Abstract:
OBJECTIVES:To determine the outcome of a bailout procedure using the right ventricle to re-assist the left ventricle in neonates after technically adequate coarctectomy but a failing borderline left heart. METHODS:The surgical procedure was performed on bypass. A 'reversed' 6-mm surgical shunt was inserted between the pulmonary trunk and the descending aorta together with bilateral branch pulmonary artery banding. RESULTS:Over a 10-year period, 89 neonates presented with coarctation and small left hearts. In 9 neonates, a hybrid procedure was performed at the outset. The remaining 80 underwent extended end-to-end coarctectomy. Two of these, despite adequate coarctectomy, developed retrograde cardiac failure with supra-systemic pulmonary hypertension, dilating right ventricles and progressive cardiogenic shock. The progressively dilating right ventricles inhibited left ventricular filling. Reversed surgical shunts were performed at 9 and 7 days post-coarctectomy. Both infants recovered rapidly and could be extubated after 4 and 7 days, respectively. Patient 1 proceeded to a univentricular repair and Patient 2 to a biventricular repair. CONCLUSIONS:Reversed surgical shunt with bilateral banding of the branch pulmonary arteries after neonatal coarctectomy can be successfully employed as a bailout procedure in cases where a borderline left heart with growth potential cannot tolerate a biventricular circulation. It may act as an acute life-saving measure as well as a bridge to later repair. If high risk for backward failure exists in a borderline left heart with catch-up growth potential, a primary hybrid procedure is probably a more elegant and predictable strategy.
journal_name
Interact Cardiovasc Thorac Surgjournal_title
Interactive cardiovascular and thoracic surgeryauthors
Brown SC,Eyskens B,Boshoff D,Cools B,Heying R,Rega F,Meyns B,Gewillig Mdoi
10.1093/icvts/ivw254subject
Has Abstractpub_date
2016-12-01 00:00:00pages
929-932issue
6eissn
1569-9293issn
1569-9285pii
ivw254journal_volume
23pub_type
杂志文章abstract:OBJECTIVES:The ability to accurately characterize a pulmonary air leak is an essential skill in chest medicine and surgery. The objective was to evaluate interobserver variability in air leak assessments using analogue and digital pleural drainage systems. METHODS:Air leak severity in lung resection patients with a pu...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1093/icvts/ivv128
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abstract::Pulmonary sequestration is a relatively rare but clinically significant form of congenital broncho-pulmonary foregut malformation. It is characterized by a segment of non-functioning lung parenchyma that receives its blood supply from anomalous systemic arteries. This report shows the role of contrast enhanced three-d...
journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1016/S1569-9293(03)00118-X
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journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1093/icvts/ivr063
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journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1093/icvts/ivr005
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journal_title:Interactive cardiovascular and thoracic surgery
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journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1510/icvts.2010.247213
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journal_title:Interactive cardiovascular and thoracic surgery
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journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
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pub_type: 临床试验,杂志文章
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pub_type: 杂志文章,多中心研究
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pub_type: 临床试验,杂志文章,多中心研究
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journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
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更新日期:2018-06-01 00:00:00
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journal_title:Interactive cardiovascular and thoracic surgery
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更新日期:2011-01-01 00:00:00
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journal_title:Interactive cardiovascular and thoracic surgery
pub_type: 杂志文章
doi:10.1093/icvts/ivw009
更新日期:2016-05-01 00:00:00
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journal_title:Interactive cardiovascular and thoracic surgery
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更新日期:2006-08-01 00:00:00