SA and AV nodes the electrical supply http://accidentalpurpose.

com/the-waiting-place/ of the heart

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1 : / The wall between the right and left sides of the / heart and the chambers of the atrium and ventricle a c c Evans heart i a left and right side of his heart, the has holes and very little differentiation between the 1 - NO septum he has large holes in the middle of his heart so while he has atrium and ventricles he has a large chamber where oxygenated blood andddeoxygenated blood flow 2a, 2b because of the large holes in his heart and where the walls of hit heart e did not form, he does not have these key valves for the right and left atrium to ventricles has a common AV (atrioventriular valve) valve into the large chamber (he lacks the tricuspid valve and mitral valve) n t a l p u

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3 his pulmonary artery is very narrowed called stenosis above, below and right where the opening is. This makes it very hard for blood to be pushed into the lungs from the right side of his heart. This is also referred to at the Right Ventricular Outflow Tract. This causes pressures in his heart namely the right side to be higher and cause the heart to work harder. 4 the aorta is responsible for oxygenated blood to the body. His curves to the right instead of the left. And because of the large, single chamber of his heart, it currently leaves from the Right Ventricle instead of the Left ventricle. 5 Superior vena cava this allows blood to return to the heart Evan has 2 of these called bilateral SVCs. 6 Inferior vena cava this allow allows blood return to the heart Evan does NOT have an inferior vena cava. He has flow through his liver which allows blood to return to the heart via other routes. This puts pressure on his liver. 7a, 7b Pulmonary veins they are not in the correct place called Total Anomalous Pulmonary Venous return 8 his heart is what is called dextrocardic it sits in the right side of his chest instead of his left. Evans planned repair 1 septate the heart. The surgeon will use synthetic material to make right and left ventricles to make very clear pathways for de-oxygenated blood (Right side) and oxygenated blood (left side) to go. 2a, 2b Dr. Del Nido will split the common AV valve into right and left valves tricuspid and mitral , respectively. 3 his artery will be replaced with what is called a pulmonary conduit with either a human donor valve, synthetic, or animal valve. 4 once the heart is septated the surgeon will move the aorta to the left side of the heart so when the heart pumps, it will pump from the Left ventricle as in a normal heart. 5 he will unhook the current connections to his pulmonary arteries that were established by our Dallas team. Because the blo od flow through the pulmonary artery is how the blood will get to the lungs. 6 nothing but with the additions of the repairs above there will be less stress on the liver 7 when the surgeon septates the heart, he will do so in a way that the veins will go to the right place in his heart. 8 just adds a level of complexity and difficulty for the surgeon. Nothing to be donejust make sure when Evan says the Pledge of Allegiance he puts his left hand over his right sided heart. Possible complications and things to pray FOR and against: 1 the ventricles will be too unbalanced meaning one side is bigger than the other pray FOR perfect balance between the right and left sides. 2 the valves to leak causing backflow and increased pressures, not enough tissue for the valve to be split and a foreign valve needs to be uses PRAY FOR enough tissue for the tricuspid and mitral valves, pray for low pressures in the chambers, pray for NO leaks in the both valves 3 pray that the correct size of the conduit allows for adequate (not too much, not too little) blood flow to the lungs pray FOR no clotting in this valve 4 pray FOR good connection to the left side of the heart and no leaks where the heart is sutured to the LV 5 Pray for no complications when he disconnects this circuit. 6 Pray for stress to leave the liver.

7 pray that septation of the heart will be adequate in where the veins will go. Pray AGAINST the surgeon having to move the veins. 8a, 8b pray that the surgeon does not disturb the electrical pathway of the heart. Pray for a regular, sinus rhythm. Pray AGAINST arrhythmias.

Normal heart 2 atrium and 2 ventricles separated into right and left sides with walls called septums 4 chambers total (blue blood de-oxygenated) enters the Right atrium via the Superior Vena cava and the inferior vena cava - Blue Blood flows from the right atrium into the right ventricle via the tricuspid valve (valves help prevent backflow) - Blue Blood is then forcefully pushed out the right ventricle through pulmonary artery to the lungs - Blood will get oxygenated in the lungs - Blood returns to the Left Atrium via the pulmonary veins (blood is now oxygengated RED blood) - Red blood flows from the Left Atrium (LA) to the Left Ventricle - Red blood is forcefully pumped out of the LV to the body via the aorta