The Heart Center at Arnold Palmer Hospital for Children, Orlando, Fla; and College of Medicine, University of Central Florida, Orlando, Fla.
The Heart Center at Arnold Palmer Hospital for Children, Orlando, Fla; and College of Medicine, University of Central Florida, Orlando, Fla.
J Thorac Cardiovasc Surg. 2015 Apr;149(4):1095-100. doi: 10.1016/j.jtcvs.2014.11.081. Epub 2014 Dec 3.
The objective of a hybrid approach to staged palliation of single-ventricle anomalies is designed to minimize the trauma of the first stage. However, the second stage is a complex procedure that may negate the advantages of the first stage. We sought to devise a "hybrid" approach to the second stage when aortic outflow is expected to remain unobstructed.
The procedure involves a simple incision into the main pulmonary artery, dilation/stenting of the ductal continuation, formation of a stented baffle between the branch pulmonary arteries' orifices, and a bidirectional Glenn connection. It avoids dissection of the distal arch and ductal continuation and obviates the need for a Damus-Kaye-Stansel connection. We carried out this procedure in 2 patients, one with unbalanced atrioventricular canal and the other with mitral atresia.
Both patients underwent an uncomplicated operative procedure. Both patients were successfully weaned from the ventilator, with no clinically evident neurologic injury. The first patient died of complications related to thrombosis of the left pulmonary artery before initiation of anticoagulation. The second patient is alive and well 1 year postoperation with no obstruction to either systemic or pulmonary flow and no baffle leak and good right ventricle function.
This hybrid comprehensive stage II operation appears feasible and technically simpler than the conventional comprehensive stage II procedure. It is applicable to a subset of single-ventricle cases in which aortic outflow is anticipated to remain unobstructed. We recommend early postoperative anticoagulation to avoid early left pulmonary artery thrombosis.
单心室畸形分期姑息治疗的混合方法旨在将第一阶段的创伤最小化。然而，第二阶段是一个复杂的过程，可能会否定第一阶段的优势。当预计主动脉流出道保持通畅时，我们试图设计一种“混合”方法来进行第二阶段手术。
该手术包括在主肺动脉上做一个简单的切口，扩张/支架置入导管延续部，在肺动脉分支开口之间形成一个带支架的隔障，并进行双向 Glenn 连接。它避免了远端弓和导管延续部的解剖，也不需要进行 Damus-Kaye-Stansel 连接。我们在 2 例患者中实施了该手术，其中 1 例为房室间隔缺损伴左心室发育不良，另 1 例为二尖瓣闭锁。
两名患者均顺利完成了手术，无明显神经系统损伤。第 1 例患者在开始抗凝治疗前因左肺动脉血栓形成而死亡。第 2 例患者术后 1 年，全身及肺血流均无阻塞，隔障无渗漏，右心室功能良好，生活状况良好。
这种综合二期手术的混合方法似乎是可行的，且比传统的综合二期手术技术更简单。它适用于预计主动脉流出道保持通畅的单心室畸形的亚组患者。我们建议术后早期进行抗凝治疗，以避免早期左肺动脉血栓形成。
