Nova técnica: operação de Norwood com perfusão regional cerebral e coronariana

Abstract

Objective: To assess the immediate result of the modified Norwood procedure with new technique of anterograde regional cerebral perfusion (rACP) and retrograde regional coronary perfusion (rRCorP) in substitution of profound hypothermia and circulatory arrest in children with hypoplastic left heart syndrome (HLHS) with extremely hypoplastic ascending aorta (HA).Methods: In the period of December of 2006 to February 2008 the modified Norwood procedure with tube between the right ventricle and pulmonary arteries or Sano shunt was performed in eight children with HLHS and with ascending aorta diameter less than 3 mm, (four male and four female) with median age of 9.2 days (ranging from 1 to 29 days) and median weigh of 3.3 kg (ranging from 2.7 to 3.8 kg). We used cardiopulmonary bypass and hypothermia at 25°C with two venous cannulas and suture with a polytetrafluoroethylene graft sutured to the innominate artery as an arterial line and used to ARCeP. The RRCoP was performed by a deviation in the arterial line and placement of a catheter in the ascending aorta. The immediate surgical results and the clinical neurological manifestation were assessed. Results: The immediate surgical results revealed mortality of 25% and there were absence of neurological injury at clinical examination. Conclusions:The modified Norwood procedure can be accomplished with ARCeP and RRCoP in children with HLHS with HA with satisfactory immediate surgical result and without neurological complications.Descriptors: Hypoplastic left heart syndrome. Heart defects, congenital/surgery. Cardiac surgical procedures. Extracorporeal circulation/methods.

A milestone in congenital cardiac surgery: Four decades of the Norwood procedure

“…16 In recent years several attempts have been made to develop the optimal method of perfusion during the Norwood procedure. [17][18][19][20] For patients with failing physiology, extracorporeal membrane oxygenation provided rescue therapy as a bridge to heart transplantant. In a recent years, Berlin Heart EXCOR devices were available in infants with a single ventricle who had undergone the Norwood procedure as mechanical circulatory support.…”

Dominância coronariana na síndrome da hipoplasia do coração esquerdo

“…Although the HLHS is extensively studied, the surgical treatment performed by the Norwood-type palliative surgery [3][4] or by the so-called hybrid procedures [5][6] has satisfactory results in many centers [7][8]. Nevertheless, this disease still has a high mortality rate between the first and second stage, when compared to other diseases treated as univentricular physiology.…”

Circulação Extracorpórea

“…Entering the heart chambers was made possible by this discovery in an almost bloodless field and to correct birth [7][8][9][10] or acquired defects [11][12][13][14][15], which restricted the lives of those who had the misfortune to present problems in the blood propulsive organ and in their own lives.…”