The Senning Procedure Re...
Highlights
- The Senning procedure requires tissue rearrangement that is difficult to understand. This beautiful cardiac CT visually demonstrates the fates of the different tissues from an #ACHD double switch patient.
A thread 🧵 [1/5]
(View Tweet)
- Challenge 1 is understanding the flow of blood. Here are labels to help.
Challenge 2 (relevant for #EPeeps) is understanding the origins of the tissues used in the reconstruction, as they retain their original electrical connections except where incised…
[2/5]
(View Tweet)
- Here is the classic diagram (flipped from surgical view to imaging view) and CT in color:
- Red - atrial septum
- Orange - hinge point of septum and free wall at Waterston’s groove
- Yellow - RA free wall
- Green - front of left PVs
- Blue - “Coumadin ridge” / front of right PVs
(View Tweet)
- I was struck in this CT how well preserved (despite years of somatic growth) are the thickness of the ridge and the right-angle nature of the hinge point between former septum and former free wall, serving as landmarks to understand the surgical anatomy
[4/5] (View Tweet)
- Challenge 3 is to the surgeons who manage to construct such intricate repairs, often in young infants.
Challenge 4 is to the electrophysiologist, who has to understand the fate of infolded “L” of free wall and septum to appreciate the flutter circuits.
[5/5] but examples below (View Tweet)
- One beautiful example from @J_Francisco_EP (there is a whole thread linked below) https://t.co/ZdeGp12OBn (View Tweet)
- Here is another beautiful example from @ericlim1975 complete with video 🎥 https://t.co/Sc6fSloGnY (View Tweet)
- And another beautiful movie 🎥 from @drashnisbet https://t.co/TBP70mcE0s (View Tweet)
- Can’t resist linking in this quote from Dr Baffes about Dr Senning https://t.co/SCGqcXIxZT (View Tweet)
- Here is an ICE image of tackling the CTI post Senning from @finnakerstrom , the live video is linked up the thread https://t.co/fC75o2hIje (View Tweet)
- Back to basics with the simple ol’ Mustard, here’s a post about where the flow of blood goes, and it has another linked inside of it. https://t.co/JQ1GwOhiLX (View Tweet)
- And finally, a small tip about how to place atrial leads when pacing these patients, beware the phrenic.
Also the V leads are not easy. They like to go on the basal/mid free wall with high risk for pacemaker induced cardiomyopathy. Work hard for apex of pancaked ventricle. https://t.co/npeM4HUnTz (View Tweet)