HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Christian Pizarro Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Pizarro, C. Articles by Norwood, W. I. Search for Related Content PubMed PubMed Citation Articles by Pizarro, C. Articles by Norwood, W. I. Related Collections Congenital - acyanotic Congenital - cyanotic

Eur J Cardiothorac Surg 2003;23:991-995
© 2003 Elsevier Science NL

Right ventricle to pulmonary artery conduit has a favorable impact on postoperative physiology after Stage I Norwood: preliminary results

Nemours Cardiac Center, Alfred I,. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19899, USA

Received 14 February 2003; received in revised form 27 February 2003; accepted 3 March 2003.

^* Corresponding author. Tel.: +1-302-651-6600; fax: +1-302-651-5345
e-mail: cpizarro{at}nemours.org

Objective: Although significant progress has been made in the perioperative management of neonates with hypoplastic left heart syndrome (HLHS), early survival has plateaued. Moreover, low but important interstage mortality remains unsolved. With a systemic to pulmonary artery shunt, the combination of significant diastolic runoff into the pulmonary circulation, a large volume load on the single ventricle and precarious coronary perfusion result in a delicate physiologic state. In order to minimize these detrimental features, a right ventricle to pulmonary artery (RV to PA) conduit was used as the source of pulmonary blood flow in patients undergoing Stage I Norwood for HLHS. Methods: Prospective data collection in 15 consecutive patients who underwent Stage I Norwood with an RV to PA conduit. Results: Mean age at surgery was 2.5±2 days (range 1–8), mean weight was 2.9±0.3 kg (range 2.2–3.6) and mean gestational age was 37 weeks (range 35–40). Anatomic diagnosis was HLHS in all patients, aortic atresia was present in ten. Mean ascending aortic size was 2.9±0.9 mm (range 1.5–5). Two patients had moderate atrioventricular valve regurgitation and a genetic syndrome and/or congenital anomaly was present in five patients. Thirteen patients received a 5-mm polytetrafluoroethylene RV to PA conduit, and a 4-mm conduit was used in two. Mean circulatory arrest time was 55±6 min. Postoperatively, mean diastolic blood pressure at 1, 8 and 24 h were 47±7, 46±3 and 43±6 mmHg, respectively. Median time to extubation was 23 h (range 9–96) and was less than 24 h in ten patients. Median intensive care unit and hospital stay were 5 days (range 2–19) and 10 days (6–22), respectively. Early mortality was 1/15 (6%). At a mean follow-up of 10.8±3.4 months, 12 patients underwent stage II, and three patient have completed the Fontan. Conclusion: RV to PA conduit eliminated diastolic runoff into the pulmonary vascular bed resulting in a higher diastolic blood pressure. This physiology appears to be associated with a more stable postoperative course and improved hospital survival.

Key Words: Hypoplastic left heart syndrome • Norwood procedure • Congenital • Pediatric • Cardiac surgery • Single ventricle

This article has been cited by other articles:

				K. Januszewska, A. Stebel, and E. Malec Consequences of Right Ventricle to Pulmonary Artery Shunt at the First Stage for the Fontan Operation Ann. Thorac. Surg., November 1, 2007; 84(5): 1611 - 1617. [Abstract] [Full Text] [PDF]

				J. A. Ballweg, T. E. Dominguez, C. Ravishankar, J. Kreutzer, B. S. Marino, G. L. Bird, P. J. Gruber, G. Wernovsky, J. W. Gaynor, S. C. Nicolson, et al. A contemporary comparison of the effect of shunt type in hypoplastic left heart syndrome on the hemodynamics and outcome at stage 2 reconstruction J. Thorac. Cardiovasc. Surg., August 1, 2007; 134(2): 297 - 303. [Abstract] [Full Text] [PDF]

				L. Lai, P. C. Laussen, C. L. Cua, D. L. Wessel, J. M. Costello, P. J. del Nido, J. E. Mayer, and R. R. Thiagarajan Outcomes After Bidirectional Glenn Operation: Blalock-Taussig Shunt Versus Right Ventricle-to-Pulmonary Artery Conduit Ann. Thorac. Surg., May 1, 2007; 83(5): 1768 - 1773. [Abstract] [Full Text] [PDF]

				O. Reinhartz, V. M. Reddy, E. Petrossian, M. MacDonald, J. J. Lamberti, S. J. Roth, G. E. Wright, S. B. Perry, S. Suleman, and F. L. Hanley Homograft Valved Right Ventricle to Pulmonary Artery Conduit as a Modification of the Norwood Procedure Circulation, July 4, 2006; 114(1_suppl): I-594 - I-599. [Abstract] [Full Text] [PDF]

				J. Cleuziou, F. Haas, C. Schreiber, H.-J. Mossinger, and R. Lange Hypoplastic Left Heart Syndrome With Anomalous Origin of the Right Coronary Artery Ann. Thorac. Surg., January 1, 2006; 81(1): 341 - 343. [Abstract] [Full Text] [PDF]

				J. J. Nigro, R. D. Bart, C. D. Derby, M. S. Sklansky, and V. A. Starnes Proximal Conduit Obstruction After Sano Modified Norwood Procedure Ann. Thorac. Surg., November 1, 2005; 80(5): 1924 - 1928. [Abstract] [Full Text] [PDF]

				C. L. Cua, R. R. Thiagarajan, R. Taeed, T. M. Hoffman, L. Lai, J. Hayes, P. C. Laussen, and T. F. Feltes Improved Interstage Mortality With the Modified Norwood Procedure: A Meta-Analysis Ann. Thorac. Surg., July 1, 2005; 80(1): 44 - 49. [Abstract] [Full Text] [PDF]

				K. Januszewska, J. Kolcz, T. Mroczek, M. Procelewska, and E. Malec Right ventricle-to-pulmonary artery shunt and modified Blalock-Taussig shunt in preparation to hemi-Fontan procedure in children with hypoplastic left heart syndrome Eur. J. Cardiothorac. Surg., June 1, 2005; 27(6): 956 - 961. [Abstract] [Full Text] [PDF]

				U Theilen and L Shekerdemian The intensive care of infants with hypoplastic left heart syndrome Arch. Dis. Child. Fetal Neonatal Ed., March 1, 2005; 90(2): F97 - F102. [Abstract] [Full Text] [PDF]

				C. Pizarro, T. Mroczek, E. Malec, and W. I. Norwood Right Ventricle to Pulmonary Artery Conduit Reduces Interim Mortality After Stage 1 Norwood for Hypoplastic Left Heart Syndrome Ann. Thorac. Surg., December 1, 2004; 78(6): 1959 - 1964. [Abstract] [Full Text] [PDF]

				K. N. Fenton, F. A. Pigula, S. K. Gandhi, L. Russo, and K. F. Duncan Interim Mortality in Pulmonary Atresia With Intact Ventricular Septum Ann. Thorac. Surg., December 1, 2004; 78(6): 1994 - 1998. [Abstract] [Full Text] [PDF]

				S. M. Bradley, J. M. Simsic, T. C. McQuinn, D. M. Habib, G. S. Shirali, and A. M. Atz Hemodynamic status after the Norwood procedure: A comparison of right ventricle-to-pulmonary artery connection versus modified blalock-taussig shunt Ann. Thorac. Surg., September 1, 2004; 78(3): 933 - 941. [Abstract] [Full Text] [PDF]