Anthony Azakie, MD, Natalie C. Johnson, BS, Petros V

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Presentation transcript:

Stage II palliation of hypoplastic left heart syndrome without cardiopulmonary bypass Anthony Azakie, MD, Natalie C. Johnson, BS, Petros V. Anagnostopoulos, MD, Sami M. Akram, MD, Patrick McQuillen, MD, Anil Sapru, MD The Journal of Thoracic and Cardiovascular Surgery Volume 141, Issue 2, Pages 400-406 (February 2011) DOI: 10.1016/j.jtcvs.2010.10.047 Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Operative technique. See text for details. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 400-406DOI: (10.1016/j.jtcvs.2010.10.047) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Flow diagram of the cohort of patients having undergone a Norwood procedure and the subsequent study population of patients who were palliated with bidirectional cavopulmonary anastomosis (BCPA) without cardiopulmonary bypass (CPB) from April 2003 to March 2010. CI, Confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 400-406DOI: (10.1016/j.jtcvs.2010.10.047) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Intraoperative near-infrared spectroscopy as an indicator of cerebral oxygenation during off-pump bidirectional cavopulmonary anastomosis. A, Baseline near-infrared spectroscopic oximetry in an infant with hypoplastic left heart syndrome who had a right ventricle–pulmonary artery conduit modification of the Norwood procedure. The procedure was performed after achievement of general anesthesia for stage II palliation. B, The fraction of inspired oxygen is increased to 1, and cerebral oxygen saturation increases from 50% to 65%. C, The right pulmonary artery is controlled, and the superior vena caval–right atrial venous shunt is inserted. The superior vena cava is snared. The cerebral oxygen saturation decreases to 50%. D, The bidirectional cavopulmonary anastomosis is complete, and the caval snares and right pulmonary artery clamps are released. The cerebral oxygen saturation increases to 60%. E, The single right ventricle is retracted, and the right ventricle–pulmonary artery conduit is dissected, encircled, and ligated and divided. F, The cardiac retraction is terminated. G, The bidirectional cavopulmonary anastomosis with division of the right ventricle–pulmonary artery conduit is complete. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 400-406DOI: (10.1016/j.jtcvs.2010.10.047) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions