2024 Volume 40 Issue 1 Pages 3-8
Although treatment for hypoplastic left heart syndrome has improved, this condition is still considered high-risk.
[Aortic reconstruction] Aortic stenosis causes postoperative heart failure by increasing afterload and thus pulmonary blood flow. Patch augmentation of the entire arch is a common reconstruction technique for creating a large flow path. In Japan, however, reconstruction with primarily autologous tissue is common.
[Pulmonary artery reconstruction] The pulmonary blood flow must be adequate. Excessive pulmonary blood flow causes cardiac volume overload, while insufficient blood flow results in hypoxemia. A right ventricular-pulmonary artery conduit provides hemodynamic stability. This is considered an option, particularly for patients with a poor preoperative condition, such as low cardiac function or tricuspid valve regurgitation. However, there are concerns about the right ventricular incision, which can lead to ventricular dysfunction, and conduit stenosis.
[Bilateral pulmonary artery banding] Many Japanese institutions perform bilateral pulmonary artery banding as the first palliative procedure. It significantly reduces the risk of low birth weight, prematurity, cerebral hemorrhage, and complications of early cardiopulmonary bypass. It is expected to improve long-term outcomes, including neurodevelopment, by postponing open chest surgery during the neonatal period.
[Extracorporeal circulation] Partial cerebral perfusion is widely used in Japan. Complete circulatory arrest by hypothermia is most commonly used in North America and Europe, though the number of such procedures has grown in recent years. Lower body perfusion is also commonly used in Japan, but it has not become the standard method in other countries. Lower body blood perfusion is expected to reduce renal failure and shorten the intensive care unit stay.
