Initial Palliative Surgery Research Articles

Outcome and assessment after the modified Fontan procedure for hypoplastic left heart syndrome.

We reviewed the outcome of 76 consecutive patients (age range, 5 months to 6 years; median age, 19 months) who underwent a modified Fontan procedure after initial palliative surgery for hypoplastic left heart syndrome (HLHS) between January 1984 and December 1989. Modifications of the Fontan procedure included transatrial baffle of pulmonary venous return to the tricuspid valve (n = 10) or inferior vena cava baffle within the right atrium to the superior vena caval-pulmonary artery anastomosis, with pulmonary artery augmentation (n = 66). Actuarial survival rates were 74% (1 month), 58% (12 months), 56% (2 years), and 52% (4 years). Of the 43 survivors, 25 patients have returned for postoperative cardiac catheterization at a medium of 13 months after the Fontan procedure. Mean +/- SD hemodynamic values were cardiac index, 2.8 +/- 0.6 l/min/m2; right arterial pressure, 11 +/- 2 mm Hg; pulmonary artery wedge pressure, 6 +/- 3 mm Hg; and arterial oxygen saturation, 94 +/- 3%. No patient had significant tricuspid or native pulmonary valve insufficiency. Survival after the Fontan procedure in patients with HLHS is comparable to survival after a Fontan procedure in patients with other complex congenital heart lesions. In the subgroup of patients with HLHS who survived both reconstructive surgery and a Fontan procedure and have been evaluated by cardiac catheterization after a Fontan procedure, the use of the right ventricle as the systemic ventricle yielded excellent intermediate results for Fontan physiology.

Nuclear magnetic resonance imaging of the palliative operation for hypoplastic left heart syndrome

Electrocardiographic-gated nuclear magnetic resonance (NMR) imaging has been shown to be effective for the evaluation of congenital heart disease, particularly in supracardiac regions. This study evaluated the postoperative status after a stage I palliative operation (Norwood procedure) for hypoplastic left heart syndrome. The NMR images from three patients were compared with those of angiography and depicted all components of the reconstructed supracardiac and intracardiac anatomy after this operation. Nonobstructive anastomosis of the main pulmonary artery to the proximal aorta was clearly demonstrated in each patient. The caliber of the central or branch pulmonary artery, patency and caliber of the systemic to pulmonary artery shunt and the size of the atrial communication were also depicted in each patient and these findings corresponded with angiographic results.The results suggest that NMR imaging is effective for assessing the results of initial palliative surgery for hypoplastic left heart syndrome, which seems to be important for managing patients before subsequent definitive surgery.

Two-stage palliative surgical approach for pulmonary atresia with intact ventricular septum (type I)

Fifteen infants with an angiographie or autopsy diagnosis, or both, of pulmonary valvular atresia with intact ventricular septum (type I) were treated by various surgical procedures. An angiographie right ventricular cavity-intramyocardial sinusoid method was used to assess the “true” right ventricular size. The clinical, electrocardiographic and roentgenographic findings as well as the cardiac catheterization data were similar to those of other observers.A 2-stage palliative surgical approach is proposed. The first stage consists of combined Waterston-Cooley (ascending aorta to right pulmonary artery anastomosis) and Blalock-Hanlon (surgical atrial septectomy) procedures at the time of initial diagnosis. In the second stage a transventricular pulmonary valvotomy is performed 3 to 4 months after the initial palliative surgery. A definite improvement in morbidity and mortality was achieved. Furthermore, evidence is presented to demonstrate the capability for growth of the right ventricle.