Modified Norwood Operation for Single Left Ventricle and Ventriculoarterial Discordance: An Improved Surgical Technique
| Autor: | Ralph S. Mosca, Achi Ludomirsky, Edward L. Bove, Dennis C. Crowley, Thomas J. Kulik, Erik C. Michelfelder, Hani A. Hennein |
|---|---|
| Rok vydání: | 1997 |
| Předmět: |
Heart Defects
Congenital Pulmonary and Respiratory Medicine Aortic arch medicine.medical_specialty Heart block Heart Ventricles medicine.medical_treatment Tricuspid Atresia Fontan procedure Actuarial Analysis medicine.artery Internal medicine medicine Humans Abnormalities Multiple Tricuspid atresia Cardiac Surgical Procedures Aorta business.industry Palliative Care Infant Newborn Infant medicine.disease Norwood Operation Surgery Survival Rate medicine.anatomical_structure Ventricle Pulmonary artery Cardiology Norwood procedure Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Annals of Thoracic Surgery. 64:1126-1132 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/s0003-4975(97)00848-5 |
| Popis: | Background . Patients with univentricular hearts and ventriculoarterial discordance with potentially obstructed systemic blood flow continue to pose difficult management problems. The goals of neonatal palliative operations are to control pulmonary blood flow while avoiding pulmonary artery distortion, to relieve systemic outflow tract obstruction, and to avoid heart block. Methods . Between January 1987 and December 1996, 38 patients with either tricuspid atresia or a double-inlet left ventricle and ventriculoarterial discordance underwent a modified Norwood procedure. Their mean age was 15 days, and their mean weight was 3.4 kg. Aortic arch anomalies were present in 92% of the patients. Morbidity and mortality statistics, intraoperative data, and postoperative echocardiograms were reviewed. Results . There were 3 early deaths (7.8%) and 5 late deaths (13.1%). The actuarial survival rates at 1 month, 1 year, and 5 years were 89%, 82%, and 71%, respectively. Follow-up was complete in all children at a mean interval of 30 ± 9 months. None of the patients had significant neoaortic valve insufficiency, and 1 patient required therapy for residual aortic arch obstruction. Nine patients (30% of the survivors) have undergone the hemi-Fontan procedure, and 18 patients (60%) successfully have undergone the Fontan procedure. Conclusions . In this patient population, we recommend the modified Norwood procedure as the neonatal palliative treatment of choice. It can be performed with acceptable early morbidity and mortality, and it improves suitability for the Fontan procedure. It reliably relieves all levels of systemic outflow tract obstruction, controls pulmonary blood flow, and avoids heart block. |
| Databáze: | OpenAIRE |
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