How I Do It - Single Ventricle Palliation In Hypoplastic Left Heart Syndrome
Alan O'Donnell, James Tweddell.
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Stage I Palliation: Norwood Procedure with Sano Shunt Median sternotomy incision. All relevant structures mobilized. IA isolated. Longitudinal arteriotomy with end-to-side anastomosis between IA/ePTFE graft. CPB initiated. Ductus snared. Vent placed in RA free wall. Cooling to 18C. Pulmonary homograft 3cm x 3cm half-circle and small circular patches cut. MPA divided. Patch arterioplasty of branch PAs. DHCA established. Cardioplegia delivered. Atrial septectomy via RAA cannula site. Division of the ductus. DAo mobilized. Three intercostal branches divided. Clamp on Dao. Coarctectomy. ACP initiated. Arch incised along the inferior surface and down the AAo to the kissing point. Cutback onto left lateral side of the DAo. Interdigitating aortic arch reconstruction. Damus-Kaye-Stansel. Sano placed in RV free-wall via "Dunk Technique". Additional cutback on dAO. Anterior patch aortoplasty. Full cardiopulmonary bypass resumed. Rewarming. Distal Sano anastomosis. MUF. Chest closed. Superior Cavopulmonary Anastomosis (Bidirectional Glenn)A redo sternotomy is performed. CPB is initiated. No cardioplegia unless intracardiac work necessary. Blue clamp is placed on SVC/RA junction. ECG is monitored. Ligation and division of Sano. Sano excised from PAs. Underside of PAs opened as needed. SVC divided, RA oversewn. Posterior edge of SVC sutured to posterior edge of PA incision. Anterior PA arterioplasty with small pulmonary homograft patch.. Total Cavopulmonary Connection (Extracardiac Fenestrated Fontan) A redo sternotomy is performed. PAs mobilized. CPB initiated. Blue clamp placed on IVC/RA junction. ECG monitored. Division of IVC/RA. RA end oversewn. SVC connection to graft, followed by IVC. Fenestration sutured to RA.
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