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WithAScalpel
1.1K posts
WithAScalpel
@WithAScalpel
Fumiya Yoneyama, MD, PhD – Cardiac surgeon. Visual insights in cardiology, intensive care & surgery.
เข้าร่วม Temmuz 2025
125 กำลังติดตาม4K ผู้ติดตาม
Mitral Valve Anatomy #1: Leaflets and Annulus
👉The mitral valve consists of the annulus, two leaflets, and two commissures functioning as one integrated unit.
👉The posterior leaflet has P1–P3 scallops, while the anterior leaflet is described by the corresponding A1–A3 segments.
👉Anteriorly, the annulus is continuous with the aortic valve through the aorto-mitral curtain, and forms a dynamic saddle shape.
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@WithAScalpel The anatomical ccTGA repair (ASO + Sennung or ASO + Mustard) is also called double switch operation.
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ccTGA Repair Strategy:
❤️Anatomical repair: restores the morphologic LV as the systemic ventricle and the morphologic RV as the pulmonary ventricle (e.g., Senning + ASO, Senning + Rastelli).
💚Physiological repair: corrects associated lesions without reversing the discordance (e.g., VSD closure with LV-PA conduit).
Oung Savly MD FACC FASE FESC FAAP FEACVI 🇰🇭@OungSavly
3M old. CCTGA 📌PLAX provides early clues, but always confirm with additional views & segmental analysis 📌Do not stick only to d-TGA. Crucial clue is coronary origin! @AEPCcongenital @iamritu @CASivaram1 @DavidWienerMD @dkthekkoott @alexsfelixecho @echoleolopez @alex1708ander
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Complete AVSD Repair: Two-Patch Technique
🎥Step-by-step operative sequence of complete AVSD repair using the two-patch technique.
Rohit loomba@loomba_rohit
@WithAScalpel There are a few videos on the channel.of AVSD! Here's one of them! youtu.be/BxENIBKEkeg
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WithAScalpel รีทวีตแล้ว
ccTGA with subaortic stenosis
📌 harmful afterload on the systemic RV
@ASE360 @AEPCcongenital @iamritu @CASivaram1 @DavidWienerMD @dkthekkoott @alexsfelixecho @echoleolopez @loomba_rohit @alex1708ander @SIwa23288585 @swatigar @sujithsp @WithAScalpel
WithAScalpel@WithAScalpel
ccTGA Repair Strategy: ❤️Anatomical repair: restores the morphologic LV as the systemic ventricle and the morphologic RV as the pulmonary ventricle (e.g., Senning + ASO, Senning + Rastelli). 💚Physiological repair: corrects associated lesions without reversing the discordance (e.g., VSD closure with LV-PA conduit).
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@loomba_rohit @OungSavly @alex1708ander @swatigar @Prasannasimha This heart was truly fascinating! Thank you for your explanations🙏
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🚨 Specimen Walkthrough 🚨
Explore the #anatomy of a #heart with right isomerism aka heterotaxy and a true single #ventricle.
youtu.be/QGpEJZNBwhc?si…
#pathology #cardiology #pedsicu #medtwitter #foamed #chd
@OungSavly @alex1708ander @WithAScalpel @swatigar @Prasannasimha
YouTube
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LSVC and Cardiopulmonary Bypass Strategy:
👉Preoperative planning starts with venous anatomy: RSVC presence, LSVC drainage, and bridging vein size.
👉During CPB, options include LSVC cannulation, temporary snaring, or targeted pump suction.
👉If a bridging vein is present, LSVC clamping may work, but cerebral venous congestion (NIRS) must be monitored.
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WithAScalpel รีทวีตแล้ว
Beautiful depiction of the aortic #valve and the left ventricular outflow tract in AVSD.
Here's a video of a an actual #heart with AVSD highlighting these as well!
youtu.be/BxENIBKEkeg
#anatomy #pathology #pedsicu #pediatrics #neotwitter #medtwitter #foamed #cardiology
YouTube
WithAScalpel@WithAScalpel
AVSD: Unwedged Aortic Valve and LVOTO 👉The AoV is displaced anteriorly in an unwedged position, no longer seated between the two AV valves. 👉This characteristic geometry elongates the LVOT and can contribute to LVOTO.
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@WithAScalpel Need to create a playlist for AVSD. I have been slow to creating them but need to get to that!
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The presence of a common atrioventricular junction leads to the "unwedging" of the #aorta which sits anterior to the common av junction rather than between two AV valves. Leads to the LV inlet outlet disproportion and elongated LVOT. Important point!
#cardiology #anatomy #chd
Jorge Faerron@cardiopedhnn
@OungSavly @ASE360 @iamritu @WGACHDChair @AEPCcongenital @CASivaram1 @alexsfelixecho @echoleolopez @loomba_rohit @SIwa23288585 @alex1708ander @DrJenniferCo_Vu 1/2 In basis of Anderson & others, all #AVSD w common AV junction have: -inlet/outlet despropotion -elongated LVOT -unwedge Ao annulus -Sup. & Inf. bridging leaflets w R & L AV mural leaflets -trileaflet LAV component related to LV #CHD #pedsheart
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Tetralogy of Fallot #2: Surgical Repair and Postoperative Physiology
👉TOF repair includes VSD patch closure, RVOT muscle resection, and pulmonary valve interventions between valve-sparing repair and transannular patch.
👉After repair, restrictive RV physiology, residual lesions, and arrhythmias—especially JET—strongly shape early management.
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@WithAScalpel There are a few videos on the channel.of AVSD! Here's one of them!
youtu.be/BxENIBKEkeg
YouTube
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AVSD: Unwedged Aortic Valve and LVOTO
👉The AoV is displaced anteriorly in an unwedged position, no longer seated between the two AV valves.
👉This characteristic geometry elongates the LVOT and can contribute to LVOTO.
Rohit loomba@loomba_rohit
The presence of a common atrioventricular junction leads to the "unwedging" of the #aorta which sits anterior to the common av junction rather than between two AV valves. Leads to the LV inlet outlet disproportion and elongated LVOT. Important point! #cardiology #anatomy #chd
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Tetralogy of Fallot #1: Anatomy and Physiology
👉Tetralogy of Fallot consists of an outlet malalignment VSD, overriding aorta, RV outflow tract obstruction, and RV hypertrophy.
👉Its central mechanism is anterior and cephalad deviation of the infundibular septum, narrowing the RVOT and shifting the aortic root rightward.
👉From the surgeon’s view, accurate understanding of the VSD rim, aortic override, RVOT muscle bundles, and conduction anatomy is essential for safe repair.
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Interrupted Aortic Arch: Surgical Options
👉Surgical strategy depends on left-sided adequacy, LVOT obstruction, VSD anatomy, and preoperative stability.
👉Options include one-stage repair, staged repair, Yasui, and Norwood-type single-ventricle palliation.
AATS@AATSHQ
Featured #congenital case in #JTCVS: Surgical management of a newborn with interrupted aortic arch and subaortic obstruction. Surgeons found that a staged approach with pulmonary artery banding is an option in select patients. Log in to read: doi.org/10.1016/j.jtcv…
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@PipeCabreraV @CiruAndes2 @MediUniandes @Uniandes @FSFB_Salud @pferrada1 @SWexner @TomVargheseJr Thank you for your kind words! I truly appreciate it😊
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@WithAScalpel @CiruAndes2 @MediUniandes @Uniandes @FSFB_Salud @pferrada1 @SWexner @TomVargheseJr Seventeen seconds of pure surgical art!
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Continuous Over and Over Sutures:
👉Behind every reliable suture line is the same foundation: spacing, needle angle, tension, and repetition.
🎥With 7-0 Prolene (BV175-6, 8.0 mm, 3/8 circle)
@CiruAndes2 @MediUniandes @Uniandes @FSFB_Salud @pferrada1 @SWexner @TomVargheseJr
Dr Luis Felipe Cabrera Vargas MD FACS@PipeCabreraV
The Connell Mayo suture pattern technique! The drunk 🥴 man mnemonics ⤵️🔪! Only in our @CiruAndes2 @MediUniandes @Uniandes @FSFB_Salud bowel suture workshop! @pferrada1 @SWexner @TomVargheseJr
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Peripheral VA-ECMO #3: Afterload and LV Decompression
👉VA-ECMO, especially with femoral cannulation, increases afterload and can suppress native LV ejection, leading to LV distension.
👉Early recognition is essential: assess AoV opening and LV size, and consider unloading strategies when distension develops.
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