- Case report
- Open Access
- Open Peer Review
Double shunt technique for hybrid palliation of hypoplastic left heart syndrome: a case report
© Jatene et al; licensee BioMed Central Ltd. 2011
- Received: 19 August 2011
- Accepted: 26 October 2011
- Published: 26 October 2011
We report a technique to palliate hypoplastic left heart syndrome, with no PDA stenting, but with double polytetrafluoroethylene shunt from pulmonary artery to ascending and descending aorta by combined thoracotomies. A 30-day-old female was operated with this technique. Five months after first operation, the child was submitted to Norwood/Glenn operation. Good hemodinamic recovery and initial clinical evolution was observed. The child was extubated in 8th post operatory day and reentubated in the next day due to pulmonary infection. Despite antibiotic treatment, the child died after systemic infectious complications.
- Congenital heart disease
- hypoplastic left heart syndrome
Different surgical techniques for hybrid procedure for hypoplastic left heart syndrome (HLHS) have being described . Taking into account local fibrosis or tissue friability during second stage operation, the possibility of aortic arch obstruction related to stent deployment and surgical difficulty in management of distal ductal stented area must be considered [2–5].
Caldarone  reported an alternative solution to palliate HLHS, with pulmonary artery (PA) to innominate artery shunt, associated to bilateral pulmonary artery banding (PAB), patent ductus arteriosus stenting and atrioseptostomy, not avoiding future events related to the stent.
The purpose of this case report is to describe a new technique to palliate HLHS with banding PA branches, without patent ductus arteriosus stent, but with a double shunt from PA to ascending and descending aorta by combined thoracotomies. This new technique provides adequate flow to aortic arch and descending aorta, avoiding patent ductus arteriosus stenting, and, eventually, future problems with patent ductus arteriosus stent removing.
The operation is performed by 2 combined approaches: 1. median sternotomy and 2. left thoracotomy. Cardiopulmonary Bypass is not used. By median sternotomy, right and left PAB with 3.0 mm Polytetrafluoroethylene bands are performed.
A 3.5 kg white female, 30 days old, was admitted; prostaglandin E-1 was initiated, after diagnosis, with 22 days of life. The echocardiogram showed 1.4 mm ascending aorta, small Atrial Septal Defect (3.0 mm), mild tricuspid regurgitation and RV systolic dysfunction.
The child experimented a sudden cardiac arrest in 75th PO day. The echo after recover showed important right ventricular dysfunction and 4.0 mm shunt occluded. Retrograde flow to aortic arch from 7.0 mm shunt was demonstrated.
Five months after first operation, a Norwood/Glenn operation was performed; pre-operative mild/moderate right ventricular dysfunction was demonstrated. Cardiopulmonary Bypass was installed, using 2 arterial lines: one with the shunt from PA to descending aorta and the second by a new shunt to innominate artery. Flow was maintained all time during Cardiopulmonary Bypass. Pulmonary artery bands were removed, with no residual stenosis; patent ductus arteriosus was disconnected and reconstruction of aortic arch was performed using a left pulmonary artery homograft, with no ascending aorta reimplantation. Atrial Septal Defect stent was removed and Glenn anastomosis was permormed.
Good hemodynamic recovery was observed (SO2 88%), and SVC/PA pressure ranged from 16 to 18 mmHg. Initial evolution was good, with tracheal extubation in 8th post operatory day, being reentubated in the next day. Pulmonary infection was detected and, despite antibiotic treatment, the child died in 12th post operatory day, after systemic infectious complications.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
This report was supported by the Brazilian Ministry of Health (Ministério da Saúde do Brasil).
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