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Surgical correction of hypoplastic left heart syndrome: a new approach.

Rocha-e-Silva R, De Mola R, Santos Ede S, Martins DM, Pesciotto VR, Hatori DM, Greco JP - Clinics (Sao Paulo) (2012)

View Article: PubMed Central - PubMed

Affiliation: Hospital Paulo Sacramento, Jundiai, SP, Brazil. rochaesilva@incor.usp.br

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A hybrid approach simplifies the surgery by maintaining the patent ductus arteriosus (DA) with a stent implantation or through the prolonged use of prostaglandin E1, associated with the banding of the pulmonary branches... However, the results of this approach have proven unsatisfactory... After opening the aortic arch, a cannula was placed through the tourniquet of the descending aorta to allow for systemic perfusion; the ECC flow was then increased to 60 ml/kg/min... This valve prevents diastolic systemic reflux to the pulmonary arteries and improves coronary perfusion pressure through the ascending aorta (retrograde flow)... The neo-aorta did not require mobilization of either the ascending aorta or the pulmonary trunk... This new technique for correcting HLHS uses a smaller number of sutures and simplifies the procedure by excluding the implantation of a heterologous systemic pulmonary shunt, decreasing surgical time and potentially reducing perioperative complications... The described technique does not require any period of coronary ischemia or surgical manipulation of the ventricle... Maintaining the anatomy of the ascending aorta simplifies the procedure while avoiding any distortion in the coronary arteries... The use of a valved pericardium to create the neo-aorta should improve systemic perfusion (including coronary circulation) and prevent diastolic systemic pulmonary reflux... The placement of the brachiocephalic trunk cannula toward the atretic aortic valve may have induced a preferential flow to the coronary arteries... A solution for this problem is the dissection and placement of a 3.5 mm Gore-Tex vascular graft implantation in the brachiocephalic trunk for ECC arterial access or the use of a 6 French cannula oriented cranially... Placing and removing the descending aortic cannula takes time and does not ensure a continuous perfusion of the descending aorta... The femoral artery should be dissected and cannulated to provide secondary arterial access to maintain continuous systemic perfusion, even during aortic clamping... The use of this technique can bring promising results.

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Photograph and diagrammatic schema of the cannulation of the brachiocephalic trunk and double venae cavae for extracorporeal circulation (ECC). A tourniquet was placed in the left carotid, the left subclavian artery and the descending aorta. ECC was initiated, and the DA was ligated. A clamp was placed at the aortic arch, isolating the ascending aorta and the brachiocephalic trunk from the systemic circulation. The tourniquets were then closed. A flap was created in the semilunar section in the initial portion of the anterior pulmonary trunk 3 cm above the pulmonary valve. A second semilunar incision was made in the anterosuperior side of the arch of the aorta near the left carotid and left subclavian arteries, creating the second flap.
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f1-cln_67p535: Photograph and diagrammatic schema of the cannulation of the brachiocephalic trunk and double venae cavae for extracorporeal circulation (ECC). A tourniquet was placed in the left carotid, the left subclavian artery and the descending aorta. ECC was initiated, and the DA was ligated. A clamp was placed at the aortic arch, isolating the ascending aorta and the brachiocephalic trunk from the systemic circulation. The tourniquets were then closed. A flap was created in the semilunar section in the initial portion of the anterior pulmonary trunk 3 cm above the pulmonary valve. A second semilunar incision was made in the anterosuperior side of the arch of the aorta near the left carotid and left subclavian arteries, creating the second flap.

Mentions: The DA was ligated (Figure 1), and the ECC flow was temporarily reduced to 20 ml/kg/min. A tourniquet was placed at the aortic arch, isolating the ascending aorta and the brachiocephalic trunk from the systemic circulation and thus preserving only the cerebral, right superior limb and coronary perfusion. The left carotid artery, left subclavian artery and descending aorta tourniquets were closed.


Surgical correction of hypoplastic left heart syndrome: a new approach.

Rocha-e-Silva R, De Mola R, Santos Ede S, Martins DM, Pesciotto VR, Hatori DM, Greco JP - Clinics (Sao Paulo) (2012)

Photograph and diagrammatic schema of the cannulation of the brachiocephalic trunk and double venae cavae for extracorporeal circulation (ECC). A tourniquet was placed in the left carotid, the left subclavian artery and the descending aorta. ECC was initiated, and the DA was ligated. A clamp was placed at the aortic arch, isolating the ascending aorta and the brachiocephalic trunk from the systemic circulation. The tourniquets were then closed. A flap was created in the semilunar section in the initial portion of the anterior pulmonary trunk 3 cm above the pulmonary valve. A second semilunar incision was made in the anterosuperior side of the arch of the aorta near the left carotid and left subclavian arteries, creating the second flap.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3351261&req=5

f1-cln_67p535: Photograph and diagrammatic schema of the cannulation of the brachiocephalic trunk and double venae cavae for extracorporeal circulation (ECC). A tourniquet was placed in the left carotid, the left subclavian artery and the descending aorta. ECC was initiated, and the DA was ligated. A clamp was placed at the aortic arch, isolating the ascending aorta and the brachiocephalic trunk from the systemic circulation. The tourniquets were then closed. A flap was created in the semilunar section in the initial portion of the anterior pulmonary trunk 3 cm above the pulmonary valve. A second semilunar incision was made in the anterosuperior side of the arch of the aorta near the left carotid and left subclavian arteries, creating the second flap.
Mentions: The DA was ligated (Figure 1), and the ECC flow was temporarily reduced to 20 ml/kg/min. A tourniquet was placed at the aortic arch, isolating the ascending aorta and the brachiocephalic trunk from the systemic circulation and thus preserving only the cerebral, right superior limb and coronary perfusion. The left carotid artery, left subclavian artery and descending aorta tourniquets were closed.

View Article: PubMed Central - PubMed

Affiliation: Hospital Paulo Sacramento, Jundiai, SP, Brazil. rochaesilva@incor.usp.br

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

A hybrid approach simplifies the surgery by maintaining the patent ductus arteriosus (DA) with a stent implantation or through the prolonged use of prostaglandin E1, associated with the banding of the pulmonary branches... However, the results of this approach have proven unsatisfactory... After opening the aortic arch, a cannula was placed through the tourniquet of the descending aorta to allow for systemic perfusion; the ECC flow was then increased to 60 ml/kg/min... This valve prevents diastolic systemic reflux to the pulmonary arteries and improves coronary perfusion pressure through the ascending aorta (retrograde flow)... The neo-aorta did not require mobilization of either the ascending aorta or the pulmonary trunk... This new technique for correcting HLHS uses a smaller number of sutures and simplifies the procedure by excluding the implantation of a heterologous systemic pulmonary shunt, decreasing surgical time and potentially reducing perioperative complications... The described technique does not require any period of coronary ischemia or surgical manipulation of the ventricle... Maintaining the anatomy of the ascending aorta simplifies the procedure while avoiding any distortion in the coronary arteries... The use of a valved pericardium to create the neo-aorta should improve systemic perfusion (including coronary circulation) and prevent diastolic systemic pulmonary reflux... The placement of the brachiocephalic trunk cannula toward the atretic aortic valve may have induced a preferential flow to the coronary arteries... A solution for this problem is the dissection and placement of a 3.5 mm Gore-Tex vascular graft implantation in the brachiocephalic trunk for ECC arterial access or the use of a 6 French cannula oriented cranially... Placing and removing the descending aortic cannula takes time and does not ensure a continuous perfusion of the descending aorta... The femoral artery should be dissected and cannulated to provide secondary arterial access to maintain continuous systemic perfusion, even during aortic clamping... The use of this technique can bring promising results.

Show MeSH