Preview

Complex Issues of Cardiovascular Diseases

Advanced search

THE 1st STAGE OF HEMODYNAMIC STRATEGIES FOR MANAGEMENT OF HYPOPLASTIC LEFT HEART SYNDROME

https://doi.org/10.17802/2306-1278-2026-15-1-109-125

Abstract

Highlights

The research presented in this paper evaluates the alternatives for the 1st stage of hemodynamic correction of HLHS, outlines possible complications that may emerge in the postoperative phase, and provides approaches for their overcome in the intraoperative period.

 

Abstract

Hypoplastic left heart syndrome (HLHS) is a congenital heart disease that describes in the underdevelopment of the left-sided structures of the heart. HLHS is a rare defect in infants born and occurs in 2–3% of all congenital heart diseases. Primary heart transplantation demonstrates a radical correction of HLHS. However, a shortage of organs and a prohibition on this procedure to juvenile make it unavailable. Therefore, this review presents options for surgical correction of newborns with hypoplastic left heart syndrome, their advantages and disadvantages, as well as possible complications.

About the Authors

Ekaterina N. Amansakhatova
Meshalkin National Medical Research Center; Novosibirsk State University
Russian Federation

Research Intern, Department of Congenital Heart Disease Research, Resident Physician in Cardiovascular Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation; Student of V. Zelman Institute of Medicine and Psychology, Novosibirsk State University, Novosibirsk, Russian Federation



Ilya A. Soynov
Meshalkin National Medical Research Center
Russian Federation

PhD, MD, Head of the Department of Congenital Heart Disease Research, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation



Yuriy Yu. Kulyabin
Meshalkin National Medical Research Center
Russian Federation

PhD, Cardiovascular Surgeon, Department of Congenital Heart Disease Surgery, Research Fellow, Department of Congenital Heart Disease Research, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation



Nataly R. Nichay
Meshalkin National Medical Research Center; Novosibirsk State Medical University
Russian Federation

PhD, Cardiovascular Surgeon, Department of Congenital Heart Disease Surgery, Research Fellow, Department of Congenital Heart Disease Research, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation; Assistant Department of Cardiovascular Surgery, Novosibirsk State Medical University, Novosibirsk, Russian Federation



Kseniya A. Rzaeva
Almazov National Medical Research Center
Russian Federation

PhD, Endovascular Surgeon, Almazov National Medical Research Center, Saint Petersburg, Russian Federation



Olga S. Anikina
Meshalkin National Medical Research Center
Russian Federation

Anesthesiologist and Intensive Care Physician, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation



Ilya A. Velyukhanov
Meshalkin National Medical Research Center
Russian Federation

Head of the Pediatric Intensive Care Unit, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation



Alex N. Arkhipov
Meshalkin National Medical Research Center
Russian Federation

PhD, Head of the Department of Congenital Heart Disease, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation



References

1. Tulzer A., Huhta J.C., Hochpoechler J., Holzer K., Karas T., Kielmayer D., Tulzer G. Hypoplastic Left Heart Syndrome: Is There a Role for Fetal Therapy? Frontiers Pediatrics. 2022;10:944813. doi: 10.3389/fped.2022.944813.

2. Alphonso N., Angelini A., Barron D.J., Bellsham-Revell H., Blom N.A., Brown K., Davis D., Duncan D., Fedrigo M., Galletti L., Hehir D., Herberg U., Jacobs J.P., Januszewska K., Karl T.R.; (Chaiman HLHS Guidelines Task Force); Malec E., Maruszewski B., Montgomerie J., Pizzaro C., Schranz D., Shillingford A.J., Simpson J.M. Guidelines for the management of neonates and infants with hypoplastic left heart syndrome: The European Association for Cardio-Thoracic Surgery and the Association for European Paediatric and Congenital Cardiology Hypoplastic Left Heart Syndrome Guidelines Task Force. European Journal Cardio-t-Thoracic Surgery. 2020; 58(3):416-499. doi: 10.1093/ejcts/ezaa188.

3. Knirsch W., De Silvestro A., von Rhein M. Neurodevelopmental and functional outcome in hypoplastic left heart syndrome after Hybrid procedure as stage I. Frontiers Pediatrics. 2023;10:1099283. doi: 10.3389/fped.2022.1099283.

4. Halivopulo I.K., Troshkinev N.M., Shabaev I.F., Borisenko D.V., Lyapin A.A., Evtushenko A.V., Barbarash L.S. The modified Norwood procedure for hypoplastic left heart syndrome: first experince of using the «KemAngioprotez» vascular xenograft. Complex Issues of Cardiovascular Diseases. 2023;12(3): 145-151. DOI: 10.17802/2306-1278-2023-12-3-145-151

5. Kritzmire S.M., Cossu A.E. Hypoplastic Left Heart Syndrome. Treasure Island (FL): StatPearls Publishing; 2023. Available at: https://www.ncbi.nlm.nih.gov/books/NBK554576/ (accessed 12.03.2024)

6. Suvorov V.V., Zaitsev V.V., Pilyugov N.G., Badurov R.B., Kupatadze D.D., Komissarov M.I., Dolgova E.V., Kolbaya L.M., Aleshin I.Yu. Techniques for pulmonary artery narrowing in patients with congenital heart disease and ductal-dependent systemic circulation. Journal of Cardiology and Cardiovascular Surgery. 2023;16(1):24–31. (In Russ.). doi: 10.17116/kardio20231601124

7. Schranz D., Esmaeili A., Akintuerk H. Hypoplastic Left Heart: Stage-I Will be Performed Interventionally, Soon. Pediatric Cardiologist. 2021;42(4):727-735. doi: 10.1007/s00246-021-02597-y.

8. Soynov I., Omelchenko A., Keyl I., Leykekhman A., Chaschin O., Galstyan M., Gorbatykh Y., Arkhipov A. Palliative surgery of a patient with hypoplastic left heart syndrome and low body weight. Journal of Experimental and Clinical Surgery. 2020; 13(1), 51-54. (In Russ.) doi: 10.18499/2070-478X-2020-13-1-51-54

9. Arnaout A.Y., Nerabani Y., Ali H.A., Shahrour M.Z., Fallaha M.Y., Arnaout I., Sajee A., Morjan M., Al-Kanj H. Mortality and Survival after Norwood Procedure Comparison between Shunt Type in Patients with Hypoplastic Left Heart Syndrome or Its Variants: A Systematic Review and Meta-Analysis Study. Journal of Cardiac Surgery. 2023;18. doi: 10.1155/2023/8534205

10. Rai V., Gładki M., Dudyńska M., Skalski J. Hypoplastic left heart syndrome [HLHS]: treatment options in present era. Indian Journal Thoracic Cardiovascular Surgery. 2019;35(2):196-202. doi: 10.1007/s12055-018-0742-z. Epub 2018 Oct 31. PMID: 33061005; PMCID: PMC7525540.

11. John M.M., McKenzie E.D. Norwood procedure: How I do it. JTCVS Techniques. 2020;4:205-207. doi: 10.1016/j.xjtc.2020.08.026.

12. Suvorov V., Zaitcev V., Andrzejczyk K. Effectiveness of Bilateral Pulmonary Artery Banding in Patients with Hypoplastic Left Heart Syndrome and Congenital Heart Defects with A Functional Single Ventricle: A Single-Center Retrospective Study. Congenital Heart Disease. 2022; 17(3):365–374. doi: 10.32604/chd.2022.019126.

13. Wilder T.J., Caldarone C.A. Apples to oranges: Making sense of hybrid palliation for hypoplastic left heart syndrome. JTCVS Open. 2020; 4:47-54. doi: 10.1016/j.xjon.2020.10.002.

14. Avramenko A. A., Khokhlunov S. M. Technical features of Norwood procedure as the most important factor, affecting theoutcome of treatment of single-ventricle patients with obstructed systemic output. Vestnik khirurgii imeni I. I. Grekova. 2019;178(1):11–16. (In Russ) doi: 10.24884/0042-4625-2019-178-1-11-16.

15. Mahat U., Ahuja S., Talati R. Shunt thrombosis in pediatric patients undergoing staged cardiac reconstruction for cyanotic congenital heart disease. Progress in Pediatric Cardiology. 2020; 56. doi:10.1016/jj.ppedcard.2019.101190

16. Mahle W.T., Hu C., Trachtenberg F., Menteer J., Kindel S.J., Dipchand A.I., Richmond M.E., Daly K.P., Henderson H.T., Lin K.Y., McCulloch M., Lal A.K., Schumacher K.R., Jacobs J.P., Atz A.M., Villa C.R., Burns K.M., Newburger J.W.; Pediatric Heart Network Investigators. Heart failure after the Norwood procedure: An analysis of the Single Ventricle Reconstruction Trial. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 2018; 37(7):879-885. doi: 10.1016/j.healun.2018.02.009.

17. Sun Y., Deng X.M., Cai Y., Shen S.E., Dong L.Y. Post-cardiopulmonary bypass hypoxaemia in paediatric patients undergoing congenital heart disease surgery: risk factors, features, and postoperative pulmonary complications. BMC cardiovascular disorders. 2022; 22(1):430. doi: 10.1186/s12872-022-02838-9.

18. Gellings J.A., Johnson W.K., Ghanayem N.S., Mitchell M., Tweddell J., Hoffman G., Hraska V., Kuhn E.M., Woods R.K. Norwood Procedure-Difficulty in Weaning From Cardiopulmonary Bypass and Implications for Outcomes. Seminars in Thoracic and Cardiovascular Surgery. 2020; 32(1):119-125. doi: 10.1053/j.semtcvs.2019.08.005.

19. Roberts A., Duncan E.C., Hargrave P., Kingery D.R., Barnes J., Horstemeyer D.L., Stahl R.F. Complications of Cardiopulmonary Bypass From an Anesthesia Perspective: A Clinical Review. HCA Healthcare Journal Medicine. 2023; 4(1):13-21. doi: 10.36518/2689-0216.1525.

20. Sano S., Kouretas P.C., Kobayashi Y., Kotani Y., Kasahara S. How to Reconstruct Neo-Aortic Arch Without Patch at Norwood-Sano Procedure. Operative Techniques in Thoracic and Cardiovascular Surgery. 2020; 25(4): 221-241. doi:10.1053/j.optechhstcvs.2020.07.004.

21. White M.H., Kelleman M., Sidonio R.F. Jr., Kochilas L., Patel K.N. Incidence and Timing of Thrombosis After the Norwood Procedure in the Single-Ventricle Reconstruction Trial. Journal of American Heart Association. 2020; 9(24):e015882. doi: 10.1161/JAHA.120.015882.

22. Kalfa D., Buratto E., Goldstone A., Bacha E. Valved Conduit for Norwood-Sano Procedure. Operative Techniques in Thoracic and Cardiovascular Surgery. 2023; 29(1):25-36. doi:10.1053/j.optechstcvs.2023.09.005.

23. Mascio, C.E., Spray, T.L. Surgical Approaches to the Hypoplastic Left Heart Syndrome. Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care. 2020. doi:10.1007/978-1-4471-4999-6_38-2.

24. Asada S., Yamagishi M., Maeda Y., Itatani K., Fujita S., Hongu H, Nakatsuji H., Yaku H. Chimney reconstruction provides a wider subaortic space and reduces the risk of pulmonary artery compression in the Norwood-type aortic arch reconstruction without patch supplementation. European Journal of Cardio-Thoracic Surgery. 2021; 60(6):1408–1416. doi:10.1093/ejcts/ezab184.

25. Winder MM, Ware A, Husain A, Griffiths E, Swink JM, Ou Z, Eckhauser A. Interdigitating Technique for Repair of Aortic Arch Obstruction to Reduce Reintervention Rates. Ann Thorac Surg. 2024 Feb;117(2):387-394. doi: 10.1016/j.athoracsur.2023.06.015.

26. Soynov IA, Gorbatykh AV, Kulyabin YuYu, Arkhipov AN, Nichay NR, Zubritskiy AV, Voitov AV, Gorbatykh YuN, Galstyan MG, BogachevProkophiev AV. Early and long-term results after the Norwood procedure. Diagnostic clinical algorithm for mediastinal tumors. Pirogov Russian Journal of Surgery = Khirurgiya. Zurnal im. N.I. Pirogova. 2022;5:59–67. (In Russ.). https://doi.org/10.17116/hirurgia202205159

27. Vitanova K., Cleuziou J., Pabst von Ohain J., Burri M., Eicken A., Lange R. Recoarctation After Norwood I Procedure for Hypoplastic Left Heart Syndrome: Impact of Patch Material. Annals of Thoracic Surgery. 2017; 103(2):617-621. doi: 10.1016/j.athoracsur.2016.10.030.

28. Asada S., Yamagishi M., Itatani K., Maeda Y., Taniguchi S., Fujita S., Hongu H., Yaku H. Early outcomes and computational fluid dynamic analyses of chimney reconstruction in the Norwood procedure. Interactive cardiovascular and thoracic surgery. 2019; 29(2):252–259. doi: 10.1093/icvts/ivz040.

29. Yamagishi M. Chimney Technique for Aortic Arch Repair in the Norwood Operation, Operative Techniques in Thoracic and Cardiovascular Surgery. 2019; 24(4): 237-255. doi: 10.1053/j.optechstcvs.2019.10.004.

30. Asada S., Yamagishi M., Itatani K., Yaku H. Chimney reconstruction of the aortic arch in the Norwood procedure. Journal of Thoracic and Cardiovascular Surgery. 2017; 154(3):e51-e54. doi: 10.1016/j.jtcvs.2017.04.079.

31. Bautista-Hernandez V., Avila-Alvarez A., Marx G.R., Del Nido P.J. Current surgical options and outcomes for newborns with hypoplastic left heart syndrome. Anales de Pediatria. 2019; 91(5):352.e1-352.e9. doi: 10.1016/j.anpedi.2019.09.007.

32. Tanem J., Rudd N., Rauscher J., Scott A., Frommelt M.A., Hill G.D. Survival After Norwood Procedure in High-Risk Patients. Annals of Thoracic Surgery. 2020; 109(3):828-833. doi: 10.1016/j.athoracsur.2019.07.070.

33. Sower C.T., Romano J.C., Yu S., Lowery R., Pasquali S.K., Zampi J.D. Early and Midterm Outcomes in High-risk Single-ventricle Patients: Hybrid Vs Norwood Palliation. Annals of Thoracic Surgery. 2019; 108(6):1849-1855. doi: 10.1016/j.athoracsur.2019.06.061.

34. Wilder T.J., Caldarone C.A. Apples to oranges: Making sense of hybrid palliation for hypoplastic left heart syndrome. JTCVS Open. 2020; 4:47-54. doi: 10.1016/j.xjon.2020.10.002.

35. Oreto L., Guccione P., Gitto P., Bruno L., Zanai R., Grasso N., Iannace E., Zito C., Carerj S., Agati S. Hybrid Palliation for Hypoplastic Left Heart Syndrome: Role of Echocardiography. Children (Basel). 2023; 10(6):1012. doi: 10.3390/children10061012.

36. Akay E., Işık O., Engin A.Y., Çakır V. Stage 1 hybrid palliation of hypoplastic left heart syndrome: an initial experience in pulmonary trunk approach, procedural modifications, and complication management. Turkish journal of medical sciences. 2019; 49(5):1374-1380. doi: 10.3906/sag-1903-1

37. Ross C.J., Mir A., Burkhart H.M., Holzapfel G.A., Lee C.H. Tricuspid Valve Regurgitation in Hypoplastic Left Heart Syndrome: Current Insights and Future Perspectives. Journal of Cardiovascular Development and Disease. 2023; 10(3):111. doi: 10.3390/jcdd10030111.

38. Ponzoni M., Azzolina D., Vedovelli L., Gregori D., Vida V.L., Padalino M.A. Tricuspid Valve Repair Can Restore the Prognosis of Patients with Hypoplastic Left Heart Syndrome and Tricuspid Valve Regurgitation: A Meta-analysis. Pediatric Cardiologist. 2023. doi: 10.1007/s00246-023-03256-0.

39. Ono M., Mayr B., Burri M., Piber N., Röhlig C., Strbad M., Cleuziou J., Hager A., Hörer J., Lange R. Tricuspid valve repair in children with hypoplastic left heart syndrome: impact of timing and mechanism on outcome. European Journal of Cardio-Thoracic Surgery. 2020; 57(6):1083-1090. doi: 10.1093/ejcts/ezaa004.

40. Kanno K., Ikai A., Murata M., Sakamoto K. The interannular bridge: A new technique for the management of tricuspid regurgitation in hypoplastic left heart syndrome. Journal of thoracic and cardiovascular surgery. 2020; 159(3):e219-e221. doi: 10.1016/j.jtcvs.2019.06.080.

41. Pisesky A., Shah S., Seed M., Schwartz S.M., Russell J., Pereira-Solomos P., Thomas J., Van Arsdell G., Floh A. Standardisation of management after Norwood operation has not improved 1-year outcomes. Cardiology in the Young. 2021; 31(1):105-113. doi: 10.1017/S1047951120003376.

42. Sames-Dolzer E., Gierlinger G., Kreuzer M., Mair R., Gitter R., Prandstetter C., Tulzer G., Mair R. Aortic arch reconstruction in the Norwood procedure using a curved polytetrafluorethylene patch. European Journal of Cardio-Thoracic Surgery. 2022; 61(2):329-335. doi: 10.1093/ejcts/ezab433.

43. Kobayashi Y., Kotani Y., Kawabata T., Kuroko Y., Sano S., Kasahara S. Does the size of pulmonary artery impact on recoarctation of the aorta after the Norwood procedure without patch? Interactive CardioVascular and Thoracic Surgery. 2021; 33(5):765-772. doi: 10.1093/icvts/ivab170.

44. Szypulski A., Rai V., Sacharczuk J., Gładki M., Mokra A., Żurek R., Skalski J.H., Mroczek T. Risk factors for recoarctation of aorta after Norwood procedure in patients with hypoplastic left heart syndrome. Folia Medica Cracoviensia. 2018; 58(3):11-21. doi: 10.24425/fmc.2018.125070.

45. Mroczek T., Czerżyńska M., Sacharczuk J., Żurek R., Wójcik E., Morka A,. Kuźma J., Skalski J.H. Recoarctation of the aorta after the Norwood procedure may be treated during the second stage of the surgical palliation. European Journal of Cardio-Thoracic Surgery. 2019; 56(6):1186-1191. doi: 10.1093/ejcts/ezz241.

46. Devlin P.J., McCrindle B.W., Kirklin J.K., Blackstone E.H., DeCampli W.M., Caldarone C.A., Dodge-Khatami A., Eghtesady P., Meza J.M., Gruber P.J., Guleserian K.J., Alsoufi B., Lambert L.M., O'Brien J.E. Jr, Austin E.H. 3rd, Jacobs J.P., Karamlou T. Intervention for arch obstruction after the Norwood procedure: Prevalence, associated factors, and practice variability. Journal of thoracic and cardiovascular surgery. 2019; 157(2):684-695.e8. doi: 10.1016/j.jtcvs.2018.09.130.

47. Santro T., d'Udekem Y., Zannino D., Hobbes B., Konstantinov I.E., Brizard C., Brink J. Determinants of acute events leading to mortality after shunt procedure in univentricular palliation. Journal of thoracic and cardiovascular surgery. 2019; 158(4):1144-1153.e6. doi: 10.1016/j.jtcvs.2019.03.126.

48. Soynov IA, Kulyabin YuYu, Omel'chenko AIu, Leykekhman AV, Voitov AV, Gorbatykh IuN, Arkhipov AN, Bogachev-Prokof'ev AV. Home monitoring of patients with hypoplastic left heart syndrome within the interstage period. Russian Journal of Cardiology and Cardiovascular Surgery. 2020;13(2):134‑141. (In Russ.) https://doi.org/10.17116/kardio202013021134

49. Balsara S.L., Burstein D., Ittenbach R.F., Kaplinski M., Gardner M.M., Ravishankar C., Rossano J., Goldberg D.J., Mahle M., O'Connor M.J., Mascio C.E., Gaynor J.W., Preminger T.J. Combined ventricular dysfunction and atrioventricular valve regurgitation after the Norwood procedure are associated with attrition prior to superior cavopulmonary connection. JTCVS Open. 2023; 16:714-725. doi: 10.1016/j.xjon.2023.09.042.

50. Friedberg M.K., Reddy S. Right ventricular failure in congenital heart disease. Current opinion in pediatrics. 2019; 31 (5):604-610. doi: 10.1097/MOP.0000000000000804.

51.


Review

For citations:


Amansakhatova E.N., Soynov I.A., Kulyabin Yu.Yu., Nichay N.R., Rzaeva K.A., Anikina O.S., Velyukhanov I.A., Arkhipov A.N. THE 1st STAGE OF HEMODYNAMIC STRATEGIES FOR MANAGEMENT OF HYPOPLASTIC LEFT HEART SYNDROME. Complex Issues of Cardiovascular Diseases. 2026;15(1):109-125. (In Russ.) https://doi.org/10.17802/2306-1278-2026-15-1-109-125

Views: 96

JATS XML


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 2306-1278 (Print)
ISSN 2587-9537 (Online)