Takeda Yuko, Asou Toshihide
Department of Cardiovascular Surgery, Kanagawa Children's Medical Center, Yokohama, Japan.
Kyobu Geka. 2014 Apr;67(4):294-8.
On behalf of rapid progress of diagnostic technologies and new development of surgical technique or strategy, outcomes of surgical treatment of hypoplastic left heart syndrome (HLHS) has remarkably improved in the current practice. One of such approaches is the staged Norwood operation. We have reviewed our patients (n=54) between 2003 and 2013. A half of the patients with the staged group accomplished Norwood procedure and concomitant bidirectional cavopulmonary shunt at the mean age of 4 months old. An another half of the patients underwent secondary Norwood operation with Blalock-Taussig( BT) shunt or right-ventricle to pulmonary artery( RV-PA) conduit, because of ductal closure in spite of prostaglandin, or progressive reversed coarctation. Cardiac catheterization showed good results in both the primary (n=17) and the staged approach (n=37), partly because even in the primary Norwood group we used a smaller calibered graft for BT shunt or RV-PA conduit to unload the ventricle as much as possible. In conclusion, since the surgical mortality of staged group was superior to that of the primary group and the mid-term survival in the staged seemed to be better than that of primary, we would pursue our strategy of the staged approach in the surgical treatment of hypoplastic left heart syndrome.
鉴于诊断技术的快速进步以及手术技术或策略的新发展，目前，左心发育不全综合征（HLHS）的外科治疗效果有了显著改善。其中一种方法是分期诺伍德手术。我们回顾了2003年至2013年间的患者（n = 54）。分期组中有一半的患者在平均4个月大时完成了诺伍德手术并同期进行双向腔肺分流术。另一半患者由于尽管使用了前列腺素但导管仍闭合，或出现进行性逆向缩窄，而接受了带有布莱洛克 - 陶西格（BT）分流术或右心室至肺动脉（RV - PA）导管的二次诺伍德手术。心导管检查显示，初次手术组（n = 17）和分期手术组（n = 37）的结果都很好，部分原因是即使在初次诺伍德手术组中，我们也使用了较小口径的移植物用于BT分流术或RV - PA导管，以尽可能减轻心室负担。总之，由于分期手术组的手术死亡率低于初次手术组，且分期手术组的中期生存率似乎优于初次手术组，我们将继续采用分期手术策略来治疗左心发育不全综合征。
