Use of mathematical modeling to compare and predict hemodynamic effects between hybrid and surgical Norwood palliations for hypoplastic left heart syndrome.
نویسندگان
چکیده
BACKGROUND Combining bilateral pulmonary artery banding with arterial duct stenting, the hybrid approach achieves stage 1 palliation for hypoplastic left heart syndrome with different flow characteristics than those after the surgical Norwood procedures. Accordingly, we used computational modeling to assess some of these differences, including influence on systemic and cerebral oxygen deliveries. METHODS AND RESULTS A 3-dimensional computational model of hybrid palliation was developed by the finite volume method, along with models of the Norwood operation with a modified Blalock-Tausig or right ventricle-to-pulmonary artery shunt. Hybrid circulation was modeled with a 7-mm ductal stent and bilateral pulmonary artery banding to a 2-mm diameter. A 3.5-mm conduit was used in the Blalock-Tausig shunt model, whereas a 5-mm conduit was used in the right ventricle-to-pulmonary artery shunt model. Coupled to all the models was an identical hydraulic network that described the entire circulatory system based on pre-stage 2 hemodynamics. This clinically validated multiscale approach predicts flow dynamics, as well as global cardiac output, mixed venous oxygen saturation, and systemic and cerebral oxygen delivery. Compared with either of the Norwood models, the hybrid palliation had higher pulmonary-to-systemic flow ratio and lower cardiac output. Total systemic oxygen delivery was markedly reduced in the hybrid palliation (Blalock-Tausig shunt 591, right ventricle-to-pulmonary artery shunt 640, and hybrid 475 mL · min(-1) · m(-2)). Cerebral oxygen delivery was similarly lower in the hybrid palliation. CONCLUSIONS These computational results suggest that the hybrid approach may provide inferior systemic and cerebral oxygen deliveries compared with either of the 2 surgical Norwood procedures before stage 2 palliation.
منابع مشابه
Norwood Procedure for Palliation of Hypoplastic Left Heart Syndrome: Right Ventricle to Pulmonary Artery Conduit vs Modified Blalock-Taussig Shunt.
Patients with hypoplastic left heart syndrome undergo a series of operations to separate the pulmonary and systemic circulations. The first of at least 3 operations occurs in the newborn period, with a stage I palliation. The goal of stage I palliation is to provide pulmonary blood flow and create an unobstructed systemic outflow tract. Advances in surgical techniques and intraoperative and pos...
متن کاملSurgical palliation strategy does not affect interstage ventricular dysfunction or atrioventricular valve regurgitation in children with hypoplastic left heart syndrome and variants.
BACKGROUND All 3 palliation strategies, Norwood, Sano, and Hybrid, currently used for hypoplastic left heart syndrome pose a risk of myocardial injury at different times and through different mechanisms. We sought to compare these strategies to understand longitudinal differences in interstage ventricular dysfunction and their subsequent impact on transplant-free survival and atrioventricular v...
متن کاملComparison of hemodynamics between Norwood procedure and systemic-to-pulmonary artery shunt for single right ventricle patients.
OBJECTIVE Despite that surgical outcomes of patients with hypoplastic left heart syndrome have improved, one of the problems remaining is the high interstage mortality after a stage I Norwood procedure. The purpose of this study was to determine the hemodynamic characteristics of hypoplastic left heart syndrome after a Norwood procedure. We examined the perioperative hemodynamic differences of ...
متن کاملHybrid Palliation for Neonates With Hypoplastic Left Heart Syndrome: Current Strategies and Outcomes
In the last decade the hybrid procedure has emerged as an alternative stage I palliation in neonates with hypoplastic left heart syndrome (HLHS). This review discusses the historical aspect, surgical and interventional techniques, current outcomes and future direction of this procedure. Hybrid palliation yields equivalent but not superior stage I palliation survival and comparable 1-year surviv...
متن کاملImproving the outcome of high-risk neonates with hypoplastic left heart syndrome: hybrid procedure or conventional surgical palliation?
OBJECTIVES Despite significant progress, surgical outcome for high-risk patients with hypoplastic left heart syndrome (HLHS) remain suboptimal. The hybrid palliation lessens the initial operative insult and is expected to improve overall survival; however the outcome of this management sequence is unknown. METHODS Retrospective review of all high-risk neonates (prematurity, low birth weight, ...
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ورودعنوان ژورنال:
- Circulation
دوره 124 11 Suppl شماره
صفحات -
تاریخ انتشار 2011