The Journal of Thoracic and Cardiovascular Surgery, Vol 99, 885-888, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Hypoplastic left heart syndrome: palliation without cardiopulmonary bypass
WY Tucker, RC McKone, KM Weesner and ND Kon
Department of Cardiothoracic Surgery, Bowman Gray School of Medicine, Wake Forest University Medical Center, Winston-Salem, N.C. 27103.
Our 100% mortality rate with first-stage palliation of hypoplastic left
heart syndrome performed with cardiopulmonary bypass led us to a procedure
not necessitating bypass. In nine neonates with this congenital heart
defect, a woven Dacron graft was placed from the main pulmonary artery to
the descending thoracic aorta. The patent ductus arteriosus was ligated and
the main pulmonary artery banded distal to the graft and proximal to the
bifurcation. Five patients were extubated within 4 days. Only low-dose
inotropic support was required in eight of the nine. There were no bleeding
problems. Four patients died in the hospital: one of Candida sepsis at 81
days, one of low cardiac output at 2 days, and two of restrictive atrial
septal defect at 3 and 5 days. The five living patients were discharged 11
to 80 days postoperatively (mean 38 days). We now perform balloon
septostomies preoperatively in all patients and believe that this will
improve the survival rate. We believe this simpler approach to the
treatment of hypoplastic left heart syndrome may allow survival for a
cardiac transplant or a staged Fontan procedure at a later date for more
definitive treatment.
