Ballard George, Tibby Shane, Miller Owen, Krasemann Thomas, Rosenthal Eric, Anderson David, Austin Conal, Qureshi Shakeel, Simpson John
Department of Congenital Heart Disease, Evelina Children's Hospital, Guy's and St Thomas Hospital Foundation Trust, 6th Floor, Westminster Bridge Road, London SE1 7EH, UK.
Eur J Echocardiogr. 2010 Dec;11(10):870-4. doi: 10.1093/ejechocard/jeq085. Epub 2010 Aug 4.
The 'hybrid' procedure is an alternative to the Norwood operation in classical hypoplastic left heart syndrome to support the systemic circulation until subsequent palliation. This approach has been extended to infants with the borderline development of left heart structures. We investigated whether or not a hybrid procedure for 'borderline' cases of underdevelopment of the left heart would lead to any improvement in the growth of those structures relative to body size or would impact on eventual repair.
Serial echocardiograms were reviewed in cases in whom left heart development was judged borderline for adequacy to support the systemic circulation. z-scores of left heart structures and aortic discriminant scores were plotted sequentially following the hybrid procedure and random-coefficient linear-mixed models were applied to quantify growth rates. Seven infants met the inclusion criteria. At birth, the median (range) of aortic discriminant scores was -2.67 (-3.26 to -1.22), suggesting that a biventricular repair would not be feasible. Following a hybrid procedure, aortic discriminant scores increased with time and three infants were managed with a biventricular repair. The rate of change was significantly higher in infants who achieved a biventricular repair compared with those who did not (P = 0.01).
The hybrid procedure allows time for growth of left heart structures in selected infants, and serial echocardiography may assist in identifying those children who may ultimately achieve a biventricular circulation.
在经典型左心发育不全综合征中，“杂交”手术是诺伍德手术的替代方案，用于在后续姑息治疗前支持体循环。这种方法已扩展应用于左心结构处于临界发育状态的婴儿。我们研究了针对左心发育不全的“临界”病例进行杂交手术是否会使这些结构相对于身体大小的生长得到任何改善，或者是否会影响最终的修复。
对左心发育被判定为临界状态、不足以支持体循环的病例的系列超声心动图进行回顾。在杂交手术后，依次绘制左心结构的z分数和主动脉判别分数，并应用随机系数线性混合模型来量化生长率。七名婴儿符合纳入标准。出生时，主动脉判别分数的中位数（范围）为-2.67（-3.26至-1.22），这表明双心室修复不可行。经过杂交手术后，主动脉判别分数随时间增加，三名婴儿接受了双心室修复。与未接受双心室修复的婴儿相比，接受双心室修复的婴儿的变化率显著更高（P = 0.01）。
杂交手术为选定婴儿的左心结构生长留出时间，系列超声心动图可能有助于识别那些最终可能实现双心室循环的儿童。
