Hybrid stage I palliation for hypoplastic left heart syndrome has no advantage on ventricular energetics: a theoretical analysis

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• 作者：Shuji Shimizu ; Toru Kawada ; Dai Une ; Toshiaki Shishido…
• 关键词：Hypoplastic left heart syndrome ; Hybrid procedure ; Norwood procedure ; Ventricular energetics ; Computational model
• 刊名：Heart and Vessels
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：31
• 期：1
• 页码：105-113
• 全文大小：656 KB
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• 作者单位：Shuji Shimizu (1) (2)
  Toru Kawada (1)
  Dai Une (1)
  Toshiaki Shishido (1)
  Atsunori Kamiya (1)
  Shunji Sano (2)
  Masaru Sugimachi (1)
  
  1. Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
  2. Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Okayama, 700-8558, Japan
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Cardiology
  Cardiac Surgery
  Vascular Surgery
  Biomedical Engineering
  Interventional Radiology
  Ultrasound
  
• 出版者：Springer Japan
• ISSN：1615-2573

文摘

A hybrid procedure combining bilateral pulmonary artery banding with ductal stenting has recently been used as stage I palliation for hypoplastic left heart syndrome. However, the advantage of the hybrid procedure over the Norwood procedure on ventricular energetics remains unclear. To clarify this, we performed a computational analysis with a combination of time-varying elastance chamber model and modified three-element Windkessel vascular model. Although mean pulmonary artery (PA) pressure, pulmonary flow, and oxygen saturation were almost equivalent with the Norwood procedure, the hybrid procedure delivered higher systolic and lower diastolic systemic arterial pressures compared to the Norwood procedure with right ventricle (RV) to PA shunt. As a result, the hybrid procedure yielded increased systolic pressure–volume area and impaired mechanical efficiency. Therefore, the hybrid procedure has probably no advantage on ventricular energetics compared to the Norwood procedure with a RV-PA shunt.