Corno Antonio F, Durairaj Saravanan, Skinner Gregory J
Houston Children's Heart Institute, Hermann Children's Hospital, University of Texas Health, McGovern Medical School, Houston, TX, USA.
East Midlands Congenital Heart Centre, University Hospitals of Leicester, Leicester, UK.
Transl Pediatr. 2021 Jan;10(1):165-176. doi: 10.21037/tp-20-227.
The individualized surgical approach in individuals with both arterial trunks arising from the morphologically right ventricle is dictated by the extreme morphological variability encountered in this setting, with each patient being unique. An individualized surgical approach has been designed to take account of the morphological variations, identifying the anatomy with the preoperative three-dimensional CT scan reconstruction. The key features have been considered the distance between tricuspid and pulmonary valves, the size and location of the interventricular communication, and the relationship between the outflow tracts. The surgical approach is tailored, whenever feasible, to create a connection between left ventricle and aorta, but primarily to achieve biventricular repair. Account has been taken of all available surgical options already reported in the literature, identifying the most suitable to provide the best outcomes for each unique morphology. To date, meaningful comparison between different reported surgical series has been difficult because of the marked variation of individual intracardiac morphology, and the lack of reports of specific surgical approaches for well-categorized groups of patients. Our approach, being tailored to the individual cardiac morphology, can be offered to any patient with this ventriculo-arterial connection. Given the difficulties of diagnosis, and the multiple therapeutic indications, very close collaboration between cardiologists and surgeons is indispensable for further progress in the understanding and management of this complex congenital cardiac lesion.
对于两个动脉干均起源于形态学右心室的个体，个体化手术方法取决于在此情况下遇到的极端形态学变异性，每个患者都是独特的。已设计出一种个体化手术方法，以考虑形态学变异，通过术前三维CT扫描重建来识别解剖结构。关键特征包括三尖瓣与肺动脉瓣之间的距离、室间隔交通的大小和位置以及流出道之间的关系。只要可行，手术方法会进行调整，以建立左心室与主动脉之间的连接，但主要是为了实现双心室修复。已考虑了文献中已报道的所有可用手术选择，确定最适合为每种独特形态提供最佳结果的方法。迄今为止，由于个体心脏形态的显著差异以及缺乏针对分类明确的患者群体的特定手术方法的报告，不同报道的手术系列之间进行有意义的比较一直很困难。我们的方法是根据个体心脏形态量身定制的，可提供给任何具有这种心室-动脉连接的患者。鉴于诊断困难和多种治疗指征，心脏病专家和外科医生之间非常密切的合作对于进一步了解和管理这种复杂的先天性心脏病变不可或缺。
