Surgical Treatment Experience of Hypoplastic Syndrome of Left Heart Parts by Hybrid Methods
Journal Title: Український журнал медицини, біології та спорту - Year 2017, Vol 5, Issue 3
Abstract
Treatment of critical heart defects is one of the most difficult problems in cardiovascular surgery. This is due to: the immaturity of all newborns and, in the first place, cardiovascular systems, which, moreover, are complicated by congenital heart disease (VVS); a stressful situation for the newborn, whose body has moved from the comfortable conditions of the existence of intrauterine into an independent life. The purpose of our work is to analyze the results of the endovascular treatment methods usage in the hypoplasia syndrome of the left heart parts (CGLVS). At the same time, GGVVS is extremely difficult, complex, with various clinical and anatomical-morphological variants of the VVS, with a frequency of distribution of 4-8% among all VVS, accompanied by extremely severe course and significant mortality in the treatment and 100% in the absence of it. Materials and methods of research. The selection criteria for treatment were the ascending aorta diameter of less than 2 mm and a small mass of patients. For this time, 15 patients were operated. Among them: 4 female (26.7%) and 11 (73.3%) males; one of them was operated second time. Thus, there were only 16 surgical interventions. On the day of surgery, the average age of patients was 9.1±2.4 days (from 2 to 12 days), respectively, the weight on average less than 2.24±0.14 kg. In 11 patients, defect was diagnosed prenatally and confirmed by Echo-KG immediately after birth, in 4 cases – at birth, which allowed to be delivered immediately to the State Medical Unitary Enterprise “National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine” for the provision of highly-qualified medical care. All of them have also undergone preoperative preparation for 1-10 days for the correction of systemic and pulmonary vascular resistance and blood oxygen saturation up to 80%. Research results. In all cases, a hybrid operation with bilateral pulmonary artery (LA) suppression was supplemented with stenting of the open arterial duct (VAP) as the first stage of treatment. With this purpose as a first step: a median sternotomy was performed and pulmonary artery branches narrowed to 2.5-3.5 mm under conditions of general anesthesia and without artificial blood circulation. In the following: Step 2: implanted a stent through a puncture of the LA near the valve through which the intraducer 6F was started. Via an intraducer in LA, a stent was inserted into the cylinder in all cases except 2. In the other two cases, a self-directed stent was used. In addition, in 3 cases, such surgical intervention was supplemented by the Rashkind procedure. In the case of repeated surgical intervention after 6 months, VAP stenting was conducted. After surgical intervention four of 15 patients were discharged from the clinic to appropriate in-patient clinics for continued treatment. It was 26.7%. Repeated surgical intervention was accompanied by improvement of the patient's condition and he was discharged from the clinic in a satisfactory condition. The purpose of the performed surgical interventions was to find a balance between systemic blood pressure and oxygen saturation in arterial blood: systolic systemic blood pressure of about 70-80 mmHg and above, saturation of blood with oxygen – 85-90%. If the saturation was higher and the pressure was lower than the LA was allowed to reach the specified parameters. The causes of fatal cases were: sepsis – 2 cases, stent thrombosis and aneurysm of the aorta, which led to coronary insufficiency – 4, endothelialization of the stent, which in turn led to the overlap of the aneurysm of the aorta and coronary blood flow with the overlap of the entrance coronary arteries with coronary insufficiency due to the overlap of the isthmus – 1, perforation of the LP in the Rashkind procedure – 1 case, surgical bleeding – 1. In all other cases, there were complicated rhythm disturbances, complete AB blockade, and cardiovascular insufficiency. This is a transient AB block with a decrease in hemodynamics, 1 is supraventricular tachycardia. Conclusions. Despite the high fatality, hybrid surgery should be performed as it is the only chance to rescue the patients. Endovascular surgical interventions with CGLVS are selective operations that allow the patient to prepare for the next stage of treatment. Endovascular interventions in the GVLDC are less-traumatic, which increases the chances of patients with a low weight and complicated anatomy to survive despite their severe state when inpatient. The complexity of surgical intervention and the low incidence among all other AUs need to concentrate such patients in one highly specialized cardiac surgery center in order to accumulate experience and gradually improve the treatment outcomes with lessons learned. The conduct of such surgical interventions requires experience, thorough preparation, coherence at all stages, and all services involved in the treatment of this category of patients. It is diagnostic, transport, anesthetic, surgical, resuscitation and postoperative medical and rehabilitation.
Authors and Affiliations
E. , Imanov, I. Dytkyvskyi, O. Plyska, Y. Truba, S. Siromaha, V. Lazoryshynets
Keywords
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