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Elizabeth M. Rumball
Simon P. McGuirk
John G. Wright
David J. Barron
William J. Brawn
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Eur J Cardiothorac Surg 2005;27:801-806
© 2005 Elsevier Science NL

The RV–PA conduit stimulates better growth of the pulmonary arteries in hypoplastic left heart syndrome

Elizabeth M. Rumball, Simon P. McGuirk, Oliver Stümper, Simon J. Laker, Joseph V. de Giovanni, John G. Wright, David J. Barron, William J. Brawn*

Department of Paediatric Cardiac Surgery, Diana, Princess of Wales Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK

Received 10 September 2004; received in revised form 10 January 2005; accepted 17 January 2005.

* Corresponding author. Tel.: +44 121 333 9435; fax: +44 121 333 9441. (E-mail: william.brawn{at}bch.nhs.uk).

Objective: This retrospective study compared the size of the central pulmonary arteries in patients with hypoplastic left heart syndrome (HLHS) following either a classical Norwood or Norwood procedure with a right ventricle to pulmonary artery (RV–PA) conduit. Methods: Between May 2001 and May 2003, 30 patients with HLHS underwent cardiac catheterization prior to stage II palliation. Patients were initially palliated with a classical Norwood (Classical group, n=18) or Norwood procedure with RV–PA conduit (RV–PA group; n=12). Indexed maximum and minimum diameters of the LPA and RPA were measured using the McGoon ratio. Cardiac catheterisation was performed at a median age of 4.0 months. There was no difference in the time interval to catheterisation (P=0.13), Qp:Qs (P=0.41) or median haemoglobin (P=0.42) between the groups. Results: The combined PA diameter was larger in the RV–PA group (B) than the classical group (A) (1.99±0.38 versus 1.63±0.29, P<0.05). There were marked differences in the relative size of the pulmonary arteries between the two groups. In RV–PA patients, the LPA and RPA sizes were comparable (0.99±0.22 versus 1.00±0.31, P=1.00) whereas, in the classical group, the LPA was smaller than the RPA (0.75±0.15 versus 0.88±0.17, P<0.05). Both techniques were also associated with discrete PA stenoses at the site of shunt insertion. Stenoses were more severe in RV–PA group (RV–PA), causing a 42±16% reduction in the combined PA diameter compared with a 28±18% reduction in Classical group (classical) (P<0.05). Conclusions: The Norwood procedure with RV–PA conduit is associated with better and more evenly distributed central pulmonary artery growth. Nevertheless, it is also associated with central PA stenoses, which may require subsequent reconstruction.

Key Words: Heart defects • Congenital • Hypoplastic left heart syndrome • Shunts • Stenosis • Catheterisation




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