Operação de Glenn bidirecional no tratamento estagiado da síndrome de hipoplasia do coração esquerdo: resultados imediatos e tardios

Abstract

Objective: To report early and long-term results of bidirectional Glenn procedure as the second stage for Hypoplastic Left Heart Syndrome (HLHS) treatment and describe a ministernotomy technique. Method: From March 1998 to February 2004, 15 patients who had been previously submitted to the Norwood procedure underwent elective partial cavopulmonary anastomosis. Ages ranged from 2 to 6 months (mean 3.46 ± 0.83 months). Six were male. Ministernotomy was performed in 11 (73.3%) patients. In order to obtain adequate initial blood oxygenation, an accessory 3-mm PTFE shunt was used in 9 patients and the right ventricle-pulmonary artery tube was maintained in one case. Clinical and echocardiographic follow-up was obtained in all patients. Results: Hospital survival was 86.6%, with one early death caused by surgical bleeding and another due to hypoxemia. Postoperative echocardiogram showed some early blood flow in the PTFE shunt and its closure in the long-term follow-up. There were two late deaths, one due to tracheostomy complications and another due to infectious meningitis. Seven patients, who are waiting for the third stage, are doing well clinically. Four patients have already undergone the third stage, successfully. The echocardiograms of 11 late survival patients showed good right ventricular function, no tricuspid regurgitation and good cavopulmonary blood flow over a 2.5-year mean follow-up time. Conclusions: The Glenn procedure in HLHS resulted in a low mortality rate and satisfactory long-term outcomes, and can be performed using the ministernotomy technique. An accessory source of systemic-pulmonary flow in very small infants seems to improve the oxygen saturation.