Abstract:Introduction and Objective
There are various management options for newborns with single ventricle physiology, ventriculoarterial discordance and subaortic stenosis, classically involving the early pulmonary banding and aortic arch repair, the restricted bulboventriculer foramen enlargement or the Norwood and the Damus–Kaye–Stansel procedures. The aim of this study is to evaluate our preferred technique and comment on the midterm results of our clinical experience with palliative arterial switch operation (pAS… Show more
“…For newborns with single ventricle physiology, ventriculo-arterial discordance and subaortic stenosis, hypoplasia of ascending aorta and aortic arch, various surgical options were introduced, classically involving early pulmonary banding and aortic arch reconstruction, with or without the enlargement of restricted bulbo-ventricular foramen, or the Damus-Kaye-Stansel procedure, associated with a new source of pulmonary blood flow, either with modified Blalock-Taussig shunt or with Sano right ventricle to pulmonary artery conduit (6,(86)(87)(88)(89)(90)(91)(92). An alternative approach introduced later was a palliative arterial or ventricular switch, both procedures requiring a longer aortic cross clamp times compared to other options but preserving systolic and diastolic ventricular function and providing a superior anatomic arrangement for the subsequent surgical stages (93)(94)(95)(96). Obstructed pulmonary venous connections is a quite rare but extremely severe complication in neonates with single ventricle physiology (97)(98)(99)(100)(101), but with proper pre-and post-operative imaging, recurrence can be monitored with reasonable outcomes (102).…”
Background and Objective: Key medical and surgical advances have been made in the longitudinal management of patients with "functionally" single ventricle physiology, with the principles of Fontan circulation applied to other complex congenital heart defects. The purpose of this article is to review all of the innovations, starting from fetal life, that led to a change of strategy for single ventricle.Methods: Our literature review included all full articles published in English language on the Cochrane, MedLine, and Embase with references to "single ventricle" and "univentricular hearts", including the initial history of the treatments for this congenital heart defects as well as the innovations reported within the last decades.
“…For newborns with single ventricle physiology, ventriculo-arterial discordance and subaortic stenosis, hypoplasia of ascending aorta and aortic arch, various surgical options were introduced, classically involving early pulmonary banding and aortic arch reconstruction, with or without the enlargement of restricted bulbo-ventricular foramen, or the Damus-Kaye-Stansel procedure, associated with a new source of pulmonary blood flow, either with modified Blalock-Taussig shunt or with Sano right ventricle to pulmonary artery conduit (6,(86)(87)(88)(89)(90)(91)(92). An alternative approach introduced later was a palliative arterial or ventricular switch, both procedures requiring a longer aortic cross clamp times compared to other options but preserving systolic and diastolic ventricular function and providing a superior anatomic arrangement for the subsequent surgical stages (93)(94)(95)(96). Obstructed pulmonary venous connections is a quite rare but extremely severe complication in neonates with single ventricle physiology (97)(98)(99)(100)(101), but with proper pre-and post-operative imaging, recurrence can be monitored with reasonable outcomes (102).…”
Background and Objective: Key medical and surgical advances have been made in the longitudinal management of patients with "functionally" single ventricle physiology, with the principles of Fontan circulation applied to other complex congenital heart defects. The purpose of this article is to review all of the innovations, starting from fetal life, that led to a change of strategy for single ventricle.Methods: Our literature review included all full articles published in English language on the Cochrane, MedLine, and Embase with references to "single ventricle" and "univentricular hearts", including the initial history of the treatments for this congenital heart defects as well as the innovations reported within the last decades.
“…The pASO was first proposed as an alternative strategy for patients with SV-TGA-SOO in the 1980s. 21 It has subsequently been successfully applied as initial palliation in the neonate and infant population 4 , 22 , 23 , 24 with successful promotion to Fontan. 4 , 23 , 24 , 25 Critiques of this approach include longer operative times, intraoperative complexity, and concern for coronary artery complications.…”
Section: Commentmentioning
confidence: 99%
“… 21 It has subsequently been successfully applied as initial palliation in the neonate and infant population 4 , 22 , 23 , 24 with successful promotion to Fontan. 4 , 23 , 24 , 25 Critiques of this approach include longer operative times, intraoperative complexity, and concern for coronary artery complications. Proposed benefits include alignment of the dominant semilunar valve with the systemic circulation, eliminating the need for BVF enlargement, postponement or avoidance of shunt-dependent physiology, and preserved LPA accessibility.…”
“…To the Editor, Okan Yurdakök et al 1 's recently published article "The choice of palliative arterial switch operation as an alternative for selected cases in a single center: Experience and midterm results" piques our interest. The authors' efforts are significant and should be recognized by the readers.…”
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