Erek Ersin, Suzan Dilek, Aydin Selim, Temur Bahar, Demir Ibrahim Halil, Odemis Ender
1 Acibadem Mehmet Ali Aydinlar University, School of Medicine, Atakent Hospital, Cardiovascular Surgery Department.
2 Acibadem Mehmet Ali Aydinlar University, School of Medicine, Atakent Hospital, Pediatric Cardiology Department.
World J Pediatr Congenit Heart Surg. 2019 Jul;10(4):426-432. doi: 10.1177/2150135119845245.
Single-stage biventricular repair remains a challenging and difficult decision in high-risk newborns and early infants with the presence of left ventricular outflow tract obstruction (LVOTO) or borderline hypoplasia of the left ventricle (LV).
Six high-risk patients underwent the initial hybrid procedure (bilateral pulmonary banding + ductal stenting) for staged biventricular repair. Their median age was 17 days (range: 7-55 days). The diagnosis was interrupted aortic arch (IAA), ventricular septal defect (VSD), and LVOTO (n = 3); IAA and VSD (n = 1); and aortic annular hypoplasia, aortic arch hypoplasia, VSD, and LVOTO (n = 1). The last patient had borderline LV with large atrial septal defect (ASD) and aortic arch hypoplasia. The patient with borderline LV had also ASD closure with small fenestration.
One patient died of sepsis after the hybrid procedure. Other patients underwent biventricular repair 8 to 13 months later. Three patients had conventional repair with conal septum resection. The other patient with IAA, in whom LVOTO was considered nonresectable, underwent Yasui operation. The last patient with borderline LV had enough development of left heart structures during follow-up and underwent aortic arch repair. One patient who had conal septum resection died after biventricular repair. One patient needed a tracheostomy; four patients were discharged uneventfully and their clinical conditions were good on postoperative year 1.
Staged biventricular repair with the initial hybrid procedure may be a feasible and safe alternative in high-risk neonates and early infants. Hybrid intervention may provide the development of cardiac structures in time and a better evaluation for the possibility of biventricular repair in borderline patients.
对于存在左心室流出道梗阻（LVOTO）或左心室（LV）临界发育不全的高危新生儿和小婴儿，一期双心室修复仍然是一个具有挑战性且困难的决策。
6例高危患者接受了用于分期双心室修复的初始杂交手术（双侧肺动脉环缩术 + 动脉导管支架置入术）。他们的中位年龄为17天（范围：7 - 55天）。诊断包括主动脉弓中断（IAA）、室间隔缺损（VSD）和LVOTO（n = 3）；IAA和VSD（n = 1）；以及主动脉瓣环发育不全、主动脉弓发育不全、VSD和LVOTO（n = 1）。最后1例患者为临界LV合并大型房间隔缺损（ASD）和主动脉弓发育不全。临界LV患者还进行了带小开窗的ASD封堵术。
1例患者在杂交手术后死于败血症。其他患者在8至13个月后接受了双心室修复。3例患者进行了常规的圆锥间隔切除术修复。另1例IAA患者，其LVOTO被认为不可切除，接受了安井手术。最后1例临界LV患者在随访期间左心结构有足够发育并接受了主动脉弓修复。1例进行圆锥间隔切除术的患者在双心室修复后死亡。1例患者需要气管切开术；4例患者顺利出院，术后第1年临床状况良好。
对于高危新生儿和小婴儿，采用初始杂交手术进行分期双心室修复可能是一种可行且安全的选择。杂交干预可能及时促进心脏结构发育，并更好地评估临界患者进行双心室修复的可能性。
