Pulmonary artery banding before Norwood procedure

Described here is the use of bilateral pulmonary artery banding as a means to achieve effective restoration of adequate systemic blood flow before a Norwood procedure in two newborns with hypoplastic left heart syndrome who presented after birth with a severe imbalance of Qp/Qs and multiorgan system dysfunction despite usual pharmacologic and ventilatory strategies.     

Effects of additional pulmonary blood flow after bidirectional Glenn procedure

Thirteen cases of functional single ventricle who had undergone bidirectional Glenn procedure were divided into 2 groups according to presence (5) or absence (8) of additional pulmonary blood flow. Additional flow was preserved in cases with relatively small pulmonary artery index (PA index), and their sources were antegrade pulmonary blood flow (2), and Blalock-Taussig (BT) shunt (3). In the control group, PA index was reduced to about 70% of the preoperative value, while in the additional group, pulmonary artery growth was recognized without significant elevation of mean pulmonary artery pressure. However, atrioventricular valve regurgitation progressed and systemic ventricular volume did not decrease after Glenn in the additional group. Therefore special consideration for the timing of Fontan procedure is mandatory.     

小儿双向Glenn手术的麻醉体会

目的总结复杂性先天心患儿在非体外循环下行双向Glenn术的麻醉管理。方法16例患儿在非体外循环下行双向Glenn术。所有患儿采用静吸复合麻醉方法。麻醉维持主要采用中小剂量的舒芬太尼或芬太尼。并辅以低浓度的七氟醚吸人。结果术毕SpO2、CVP较术前显著升高（P〈0．01），而术毕Hb及Hct较术前显著降低（P〈0．05）。术后早期均有不同程度的眼睑、面部水肿症状，6例出现全身抽搐等脑缺氧表现，1例术后出现痴呆。除了两例术后早期患儿因低心排血量综合征合并肾功能衰竭而死亡外，患儿术后紫绀症状明显改善。无麻醉并发症。结论在恰当的麻醉方式下，维护心血管功能稳定．维持较高水平的腔静脉压力并降低肺血管阻力以促进肺血流的改善，调控内环境平衡并加强脑保护等是麻醉管理的关键。     

Posterior reduction aortoplasty for left pulmonary artery compression after Norwood procedure

All patients following the Norwood I procedure have a very large ascending aorta. This can lead to extrinsic compression of the surrounding vessels. We report a case of left pulmonary artery compression secondary to an aneurysmal neo-aorta and describe a technique of posterior reduction aortoplasty to decompress the left pulmonary artery.     

Right ventricular thrombosis early after bidirectional Glenn shunt.

Thrombosis in the right ventricle occurred early after bidirectional superior cavopulmonary shunt in 2 patients with pulmonary atresia with intact ventricular septum and major right ventricular coronary artery communication, and perioperative brain infarction occurred in 1 patient. Clinicians should be aware of the hazards of this potentially lethal complication, and transfusion of platelets and fresh plasma should be minimized. Although the hemodynamic state is good, echocardiography should be performed frequently and strict anticoagulation should be started as early as possible.     

Proximal conduit obstruction after Sano modified Norwood procedure

Sano and colleagues recently described a modification of first stage palliation for hypoplastic left heart syndrome utilizing a right ventricle to pulmonary artery conduit. Preliminary results are favorable, but experience with this technique is limited. We report a case of sudden death due to obstruction of the proximal conduit by fibrointimal hyperplasia. This case of lethal conduit obstruction presented 3 months after initial palliation. Early cardiac catheterization and second stage palliation may be necessary to minimize the risk of such adverse events after the Sano modification.     

Norwood术后心导管造影检查的应用及介入治疗

目的 探讨Norwood术后心导管造影检查结果以及介入治疗方法和疗效.方法 13例病婴均为Norwood术后而尚未行Glenn手术者,其中12例接受了介入治疗.结果 13例中6例出现新主动脉弓再狭窄,行主动脉成形术.1例左肺动脉狭窄,行左肺动脉球囊扩张术,3个月后左肺动脉置入支架.2例Sano-Shunt狭窄和1例BT-Shunt狭窄,均置入支架治疗,改善肺血流.4例合并体肺动脉侧支,其中3例采用Coil行侧支血管堵塞术,另1例于次日Glenn手术术中结扎.结论 Norwood术后血流动力学异常的发生率很高,术后造影和血流动力学的评估以及对新主动脉弓或肺动脉狭窄的介入治疗是必要的.

Abstract：

Objective To evaluate the outcome of the cardiac catheter angiograplasty for patients after Norwood procedure. Methods 13 patients, who had undergone Norwood procedure (prior to Glenn procedure)received cardiac catheterization and angiography. lnterventional therapy was performed in 12 patients as indicated. Results Angioplasty was carried out for re-coarctation in 6 of the13 patients. 1 patient with left pulmonary artery stenosis received balloon dilation and 3 months later a stent implantation. A stent was implanted to improve the pulmonary blood flow in 2 patients with Sano-Shunt stenosis and 1 patient with BT-Shunt stenosis. Transcatheter coil embolization was performed in 3 of the 4 patients with systemic to pulmonary collateral vessels. The other one was scheduled for Glenn procedure the next day. Conclusion The incidence of hemodynamic restrictions after Norwood procedure is high (12 of 13 patients). Postoperative angiography and hemodynamic assessment for diagnosis and interventional treatment for new pulmonary artery or aortic arch stenosis is necessary after Norwood procedure.     

Isolated left ventricular ischemia after the Norwood procedure

Aortic atresia is the most severe variant of hypoplastic left heart syndrome (HLHS), and has been associated with significant mortality after stage I palliation. Coronary artery abnormalities are more prominent in this group of patients, especially in the presence of a patent mitral valve. Herein, we describe a case of isolated left ventricular ischemia after the Norwood procedure in a neonate with hypoplastic left heart syndrome, left ventricular hypertrophy, mitral stenosis, aortic atresia, and anomalous left coronary artery.     

双向Glenn手术治疗儿童功能性单心室68例分析

目的总结1998年4月至2005年12月行双向Glenn手术治疗68例儿童功能性单心室的经验。方法本组男47例,女21例;年龄5个月～14岁（中位年龄3．7岁）;体重6．7～30．0kg（中位体重12．5kg）。右侧双向Glenn手术39例,左侧双向Glenn手术13例,双侧者16例。同期行肺动脉环束3例、肺动脉结扎1例、主动脉-肺动脉分流管道切断缝合术1例、动脉导管结扎6例、大侧支循环切断4例、全肺静脉异位引流矫治1例、部分肺静脉异位引流矫治2例、房室瓣整形4例。结果68例患者死亡3例,病死率4．4％。术后上腔静脉压力（15．9±2．4）mmHg（1mmHg=0．133kPa）,较术前的（8．3±1．8）mmHg显著上升（P〈0．01）。术后安静时经皮血氧饱和度（89．3±4．2）％,较术前的（78．4±6．0）％显著上升（P〈0．01）。结论双向Glenn手术治疗功能性单心室效果满意;双向Glenn手术宜保留肺动脉的搏动性血流。