da Silva Luciana da Fonseca, Morell Victor, Medina Mario Castro, da Silva Jose Pedro
University of Pittsburgh, Cardiothoracic Surgery Department, Division of Pediatric Cardiothoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.
University of Pittsburgh, Head of Cardiothoracic Surgery Department, Division of Pediatric Cardiothoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.
Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2025;28:38-45. doi: 10.1053/j.pcsu.2025.02.007. Epub 2025 Feb 14.
Following the Starnes procedure, a progressive reduction in the RV cavity occurs, suggesting that the RV was unsuitable for a biventricular repair. For that reason, those patients traditionally followed the single ventricle pathway. In 2019, we performed the initial tricuspid valve (TV) repair cases after Starnes. Since then, we have routinely applied the staged treatment with Cone repair after Starnes achieving 2-ventricle or one-and-a-half ventricle repair in 17 patients. A Glenn procedure associated with pulmonary valve (PV) commissurotomy has been offered as an intermediate stage in patients with associated pulmonary atresia (PAt). Aiming to facilitate the following surgical steps and allow RV growth, we have described some maneuvers for these patients during the Starnes and the Glenn procedure. In this paper, we describe the up-to-date staged repair for critical neonatal Ebstein, emphasizing surgical details of the Starnes procedure, the intermediate interventions, and the Cone repair after Starnes.
按照斯塔恩斯手术流程，右心室腔会逐渐缩小，这表明右心室不适合进行双心室修复。因此，这些患者传统上遵循单心室路径。2019年，我们开展了斯塔恩斯手术后的首例三尖瓣修复病例。从那时起，我们常规应用斯塔恩斯手术后的圆锥修复分期治疗，使17例患者实现了双心室或一个半心室修复。对于合并肺动脉闭锁（PA）的患者，已采用与肺动脉瓣（PV）交界切开术相关的格林手术作为中间阶段。为了便于后续手术步骤并促进右心室生长，我们描述了在斯塔恩斯手术和格林手术期间针对这些患者的一些操作。在本文中，我们描述了针对重症新生儿埃布斯坦畸形的最新分期修复，重点介绍了斯塔恩斯手术的手术细节、中间干预措施以及斯塔恩斯手术后的圆锥修复。
