1 · Segment the anatomy
Ask: systemic veins → atria → AV valves → ventricles → outflow tracts → great arteries → pulmonary veins. Name the connections before naming the operation.
LSU Health Shreveport · Pediatric Cardiology Rotation
Congenital Heart Surgery
Visual Education Module
See the lesion. Follow the rerouting. Predict the postoperative physiology. This module is built for residents who need to understand what the operation changes—not memorize a surgeon's technical manual.
9Primary atlas diagrams
55PTED visual topics
44Board-style questions
26Decoded eponyms
How to use it: Start with normal flow → study the nine-image CHD Atlas → use PTED for external animation → finish the 44-question assessment. Passing threshold is 80% with unlimited retries.
2026 evidence guardrail: PTED/Cove Point is an unusually useful illustrated congenital-heart archive, but many individual pages were last updated in 2020–2021. In this module, PTED links are used for visual anatomy and historical procedural orientation, not as the source of truth for current drug therapy, candidacy thresholds, postoperative management, or prognosis.
Foundation
Surgical reasoning before eponyms
Every operation becomes easier to remember when you can state the preoperative flow problem, the new pathway created, the structure that becomes vulnerable, and the predictable late tradeoff.
2 · Identify the bottleneck
Is the dominant problem excessive pulmonary flow, inadequate pulmonary flow, systemic obstruction, mixing failure, pulmonary venous obstruction, or a ventricle that cannot support its assigned circulation?
3 · Define the transformation
Closure, baffling, enlargement, translocation, conduit creation, cavopulmonary connection, or valve reconstruction. Most congenital operations are combinations of these moves.
4 · Track the new physiology
Which ventricle now pumps systemic blood? Is pulmonary flow pulsatile or passive? What determines preload? Where can pressure build up?
5 · Predict the failure mode
Patches can leak, anastomoses can narrow, conduits do not grow, valves can regurgitate, coronary transfers can obstruct, and surgical scars can create arrhythmia substrate.
6 · Distinguish repair from palliation
An arterial switch is an anatomic repair. Norwood–Glenn–Fontan is staged palliation: it produces a functional circulation without creating two normal ventricles.
Cardiopulmonary bypass in one paragraph
For many intracardiac repairs, cardiopulmonary bypass temporarily supports systemic perfusion and gas exchange while the heart is opened; aortic cross-clamping and cardioplegia often create a still, protected myocardium. The educational point is not to memorize a perfusion recipe. It is to recognize which repairs require intracardiac access, why myocardial protection matters, and why bypass/cross-clamp exposure interacts with neurologic, inflammatory, coagulation, renal, and myocardial risk.
Reference
Normal cardiac anatomy — teaching schematic
Use the color code throughout: blue = right heart/deoxygenated; red = left heart/oxygenated; yellow dashed = AV valves; orange = pathology; gray = patch/conduit.
Normal flow pathway
SVC / IVC
→ RA
→ RA
Tricuspid
→ RV
→ RV
PA
→ lungs
→ lungs
PVs
→ LA
→ LA
Mitral
→ LV
→ LV
Aorta
→ body
→ body
When you study a repair, explicitly redraw this chain and mark where the congenital lesion breaks it. Then redraw the postoperative chain. That single habit is more durable than memorizing a named procedure in isolation.
Right heartLeft heartDefectPatch/conduit
Primary image collection
Congenital Heart Disease Surgical Atlas
Nine high-resolution operative illustrations paired with an explicit flow transformation and resident-level interpretation checkpoint. Select an operation to load its primary image.
Interpretation boundary: These illustrations teach anatomy and routing concepts. They are not operative manuals and do not encode patient-specific anatomy, cannulation, patch geometry, surgical approach, or institutional technique.
External visual archive
PTED Library 55 of 55
Exactly 55 catalogued PTED treatment/procedure entries: four catheter interventions plus 51 treatment/surgical-repair topics. Several catalog entries intentionally point to the same lesion page because PTED groups multiple operations within one illustrated tutorial.
Use PTED visually, not prescriptively. Some legacy pages contain outdated medication, device, endocarditis, anticoagulation, exercise, timing, or outcome language. The animation/anatomic transformation can still be excellent while the surrounding prose is no longer current.
Translation layer
26 eponyms decoded
Eponyms are compressed routing instructions. Learn the blood-flow transformation first; the name then becomes useful shorthand rather than trivia.
History
From palliation to anatomic repair
Use the timeline to understand why older adults with CHD may have operations that residents rarely see performed today.
1944 — systemic-to-pulmonary shunt era
The original Blalock–Taussig operation, enabled by Vivien Thomas's experimental and technical work, established surgical palliation as a viable strategy for cyanotic CHD.
Late 1950s — cavopulmonary and atrial-redirection concepts
Glenn-type cavopulmonary connections and Senning's atrial switch showed that circulation could be rerouted rather than simply decompressed.
1960s — Mustard and Rastelli pathways
Atrial baffles and intracardiac ventricular rerouting expanded options for transposition and complex outflow anatomy, but created recognizable late systemic-RV, baffle, rhythm, and conduit problems.
1968 operation / 1971 publication — Fontan
Fontan and Baudet's concept ultimately evolved into modern total cavopulmonary connection for single-ventricle palliation.
1975 — successful Jatene arterial switch
Anatomic repair of d-TGA moved the LV back to systemic work and required reliable coronary transfer; it progressively displaced atrial-switch strategies for suitable neonates.
Early 1980s — Norwood strategy for HLHS
Staged reconstruction made survival possible for anatomy that previously had few surgical options, at the cost of a lifelong single-ventricle circulation.
1987 onward — Yasui and increasingly anatomy-specific reconstruction
Complex LVOT/arch obstruction with two usable ventricles could sometimes be treated with a biventricular LVOT-bypass strategy rather than defaulting to single-ventricle palliation.
Modern era — preserve valves, protect coronaries, plan lifetime reintervention
Current congenital surgery increasingly emphasizes valve preservation, growth potential, catheter-surgical hybrid pathways, lower reintervention burden, and lifetime physiology rather than survival of the index operation alone.
Assessment
44-question mastery test
Reason from anatomy and physiology. Immediate explanations are deliberate retrieval practice, not merely a score screen.
Provenance
Sources, scope, and limitations
Primary web sources checked
- Cove Point Foundation / Johns Hopkins Children's Hospital PTED topic index — source of the 55 linked visual topics.
- Yasui operation: 30-year institutional experience — confirms the biventricular LVOT-bypass indication/concept.
- Modified Warden repair for PAPVR — anatomy and rationale for the Warden pathway.
What this module intentionally does not do
It is not an operative manual, a substitute for a congenital cardiac surgeon, a dosing guide, or a patient-specific risk calculator. Surgical timing and technique vary with detailed anatomy, institutional strategy, era, and patient condition. The primary Atlas images encode routing concepts rather than patient-specific operative views.
Version: CHD Atlas image integration and clinical mapping reviewed August 13, 2026; evidence and external-link review performed August 12, 2026.