Login
EN
+7 (495) 482-4118
+7 (495) 482-0604

  • © 1998-2025
+7 (495) 482-43-29
EN
All journals
Journal
Year
Year
Search result: 0

Suvorov V.V.

St. Petersburg Pediatric Medical University

Zaytsev V.V.

St. Petersburg Pediatric Medical University

Pilyugov N.G.

St. Petersburg State Pediatric Medical University

Badurov R.B.

St. Petersburg State Pediatric Medical University

Kupatadze D.D.

St. Petersburg Pediatric Medical University

Komissarov M.I.

St. Petersburg State Pediatric Medical University

Dolgova E.V.

St. Petersburg State Pediatric Medical University

Kolbaya L.M.

St. Petersburg State Pediatric Medical University

Aleshin I.Yu.

St. Petersburg State Pediatric Medical University

Journal: Russian Journal of Cardiology and Cardiovascular Surgery. 2023;16(1): 24–31

Techniques for pulmonary artery narrowing in patients with congenital heart disease and ductal-dependent systemic circulation

Authors:

Suvorov V.V., Zaytsev V.V., Pilyugov N.G., Badurov R.B., Kupatadze D.D., Komissarov M.I., Dolgova E.V., Kolbaya L.M., Aleshin I.Yu.

More about the authors

DOI: 10.17116/kardio20231601124

Views : 2139

Downloaded : 78

Download PDF
Download PDF (RU)
Contact the author
Table of contents
Open to cite this article
Close metadata

OBJECTIVE

To determine intraoperative criteria of effectiveness of pulmonary artery narrowing in correction of critical congenital heart defects (CHD).

MATERIAL AND METHODS

We analyzed treatment outcomes in 37 patients with critical CHD who underwent hybrid surgery (bilateral pulmonary artery narrowing and stenting of patent ductus arteriosus (PDA)). Patients were divided into 3 groups depending on surgery. The first procedure was carried out in one stage with PDA stenting. After median sternotomy, two Gore-Tex vascular cuffs 1—2 mm wide and 3—3.5 mm in diameter were applied. Method No. 2 was based on the use of lavsan thread for pulmonary artery narrowing. Effectiveness of surgeries was assessed considering invasive blood pressure and oxygen saturation after pulmonary artery narrowing. Method No. 3 was distinguished by intraoperative assessment of blood flow at the site of pulmonary artery narrowing. A cuff for bilateral narrowing was made from a Gore-Tex vascular prosthesis. Surgery No. 1 was performed in 14 (37.8%) patients, No. 2 — in 8 (21.6%) patients, No. 3 — in 15 (40.6%) patients. Multiple logistic regression was used to identify the factors influencing hemodynamic efficiency of pulmonary artery narrowing.

RESULTS

All procedures resulted Qp/Qs=1/1 in 5 (35.7%), 3 (37.5%) and 14 (93.3%) patients, respectively. Statistical analysis revealed that technique No. 3 (odds ratio (OR) 0.013; 95% CI 0.001—0.314; p=0.007) combined with intraoperative assessment of blood flow at the site of narrowing of the left pulmonary artery (OR 17.526; 95% CI 1.944—325.462; p=0.045) were significant criteria for achieving Qp/Qs=1/1 after surgery in children with critical CHD.

CONCLUSION

The third method of bilateral pulmonary artery narrowing contributes to the most effective balance of pulmonary and systemic circulation in patients with critical CHD. This approach combined with intraoperative assessment of blood flow at the site of pulmonary artery narrowing is the most optimal criterion for achieving the ratio Qp/Qs=1/1.

Keywords:

hybrid surgery
Norwood hybrid surgery
bilateral pulmonary artery narrowing
pulmonary artery narrowing
treatment of critical CHD

Authors:

Suvorov V.V.

St. Petersburg Pediatric Medical University

Zaytsev V.V.

St. Petersburg Pediatric Medical University

Pilyugov N.G.

St. Petersburg State Pediatric Medical University

Badurov R.B.

St. Petersburg State Pediatric Medical University

Kupatadze D.D.

St. Petersburg Pediatric Medical University

Komissarov M.I.

St. Petersburg State Pediatric Medical University

Dolgova E.V.

St. Petersburg State Pediatric Medical University

Kolbaya L.M.

St. Petersburg State Pediatric Medical University

Aleshin I.Yu.

St. Petersburg State Pediatric Medical University

Received:

17.06.2021

Accepted:

06.01.2022

List of references:

  1. Pavlichev GV, Podoksenov AYu, Yanulevich OS, Ershova NV, Krivoshchekov EV. Aortic arch obstruction after the Norwood procedure in children with hypoplastic left heart syndrome. Circulatory pathology and cardiac surgery. 2014;18(2):13-16. (In Russ.). https://doi.org/10.21688/1681-3472-2014-2-13-16
  2. Schidlow DN, Anderson JB, Klitzner TS, et al. Variation in interstage outpatient care after the Norwood procedure: a report from the Joint Council on Congenital Heart Disease National Quality Improvement Collaborative. Congenit Heart Dis. 2011;6:98-107.  https://doi.org/10.1111/j.1747-0803.2011.00509.x
  3. Davies RR, Pizarro C. Decision-making for surgery in the management of patients with univentricular heart. Front Pediatr. 2015;3:61-80.  https://doi.org/10.3389/fped.2015.00061
  4. Norwood WI, Kirklin JK, Sanders SP. Hypoplastic left heart syndrome: experience with palliative surgery. The American journal of cardiology. 1980;45:87-91.  https://doi.org/10.1016/0002-9149(80)90224-6
  5. Ohye RG, Sleeper LA, Mahony L, et al. Comparison of shunt types in the Norwood procedure for single-ventricle lesions. The New England journal of medicine. 2010;362:1980-1992. https://doi.org/10.1056/NEJMoa0912461
  6. Honjo O, Benson LN, Mewhort HE, et al. Clinical outcomes, program evolution, and pulmonary artery growth in single ventricle palliation using hybrid and Norwood palliative strategies. The Annals of thoracic surgery. 2009;87:1885-1892; discussion 92-93.  https://doi.org/10.1016/j.athoracsur.2009.03.061
  7. Kussman BD, Gauvreau K, DiNardo JA, et al. Cerebral perfusion and oxygenation after the Norwood procedure: comparison of right ventricle-pulmonary artery conduit with modified Blalock-Taussig shunt. The Journal of thoracic and cardiovascular surgery. 2007;133:648-655.  https://doi.org/10.1016/j.jtcvs.2006.09.034
  8. Norwood WI, Lang P, Hansen DD. Physiologic repair of aortic atresia-hypoplastic left heart syndrome. N Engl J Med. 1983;308:23-26. 
  9. Khubulava GG, Shikhverdiev NN, Marchenko SP, et al. Risk factors for sternal infection in children after cardiac surgery. Bulletin of the Russian Military Medical Academy. 2014;48(4):218-223. (In Russ.).
  10. Sano S, Ishino K, Kawada M, Arai S, Kasahara S, Asai T, et al. Right ventricle-pulmonary artery shunt in first-stage palliation of hypoplastic left heart syndrome. J Thorac Cardiovasc Surg. 2003;126:504-510.  https://doi.org/10.1016/s0022-5223(02)73575-7
  11. Azakie A, Martinez D, Sapru A, Fineman J, Teitel D, Karl TR. Impact of right ventricle to pulmonary artery conduit on outcome of the modified Norwood procedure. Ann Thorac Surg. 2004;77:1727-1733. https://doi.org/10.1016/j.athoracsur.2003.10.002
  12. Ishino K, Stumper O, DeGiovanni JJ, Silove ED, Wright JG, Sethia B, et al. The modified Norwood procedure for hypoplastic left heart syndrome: Early to intermediate results of 120 patients with particular reference to aortic arch repair. J Thorac Cardiovasc Surg. 1999;117:920-930.  https://doi.org/10.1016/s0022-5223(99)70373-9
  13. Gaynor JW, Mahle WT, Cohen MI, et al. Risk factors for mortality after the Norwood procedure. Eur J Cardiothorac Surg. 2002;22:82-89.  https://doi.org/10.1016/s1010-7940(02)00198-7
  14. McGuirk SP, Griselli M, Stumper OF, et al. Staged surgical management of hypoplastic left heart syndrome: A single institution 12 year experience. Heart. 2006;92:364-370.  https://doi.org/10.1136/hrt.2005.068684
  15. Pizarro C, Derby CD, Baffa JM, Murdison KA, Radtke WA. Improving the outcome of high-risk neonates with hypoplastic left heart syndrome: Hybrid procedure or conventional surgical palliation? Eur J Cardiothorac Surg. 2008;33:613-618.  https://doi.org/10.1016/j.ejcts.2007.12.042
  16. Tanem J, Rudd N, Rauscher J, Scott A, Frommelt MA, Hill GD. Survival After Norwood Procedure in High-Risk Patients. Ann Thorac Surg. 2020;109(3):828-833.  https://doi.org/10.1016/j.athoracsur.2019.07.070
  17. Berishvili DO. Palliative off-pump surgery for emergency care in newborns with congenital heart defects: Dis. ... d-ra. med. nauk. M. 2010. (In Russ.).
  18. Brescia AA, Jureidini S, Danon S, et al. Hybrid versus Norwood procedure for hypoplastic left heart syndrome: contemporary series from a single center. The Journal of thoracic and cardiovascular surgery. 2014;147:1777-1782. https://doi.org/10.1016/j.jtcvs.2014.02.066
  19. Dave H, Rosser B, Knirsch W, et al. Hybrid approach for hypoplastic left heart syndrome and its variants: the fate of the pulmonary arteries. European journal of cardio-thoracic surgery: official journal of the European Association for Cardiothoracic Surgery. 2014;46:14-19.  https://doi.org/10.1093/ejcts/ezt604
  20. Galantowicz M, Cheatham JP, Phillips A, et al. Hybrid approach for hypoplastic left heart syndrome: intermediate results after the learning curve. The Annals of thoracic surgery. 2008;85:2063-2070; discussion 70-71.  https://doi.org/10.1016/j.athoracsur.2008.02.009
  21. Kitahori K, Murakami A, Takaoka T, Takamoto S, Ono M. Precise evaluation of bilateral pulmonary artery banding for initial palliation in high-risk hypoplastic left heart syndrome. The Journal of Thoracic and Cardiovascular Surgery. 2010;140(5):1084-1091. https://doi.org/10.1016/j.jtcvs.2010.07.084
  22. Baba K, Kotani Y, Chetan D, et al. Hybrid versus Norwood strategies for single-ventricle palliation. Circulation. 2012;126:123-131.  https://doi.org/10.1161/CIRCULATIONAHA.111.084616
  23. Photiadis J, Sinzobahamvya N, Hraska V, Asfour B. Does bilateral pulmonary banding in comparison to Norwood procedure improve outcome in neonates with hypoplastic left heart syndrome beyond second-stage palliation? A review of the current literature. Thorac Cardiovasc Surg. 2012;60:181-188.  https://doi.org/10.1055/s-0031-1295569
  24. Sakurai T, Kado H, Nakano T, et al. Early results of bilateral pulmonary artery banding for hypoplastic left heart syndrome. Eur J Cardiothorac Surg. 2009;36:973-979.  https://doi.org/10.1016/j.ejcts.2009.05.009
  25. Venugopal PS, Luna KP, Anderson DR, et al. Hybrid procedure as an alternative to surgical palliation of high-risk infants with hypoplastic left heart syndrome and its variants. The Journal of thoracic and cardiovascular surgery. 2010;139:1211-1215. https://doi.org/10.1016/j.jtcvs.2009.11.037
  26. Khubulava GG, Marchenko SP, Dubova EV, Suvorov VV. The role of modified ultrafiltration in reducing systemic manifestations of inflammation in cardiac surgery. Pediatrics. 2016;7(1):106-110. (In Russ.). https://doi.org/10.17816/PED71106-110
  27. Galantowicz M. The Hybrid Approach to Hypoplastic Left Heart Syndrome. Operative Techniques in Thoracic and Cardiovascular Surgery. 2009;14(2):74-85.  https://doi.org/10.1053/j.optechstcvs.2009.06.005
  28. Klauwer D, Neuhaeuser C, Thul J, Zimmermann R. A Practical Handbook on Pediatric Cardiac Intensive Care Therapy. Springer. 2019;560.  https://doi.org/10.1007/978-3-319-92441-0
Contact the author
Email
Message

Email Confirmation

An email was sent to test@gmail.com with a confirmation link. Follow the link from the letter to complete the registration on the site.

Email Confirmation

Contact us
If you have any questions, complaints or suggestions, please use this feedback form.
Email
Message
The publishing house "Media Sphere" does not provide treatment services, does not give recommendations on contacting medical institutions and specific specialists, on the prescription of medicines and dietary supplements.
Submit Application

You can become an author of one of our magazines, send a request and we will consider it in during the day.

Name
Phone
E-mail
Message
Login
E-mail
Password
Forgot Password?

Password recovery
E-mail
Login
Register

We use cооkies to improve the performance of the site. By staying on our site, you agree to the terms of use of cооkies. To view our Privacy and Cookie Policy, please. click here.