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A new technique for the correction of hypoplastic left heart syndrome.

Rocha-e-Silva R - Clinics (Sao Paulo) (2012)

View Article: PubMed Central - PubMed

Affiliation: Hospital das Clínicas, Instituto do Coração, São Paulo, Brazil. rochaesilva@incor.usp.br

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Hypoplastic left heart syndrome (HLHS) inevitably results in death within a few weeks of birth, and the surgical treatment for this condition involves three complex surgeries that are associated with a high mortality and cost... Additionally, fabrication of the neo-aorta is a laborious technique that requires the extended use of extracorporeal circulation (ECC)... Hybrid approaches involving the maintenance of the patent ductus arteriosus with the implantation of a stent or the prolonged administration of prostaglandin E1 associated with the banding of the pulmonary branches simplifies the surgical approach but have yielded unsatisfactory results... The free edges of the semilunar flaps of the aorta and pulmonary trunk are rotated and sutured edge-to-edge, originating the autologous posterior neo-aortic wall (Figure 2A)... A valved bovine pericardium patch is implanted from the anterior opening of the pulmonary trunk to the aortic arch and extends to the beginning of the descending aorta to give rise to the anterior wall of the neo-aorta (Figure 2B)... This valve prevents diastolic systemic reflow to the pulmonary arteries and improves coronary perfusion pressure through the ascending aorta (retrograde flow)... The neo-aorta does not require mobilization of the ascending aorta or the pulmonary trunk... The pulmonary trunk was represented using an 18-mm pericardial tunnel... On its posterior superior face, a second 12-mm pericardial tunnel was placed to simulate the pulmonary branches... The proposed procedure requires fewer sutures, which excludes the need to implant a heterologous systemic pulmonary shunt and decreases the surgical time... One patient who met the relevant criteria and required surgical correction was submitted to the procedure and demonstrated that it could potentially reduce the perioperative complications... The technique described does not require any period of coronary ischemia or surgical manipulation of the ventricle, as described previously... The combined effect of these improvements should promote a higher quality of postoperative ventricular function... The use of a valved pericardium for the creation of a neo-aorta should improve systemic perfusion (including the coronary circulation) and prevent diastolic systemic pulmonary reflow.

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A) The pulmonary trunk (PT) was represented using an 18-mm pericardial tunnel. A second 12-mm pericardial tunnel is placed on its posterior superior face to simulate the pulmonary branches. An additional 18-mm pericardium tube, which simulated the aortic arch (Ao), is then placed on the cranial face of the pulmonary trunk. The pulmonary trunk segment between the pulmonary branches and the aorta represented the ductus arteriosus (DA). B) The DA is ligated, and the autologous flaps were obtained through the semilunar opening of the aorta and pulmonary trunk.
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f3-cln_67p521: A) The pulmonary trunk (PT) was represented using an 18-mm pericardial tunnel. A second 12-mm pericardial tunnel is placed on its posterior superior face to simulate the pulmonary branches. An additional 18-mm pericardium tube, which simulated the aortic arch (Ao), is then placed on the cranial face of the pulmonary trunk. The pulmonary trunk segment between the pulmonary branches and the aorta represented the ductus arteriosus (DA). B) The DA is ligated, and the autologous flaps were obtained through the semilunar opening of the aorta and pulmonary trunk.

Mentions: The model was constructed with bovine pericardium tissue (HP Bioprosthesis Ltda.). The pulmonary trunk was represented using an 18-mm pericardial tunnel. On its posterior superior face, a second 12-mm pericardial tunnel was placed to simulate the pulmonary branches. On the cranial face of the pulmonary trunk, an additional 18-mm pericardium tube was placed to simulate the aortic arch. The pulmonary trunk segment between the pulmonary branches and the aorta represented the ductus arteriosus. All anastomoses were performed with prolene 6-0 (Figure 3A).


A new technique for the correction of hypoplastic left heart syndrome.

Rocha-e-Silva R - Clinics (Sao Paulo) (2012)

A) The pulmonary trunk (PT) was represented using an 18-mm pericardial tunnel. A second 12-mm pericardial tunnel is placed on its posterior superior face to simulate the pulmonary branches. An additional 18-mm pericardium tube, which simulated the aortic arch (Ao), is then placed on the cranial face of the pulmonary trunk. The pulmonary trunk segment between the pulmonary branches and the aorta represented the ductus arteriosus (DA). B) The DA is ligated, and the autologous flaps were obtained through the semilunar opening of the aorta and pulmonary trunk.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3351251&req=5

f3-cln_67p521: A) The pulmonary trunk (PT) was represented using an 18-mm pericardial tunnel. A second 12-mm pericardial tunnel is placed on its posterior superior face to simulate the pulmonary branches. An additional 18-mm pericardium tube, which simulated the aortic arch (Ao), is then placed on the cranial face of the pulmonary trunk. The pulmonary trunk segment between the pulmonary branches and the aorta represented the ductus arteriosus (DA). B) The DA is ligated, and the autologous flaps were obtained through the semilunar opening of the aorta and pulmonary trunk.
Mentions: The model was constructed with bovine pericardium tissue (HP Bioprosthesis Ltda.). The pulmonary trunk was represented using an 18-mm pericardial tunnel. On its posterior superior face, a second 12-mm pericardial tunnel was placed to simulate the pulmonary branches. On the cranial face of the pulmonary trunk, an additional 18-mm pericardium tube was placed to simulate the aortic arch. The pulmonary trunk segment between the pulmonary branches and the aorta represented the ductus arteriosus. All anastomoses were performed with prolene 6-0 (Figure 3A).

View Article: PubMed Central - PubMed

Affiliation: Hospital das Clínicas, Instituto do Coração, São Paulo, Brazil. rochaesilva@incor.usp.br

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Hypoplastic left heart syndrome (HLHS) inevitably results in death within a few weeks of birth, and the surgical treatment for this condition involves three complex surgeries that are associated with a high mortality and cost... Additionally, fabrication of the neo-aorta is a laborious technique that requires the extended use of extracorporeal circulation (ECC)... Hybrid approaches involving the maintenance of the patent ductus arteriosus with the implantation of a stent or the prolonged administration of prostaglandin E1 associated with the banding of the pulmonary branches simplifies the surgical approach but have yielded unsatisfactory results... The free edges of the semilunar flaps of the aorta and pulmonary trunk are rotated and sutured edge-to-edge, originating the autologous posterior neo-aortic wall (Figure 2A)... A valved bovine pericardium patch is implanted from the anterior opening of the pulmonary trunk to the aortic arch and extends to the beginning of the descending aorta to give rise to the anterior wall of the neo-aorta (Figure 2B)... This valve prevents diastolic systemic reflow to the pulmonary arteries and improves coronary perfusion pressure through the ascending aorta (retrograde flow)... The neo-aorta does not require mobilization of the ascending aorta or the pulmonary trunk... The pulmonary trunk was represented using an 18-mm pericardial tunnel... On its posterior superior face, a second 12-mm pericardial tunnel was placed to simulate the pulmonary branches... The proposed procedure requires fewer sutures, which excludes the need to implant a heterologous systemic pulmonary shunt and decreases the surgical time... One patient who met the relevant criteria and required surgical correction was submitted to the procedure and demonstrated that it could potentially reduce the perioperative complications... The technique described does not require any period of coronary ischemia or surgical manipulation of the ventricle, as described previously... The combined effect of these improvements should promote a higher quality of postoperative ventricular function... The use of a valved pericardium for the creation of a neo-aorta should improve systemic perfusion (including the coronary circulation) and prevent diastolic systemic pulmonary reflow.

Show MeSH