PDF(Pubmed)
Abstract：
UNASSIGNED: In select patients with borderline ventricular hypoplasia, we adopted a strategy of initial single-ventricle palliation followed by staged or direct biventricular conversion by 2 years of age.
UNASSIGNED: Between 2018 and 2023, 14 newborns with borderline hypoplastic heart disease deemed high risk for primary biventricular repair underwent palliative procedures as a neonate/infant, followed by staged or direct biventricular conversion.
UNASSIGNED: Of the 14 patients, 6 had borderline left ventricles and 8 had borderline right ventricles. Index neonatal operations were performed in 12 patients and included the Norwood operation (n = 5), pulmonary artery band (n = 3), ductal stent (n = 3), and hybrid Norwood (n = 1). Five patients underwent direct biventricular conversion, and the remaining 9 patients underwent staged ventricular recruitment operations at a mean age of 6 months (range, 3-11 months). Ventricular recruitment operations included atrial septation with or without ventricular rehabilitation, atrioventricular valve repair, or outflow tract operations. At a mean duration of 8 months (range, 4-10 months) after ventricular recruitment, there was a significant increase in chamber volume, aortic valve, and mitral valve size in patients with borderline left ventricles, and a normalization of the right ventricle:left ventricle end-diastolic volume ratio in patients with borderline right ventricles. To date, 13 of 14 patients have undergone successful biventricular conversion at a mean age of 16 months (range, 4-31 months).
UNASSIGNED: In select newborns with borderline hypoplastic heart disease, single-ventricle palliation followed by staged or direct biventricular conversion may increase infant survival while allowing for early attainment of a biventricular circulation.
UNASSIGNED: Between 2018 and 2023, 14 newborns with borderline hypoplastic heart disease deemed high risk for primary biventricular repair underwent palliative procedures as a neonate/infant, followed by staged or direct biventricular conversion.
UNASSIGNED: Of the 14 patients, 6 had borderline left ventricles and 8 had borderline right ventricles. Index neonatal operations were performed in 12 patients and included the Norwood operation (n = 5), pulmonary artery band (n = 3), ductal stent (n = 3), and hybrid Norwood (n = 1). Five patients underwent direct biventricular conversion, and the remaining 9 patients underwent staged ventricular recruitment operations at a mean age of 6 months (range, 3-11 months). Ventricular recruitment operations included atrial septation with or without ventricular rehabilitation, atrioventricular valve repair, or outflow tract operations. At a mean duration of 8 months (range, 4-10 months) after ventricular recruitment, there was a significant increase in chamber volume, aortic valve, and mitral valve size in patients with borderline left ventricles, and a normalization of the right ventricle:left ventricle end-diastolic volume ratio in patients with borderline right ventricles. To date, 13 of 14 patients have undergone successful biventricular conversion at a mean age of 16 months (range, 4-31 months).
UNASSIGNED: In select newborns with borderline hypoplastic heart disease, single-ventricle palliation followed by staged or direct biventricular conversion may increase infant survival while allowing for early attainment of a biventricular circulation.
摘要：
■在某些临界心室发育不全患者中，我们采用的策略是先进行单心室缓解,然后在2岁时进行分期或直接双心室转换.
■在2018年至2023年之间，有14名患有临界发育不良心脏病的新生儿被认为是原发性双心室修复的高风险，作为新生儿/婴儿接受了姑息治疗，然后是分期或直接双心室转换。
■在14名患者中,6个具有交界性左心室，8个具有交界性右心室。对12例患者进行了索引新生儿手术，其中包括Norwood手术（n=5），肺动脉带（n=3），导管支架（n=3），和杂种诺伍德(n=1)。五名患者接受了直接双心室转换，其余9例患者在平均年龄6个月时接受了分阶段的心室扩张手术（范围，3-11个月）。心室复张手术包括有或没有心室康复的房间隔，房室瓣修复术,或流出道操作。平均持续时间为8个月(范围，4-10个月)心室募集后，腔室容积显著增加，主动脉瓣,左心室临界的患者的二尖瓣大小，右心室正常化：右心室交界患者的左心室舒张末期容积比。迄今为止,14名患者中有13名在平均年龄16个月时成功进行了双心室转换（范围，4-31个月）。
■在某些患有临界发育不良心脏病的新生儿中，单心室缓解后分期或直接双心室转换可增加婴儿存活率,同时允许早期实现双心室循环.
■在2018年至2023年之间，有14名患有临界发育不良心脏病的新生儿被认为是原发性双心室修复的高风险，作为新生儿/婴儿接受了姑息治疗，然后是分期或直接双心室转换。
■在14名患者中,6个具有交界性左心室，8个具有交界性右心室。对12例患者进行了索引新生儿手术，其中包括Norwood手术（n=5），肺动脉带（n=3），导管支架（n=3），和杂种诺伍德(n=1)。五名患者接受了直接双心室转换，其余9例患者在平均年龄6个月时接受了分阶段的心室扩张手术（范围，3-11个月）。心室复张手术包括有或没有心室康复的房间隔，房室瓣修复术,或流出道操作。平均持续时间为8个月(范围，4-10个月)心室募集后，腔室容积显著增加，主动脉瓣,左心室临界的患者的二尖瓣大小，右心室正常化：右心室交界患者的左心室舒张末期容积比。迄今为止,14名患者中有13名在平均年龄16个月时成功进行了双心室转换（范围，4-31个月）。
■在某些患有临界发育不良心脏病的新生儿中，单心室缓解后分期或直接双心室转换可增加婴儿存活率,同时允许早期实现双心室循环.
