| From your Guide Dr.MANI |  | |
Single Ventricle | ||
| From your Guide Dr.MANI | | |
Single Ventricle | ||
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Should Single Ventricle be treated ?
The natural history of single ventricle conditions is highly variable depending on the functional condition as described earlier. In a group of patients with balanced circulations, survival at 10 years may be over 90%. Overall, as a group, two thirds of single ventricle patients will survive one year after birth, and only one third will live to their tenth birthday. In view of this poor course of events, single ventricle almost always needs early surgery, sometimes soon after diagnosis is made.
What are the surgical options for single ventricle ?
Operation for single ventricle depends on many different factors including the functional type, age, symptom status, condition of the lung blood vessels and pulmonary resistance and the presence of associated defects.
Palliative Operations
Modified B-T Shunt Pulmonary Artery Banding Damus-Stansel-Kaye Operation Norwood Operation and Arterial Switch Operation Intermediate operations ... Read on
As an initial procedure, many patients will need one of the palliative operations to tide over crises and to prepare the pulmonary arteries for definitive repair. After palliative procedures, patients are followed up at periodic intervals and plans made for repair at the earliest optimal time.
This is the same operation that is used in patients with Tetralogy of Fallot. A tube graft is used to connect the subclavian branch of the aorta to the pulmonary artery. It is necessary in patients with narrowing of the pulmonary artery causing low oxygen saturation and cyanosis. The BT shunt will increase lung blood flow, improve oxygen saturation and relieve cyanosis.
This operation is performed in the setting of increased lung blood flow due to a normal pulmonary artery. It is a closed heart operation (that is, it does not require connecting the patient to the heart lung machine) that may be carried out through an incision on the left side of the chest, or through a midline incision that cuts open the breastbone. The surgeon will place a "band" (a narrow tape of fabric) around the pulmonary artery and tighten it just enough to
allow adequate blood flow into the lungs to avoid cyanosis
reduce the excessive flow, so that pulmonary artery pressure is one half of the aortic pressure
Pulmonary Artery Banding has some disadvantages. The band may be too tight or too loose. Rarely, the band may migrate to one of the pulmonary artery branches and narrow it. In single ventricle conditions, one of the important drawbacks is the later development of sub-aortic obstruction after a banding operation.
This is an another operation that can be done in patients who have sub-aortic narrowing. The pulmonary artery is divided just below the level where it branches into the right and left pulmonary arteries. The pulmonary artery is then sutured to an opening in the side of the aorta. Blood from the single ventricle can now flow into the pulmonary artery and then into the aorta, bypassing the area of sub-aortic narrowing. Blood flow into the lungs is achieved by creating a modified BT shunt to one of the branch pulmonary arteries.
These rather more complex operations are necessary in cases where the narrowing in the sub-aortic region is combined with a more generalized under-development of the entire aortic arch. The Norwood operation is explained in the section on Hypoplastic Left Heart Syndrome and the Arterial Switch operation in the article on Transposition of the Great Arteries.
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