Barış GÜVEN, Vedide TAVLİ, Ali YILDIRIM, Emin Alp ALAYUNT, Savaş DEMİRPENÇE

Hybrid approach in two cases with hypoplastic left heart syndrome

Hipoplastik sol kalp sendromu; çoğunlukla sol ventrikül hipoplazisi veya atrezisi, mitral kapak hipoplazisi veya atrezisi ve çıkan aorta hipoplazisi veya atrezisini içeren doğumsal kalp defektleri spektrumunu kapsar. Hipoplastik sol kalp sendromu neonatal mortalitenin önemli bir nedenidir. Son yıllarda hibrid yaklaşımın popülaritesi artmıştır. Hibrid uygulama, pediyatrik kardiyolog ve kalp cerrahı arasında yakın işbirliği gerektiren, girişimsel kardiyoloji yaklaşımları ve cerrahi teknikleri birleştiren ve daha az invaziv olan birincil bir uygulamadır. Bu yazıda, hipoplastik sol kalp sendromu olan ve duktal stent ve iki taraflı pulmoner arter bantlamayı içeren hibrid yaklaşımı uygulanan iki olguyu sunduk.

Hibrid yaklaşımı uygulanan hipoplastik sol kalp sendromlu iki olgu

Hypoplastic left heart syndrome (HLHS) encompasses a spectrum of congenital cardiac defects which mostly include left ventricular hypoplasia or atresia, mitral valve hypoplasia or atresia and ascending aortic hypoplasia and atresia. Hypoplastic left heart syndrome is a leading cause of neonatal mortality. In recent years, popularity of hybrid approach has increased. Hybrid procedures which requires close cooperations between paediatric cardiologists and cardiac surgeons includes a less invasive primary procedure; integrating interventional cardiology approaches and surgical techniques. Herein, we report two cases with hypoplastic left heart syndrome. We performed hybrid approach including ductal stenting and bilateral pulmonary banding on these patients.

PDF

___

Alayunt EA, Atay Y, Uç H: Hipoplastik Sol Kalp Sendromu. In: Duran E, ed. Kalp ve Damar Cerrahisi. Baskı. İstanbul; Çapa Tıp Kitabevi ve Yay. Hizmetleri, Ulus Matbaacılık 2004: 497-508.
Pizarro C, Derby CD, Baffa JM, et al. Improving the outcome of high-risk neonates with hypoplastic left heart syndrome: hybrid procedure or conventional surgial palliation. European Journal of Cardio-thoracic Surgery 2008; 33 (4): 613-18.
Norwood WI, Lang P, Casteneda AR, Campbell DN. Experience with operations for hypoplastic left heart syndrome. The Journal of thoracic and cardiovascular surgery 1981; 82 (4): 511-9.
Hazan E, Şişli E. Hypoplastic left heart syndrome. Turkiye Klinikleri J Pediatr Sci 2006; 2 (12): 64-7
Bacha E AM, Hijazi ZM. Hybrid Procedures in Pediatric Cardiac Surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2005: 78-85.
Ashburn DA, McCrindle BW, Tchervenkov Cl,et al. Outcomes after the Norwood operation in neonates with critical aortic stenosis or aortic valve atresia. J Thorac Cardiovasc Surg 2003; 125 (5): 1070-82.
Brackley KJ, Kilby MD, Wright JG, et al. Outcome after prenatal diagnosis of hypoplastic left-heart syndrome: a case series. Lancet. 2000; 356 (9236):1143-7.
Galantowicz M, Cheatham JP, Phillips A, et al. Hybrid approach for hypoplastic left heart syndrome: intermediate results after the learning curve. Ann Thorac Surg 2008; 85 (6): 2063-70.
Robert H. Anderson, Edward J. Baker, Daniel J. Penny, Andrew N. Redington,, Michael L. Rigby and Gil Wernovsky. Paediatric Cardiology. 3 edition. Churchill Livignstone, Philadelphia, 2010: 978-986. Nadorlik HA
Egan MJ, Hill SL, Cheatham JP, Galantowicz M, Kovalchin JP. Predictors of ductus arteriosus in-stent stenosis in the hybrid approach to hypoplastic left heart syndrome. Pediatr Cardiol. 2013; 34 (3): 656-60.
Akintuerk H, Michel-Behnke I, Valeske K, et al. Stenting of the atrial duct and banding of the pulmonery arteries: basis for combined Norwood stage 1 and 2 repair in hypoplastic left heart. Circulation 2002; 105 (9): 1099-103.
Licht DJ, Shera DM, Clancy RR, et al. Brain maturation is delayed in infants with complex congenital heart defects. J Thorac Cardiovasc Surg 2009; 137 (3): 529-36.