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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) Through the opening of the pulmonary trunk, a 5-mm catheter is introduced towards the pulmonary branches. The pulmonary trunk cerclage is obtained by suturing a cardiac tape with 5-0 prolene around the catheter. B) The aortic flap is rotated caudally, and the pulmonary trunk flap is rotated cranially. These flaps are then sutured edge-to-edge with 6-0 prolene originating the autologous posterior neo-aortic wall. The red marks indicate where the top of the valve of the pericardium should be placed.
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f4-cln_67p521: A) Through the opening of the pulmonary trunk, a 5-mm catheter is introduced towards the pulmonary branches. The pulmonary trunk cerclage is obtained by suturing a cardiac tape with 5-0 prolene around the catheter. B) The aortic flap is rotated caudally, and the pulmonary trunk flap is rotated cranially. These flaps are then sutured edge-to-edge with 6-0 prolene originating the autologous posterior neo-aortic wall. The red marks indicate where the top of the valve of the pericardium should be placed.

Mentions: A 5-mm catheter was introduced through the opening of the pulmonary trunk towards the pulmonary branches. The pulmonary trunk cerclage was obtained by suturing a cardiac tape around the catheter with 5-0 prolene (Figure 4A). Following the removal of the catheter, a 5-mm systemic pulmonary shunt of autologous tissue was created.


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

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

A) Through the opening of the pulmonary trunk, a 5-mm catheter is introduced towards the pulmonary branches. The pulmonary trunk cerclage is obtained by suturing a cardiac tape with 5-0 prolene around the catheter. B) The aortic flap is rotated caudally, and the pulmonary trunk flap is rotated cranially. These flaps are then sutured edge-to-edge with 6-0 prolene originating the autologous posterior neo-aortic wall. The red marks indicate where the top of the valve of the pericardium should be placed.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f4-cln_67p521: A) Through the opening of the pulmonary trunk, a 5-mm catheter is introduced towards the pulmonary branches. The pulmonary trunk cerclage is obtained by suturing a cardiac tape with 5-0 prolene around the catheter. B) The aortic flap is rotated caudally, and the pulmonary trunk flap is rotated cranially. These flaps are then sutured edge-to-edge with 6-0 prolene originating the autologous posterior neo-aortic wall. The red marks indicate where the top of the valve of the pericardium should be placed.
Mentions: A 5-mm catheter was introduced through the opening of the pulmonary trunk towards the pulmonary branches. The pulmonary trunk cerclage was obtained by suturing a cardiac tape around the catheter with 5-0 prolene (Figure 4A). Following the removal of the catheter, a 5-mm systemic pulmonary shunt of autologous tissue was created.

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