Abstract
OBJETIVO: Avaliar o procedimento de Lecompte para a correção da transposição das grandes artérias associada à comunicação interventricular e obstrução da via de saída do ventrículo esquerdo (TGA, CIV e OVSVE) e apresentar os resultados no período pós-operatório intermediário e tardio. MÉTODO: Entre fevereiro de 1994 e julho de 2005, sete pacientes, com idade de 2 a 8 anos (mediana -M-: 3,0), portadores de TGA, CIV e OVSVE, foram submetidos a tratamento cirúrgico corretivo. Em seis casos, foi utilizado o procedimento de Lecompte. Esta técnica consiste na abordagem por ventriculotomia direita, ressecção ampla do septo conal e construção de um túnel ventricular conectando o ventrículo esquerdo à aorta; o caso restante apresentava obstrução da prótese valvulada implantada entre o ventrículo direito e a artéria pulmonar (VD-AP) e falência do VD e foi submetido à conversão no procedimento de Lecompte. RESULTADOS: Os tempos de CEC variaram entre 105 e 194 min (M: 130) e os tempos de anoxia entre 65 e 90 min (M: 78). Houve um óbito no pós-operatório imediato devido a coagulopatia, seguido de insuficiência ventricular direita. Os seis pacientes sobreviventes receberam alta hospitalar no período de 5 a 30 dias (M: 11) e permaneceram em acompanhamento entre 12 a 144 meses (M: 73,6). CONCLUSÃO: O procedimento de Lecompte teve como vantagens: 1 - Indicação cirúrgica em pacientes com menor faixa etária; 2 - Baixa morbi-mortalidade; 3 - Expectativa de acompanhamento a longo prazo, sem reoperação; 4 - Possibilidade de converter o procedimento de Rastelli em Lecompte.
Highlights
For transposition of the great arteries (TGA), anatomic correction has been the procedure of choice, giving good results in the immediate and late postoperative periods
When TGA is associated to interventricular communication (IVC) and obstruction of the left ventricle outflow tract (LVOFT), the complexity of a surgical correction increases with this option becoming less attractive
The long-term evolution of these patients shows a growing incidence of adverse events, showing that the Rastelli operation, being a good technical option for the correction of TGA, IVC and LVOFT, is not the ideal procedure when: 1 - the intracardiac autonomy is not favorable; 2 - it is necessary to indicate the operation in younger patients and 3 - there is an option for other surgical procedures with less incidence of obstruction of the right ventricle outflow tract (RVOFT) or LVOFT
Summary
For transposition of the great arteries (TGA), anatomic correction has been the procedure of choice, giving good results in the immediate and late postoperative periods. When TGA is associated to interventricular communication (IVC) and obstruction of the left ventricle outflow tract (LVOFT), the complexity of a surgical correction increases with this option becoming less attractive. The long-term evolution of these patients shows a growing incidence of adverse events, showing that the Rastelli operation, being a good technical option for the correction of TGA, IVC and LVOFT, is not the ideal procedure when: 1 - the intracardiac autonomy is not favorable; 2 - it is necessary to indicate the operation in younger patients (the extracardiac prosthesis in under two year-old patients, rapidly evolves to occlusion) and 3 - there is an option for other surgical procedures with less incidence of obstruction of the right ventricle outflow tract (RVOFT) or LVOFT.
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