.

Source: http://www.pediatriccardiacinquest.mb.ca/pdf/pcir_appendix1.pdf

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