Single Ventricle Surgery

大多数孩子有单耳心心脏缺陷need a series of three operations to treat their condition. The goal of these surgeries is to enable one ventricle to do the work normally done by two ventricles. The单个脑室计划在波士欧宝彩票平台顿儿童医院，为所有类型的单一性心室缺陷提供护理，包括下面列出的所有手术。和The Fontan Clinic at Boston Children’soffers holistic, individualized care for patients of all ages who have had the Fontan procedure.

第1阶段：Norwood程序（新生儿）

第1阶段程序，也称为Norwood程序，是表演中最复杂的先天性心脏手术之一。挪威程序于1979年由威廉·诺伍德博士开发并首先在波士顿儿童医院进行。欧宝彩票平台波士顿儿童每年表现约40至50阶段的程序，我们有一个专门从事这一程序的新生儿心脏外科医生的专门团队。

The stage 1 procedure begins with an incision in the front of the chest to expose the heart, lungs, and great vessels (pulmonary artery and aorta).

The next step is to place your baby on heart-lung bypass. This is a specialized machine that provides blood flow and oxygen to your baby during the operation. While your baby is on this machine, a dedicated team of specialists, called perfusionists, make sure your baby’s brain and other organs get enough oxygen. Bypass takes place through small special tubes, called cannulas, which are placed into the heart to drain blood returning to the heart (so that it is empty and can be opened to perform the operation), give it oxygen, and return it back into the body.

The stage 1 procedure has three main steps:

第1步：重建主动脉

The first step of the operation includes a reconstruction of the aorta, so that all of the blood coming out of the heart can go to the body, as well as supply blood flow to the coronary arteries. In this part of the operation, the root of the pulmonary artery (now called the neo-aorta) is connected to the aorta (now called the native aorta). The remainder of the aortic arch (which often is very small) is then attached to these two vessels and its size is significantly expanded using a patch of tissue. This is the most technically challenging and complex part of the operation.

Step 2: Create a source of pulmonary blood flow

In the second part of the procedure, a new source of blood flow is needed to get blood to the lungs. There are two common techniques to do this. One technique is to connect a tube, known as the Blalock-Taussig shunt, from the aorta to the pulmonary artery. The other method is to connect a tube, known as the Sano or right ventricle to pulmonary artery conduit, from the ventricle to the pulmonary artery.

第3步：去除心房隔膜

在第三步中，将壁分离瘘（心房隔膜）的右侧（心房隔膜）完全切断。

Your baby will then be weaned carefully from the bypass machine and started on medications to help the heart squeeze better. Once the operation is complete, the team will perform a complete echocardiogram to make sure the operation looks as expected. A few additional catheters will be placed into the heart for monitoring and a few drains placed into the chest and a dressing placed over the chest.

阶段1的替代方案：混合过程

Sometimes, a child’s condition may make it risky to use heart-lung bypass. For example, a child may be premature, have bleeding in the brain, or have severe lung disease. In cases like these, your care team may consider an alternative to stage 1 that does not require heart-lung bypass, but that keeps your child safe after birth. The key features of this procedure include:

• limiting the amount of blood flow going to each lung by placing a restricting suture or band on each of the pulmonary arteries
• 通过使用长期药物（前列腺素）输注或使用支架，维持血液的血液从右心室从右心室到主动脉从右心室到主动脉。

Although this is a technically somewhat less complex approach than stage 1, there are drawbacks. In most cases, all the stage 1 steps will still have to take place at a later date — and the future operations become more complicated. Nonetheless, the hybrid approach may allow valuable time for recovery and growth in certain situations.

Home monitoring between stages 1 and 2

在第1阶段和第2阶段的手术​​之间，您的宝宝的心脏需要额外的监测，以防止并发症。在此期间，我们的单一脑室家庭监测计划将为您的宝宝的增长和氧饱和度提供目标，为您的宝宝提供监控设备。您还会获取有关何时呼叫的信息。你的宝宝被医生和护士团队紧密遵循。

第2阶段：双向格伦程序（年龄4至6个月）

The goal for the next stage is to deliver oxygen to the body more efficiently. During the second surgery, the blood coming back from the head and arms is redirected and connected directly to the lung vessels. This operation is called the bidirectional Glenn (or superior cavopulmonary connection). The Glenn surgery also involves removal of any prior shunt to the lungs. The vast majority of children do well after the Glenn surgery.

Stage 3: Fontan procedure (ages 2 to 3 years)

“单心室”途径的第三阶段称为Fontan手术。在此过程中，来自身体下半部分（较下腔静脉）的血液直接向肺部转移到肺部。首次，来自头部，胳膊和腿的所有血液现在都被动地流向肺部。在Fontan之后，血液从心脏流向身体，然后直接返回肺部以再次接收氧气。尽管只有一个泵，但这种循环最为类似于正常的心脏。

对Fontan程序进行了许多修改。两种现代技术包括外形Fontan和侧向隧道Fontan。肢体Fontan是从下腔静脉连接到肺动脉的管。在横向漏斗压纳，心脏内部有一种途径，使腿从腿中排出肺部。对于大多数Fontan程序，在Fontan路径和心脏之间创建一个小孔（或更衰强）。在术后期间或肺部压力高（例如在呼吸道或呼吸道感染期间）的压力高时，该孔在疗效期间提供了有用的“弹出式”。

Biventricular repair

虽然用单一的心室治疗新生儿的最常见方法是与之结尾的三个手术，但在某些情况下，我们的外科医生可以利用新的程序和创新技术实现biventricular circulation。这涉及将心脏的左侧独立起作用，因此可以将单个脑室心脏转化为两个功能的心室。在某些情况下，这种修复可以是初始程序，但在其他情况下，可以使用一系列程序来恢复在将心脏转化为五圈循环之前恢复小型心室。我们的Complex Biventricular Repair Programcan assess if your child might be a candidate for this surgery and offer you a customized evaluation and care plan.