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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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The implantation of a bovine pericardium patch from the anterior opening of the pulmonary trunk to the aortic arch. This patch extends to the beginning of the descending aorta and gives rise to the anterior wall of the neo-aorta. The dashed line represents the valve suture on the pericardium.
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f5-cln_67p521: The implantation of a bovine pericardium patch from the anterior opening of the pulmonary trunk to the aortic arch. This patch extends to the beginning of the descending aorta and gives rise to the anterior wall of the neo-aorta. The dashed line represents the valve suture on the pericardium.

Mentions: The anterior wall of the neo-aorta was created using a bovine pericardium patch sutured with prolene 6-0 (Figure 5). The valved patch was not used in this model, although the location of the valve position is shown in Figure 4B). The black dashed line indicates where the valve suture would be inserted into the pericardial patch that forms the anterior wall of the neo-aorta.


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

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

The implantation of a bovine pericardium patch from the anterior opening of the pulmonary trunk to the aortic arch. This patch extends to the beginning of the descending aorta and gives rise to the anterior wall of the neo-aorta. The dashed line represents the valve suture on the pericardium.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f5-cln_67p521: The implantation of a bovine pericardium patch from the anterior opening of the pulmonary trunk to the aortic arch. This patch extends to the beginning of the descending aorta and gives rise to the anterior wall of the neo-aorta. The dashed line represents the valve suture on the pericardium.
Mentions: The anterior wall of the neo-aorta was created using a bovine pericardium patch sutured with prolene 6-0 (Figure 5). The valved patch was not used in this model, although the location of the valve position is shown in Figure 4B). The black dashed line indicates where the valve suture would be inserted into the pericardial patch that forms the anterior wall of the neo-aorta.

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