Repair of Ventricular Aneurysm After Stage I Modified Sano-Norwood Procedure

Montgomery, Jenny; Henderson, Mark A.; Ostrowsky, Jacob; Karimi, Mohsen; Hennein, Hani A.

doi:10.4037/ccn2010193

Cited by 5 publications

(3 citation statements)

References 11 publications

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“…This may help patients avoid complications of RV dysfunction such as pseudoaneurysm formation, heart failure requiring increased inotropic support, use of extracorporeal membrane oxygenation or ventricular assist device, heart transplants, and death. 21 , 22 , 23 , 24 Although we routinely perform left-sided RV-PA-C, the PT could potentially also be used for right-sided RV-PA-C placement.…”

Section: Discussionmentioning

confidence: 99%

Periscopic technique in Norwood operation is associated with better preservation of early ventricular function

et al. 2021

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Objective: Although the right ventricle (RV) to pulmonary artery conduit in stage 1 Norwood operation results in improved interstage survival, the long-term effects of the ventriculotomy used in the traditional technique remain a concern. The periscopic technique (PT) of RV to pulmonary artery conduit placement has been described as an alternative technique to minimize RV injury. A retrospective study was performed to compare the effects of traditional technique and PT on ventricular function following Norwood operation.Methods: A retrospective study of all patients who underwent Norwood operation from 2012 to 2019 was performed. Patients with baseline RV dysfunction and significant tricuspid valve regurgitation were excluded. Prestage 2 echocardiograms were reviewed by a blinded experienced imager for quantification of RV function (sinus and infundibular RV fractional area change) as well as for regional conduit site wall dysfunction (normal or abnormal, including hypokinesia, akinesia, or dyskinesia). Wilcoxon rank-sum tests were used to assess differences in RV infundibular and RV sinus ejection fraction and the Fisher exact test was used to assess differences in regional wall dysfunction.Results: Twenty-two patients met inclusion criteria. Eight underwent traditional technique and 14 underwent PT. Median infundibular RV fractional area change was 49% and 37% (P ¼ .02) and sinus RV fractional area change was 50% and 41% for PT and traditional technique (P ¼ .007) respectively. Similarly qualitative regional RV wall function was better preserved in PT (P ¼ .002). Conclusions:The PT for RV to pulmonary artery conduit in Norwood operation results in better preservation of early RV global and regional systolic function. Whether or not this benefit translates to improved clinical outcome still needs to be studied. (JTCVS Techniques 2021;-:1-8)

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Section: Discussionmentioning

confidence: 99%

Periscopic technique in Norwood operation is associated with better preservation of early ventricular function

et al. 2021

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“…94 -96 Other complications include perioperative arrhythmias that are more common than in mBT, 97 hypocontractile ventricular state, 98 and the development of ventricular pseudoaneurysm. 99,100…”

Section: Clinical Studies Comparing Mbt and Sano Proceduresmentioning

confidence: 99%

“…[94][95][96] Other complications include perioperative arrhythmias that are more common than in mBT, 97 hypocontractile ventricular state, 98 and the development of ventricular pseudoaneurysm. 99,100 The classic Norwood procedure and Sano modification have shown benefits as well as complications in patients with HLHS. Overall, definite evidence of one procedure being significantly better than the other is lacking, mainly due to the retrospective nature of most studies that evaluated clinically relevant outcomes.…”

Section: Clinical Studies Comparing Mbt and Sano Proceduresmentioning

confidence: 99%

Mathematical Analysis and Physical Profile of Blalock-Taussig Shunt and Sano Modification Procedure in Hypoplastic Left Heart Syndrome: Review of the Literature and Implications for the Anesthesiologist

Pérez

Riveros

2017

Semin Cardiothorac Vasc Anesth

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The first stage of surgical treatment for hypoplastic left heart syndrome (HLHS) includes the creation of artificial systemic-to-pulmonary connections to provide pulmonary blood flow. The modified Blalock-Taussig (mBT) shunt has been the technique of choice for this procedure; however, a right ventricle-pulmonary artery (RV-PA) shunt has been introduced into clinical practice with encouraging but still conflicting outcomes when compared with the mBT shunt. The aim of this study is to explore mathematical modeling as a tool for describing physical profiles that could assist the surgical team in predicting complications related to stenosis and malfunction of grafts in an attempt to find correlations with clinical outcomes from clinical studies that compared both surgical techniques and to assist the anesthesiologist in making decisions to manage patients with this complex cardiac anatomy. Mathematical modeling to display the physical characteristics of the chosen surgical shunt is a valuable tool to predict flow patterns, shear stress, and rate distribution as well as energetic performance at the graft level and relative to ventricular efficiency. Such predictions will enable the surgical team to refine the technique so that hemodynamic complications be anticipated and prevented, and are also important for perioperative management by the anesthesia team.

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Effect of Ventriculotomy on Right-Ventricular Remodeling in Hypoplastic Left Heart Syndrome: A Histopathological and Echocardiography Correlation Study

et al. 2012

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The objective of this study was to compare histopathological changes in hypoplastic left heart syndrome right ventricles (RV) of patients undergoing Sano and modified Blalock-Taussig (MBT) shunt and correlate them with echocardiographic findings. Myocardial tissue samples were obtained from hearts with Sano or MBT shunts after transplantation or at autopsy. Histologic sections were reviewed manually and by automated digital image analysis. Velocity vector imaging was performed on echocardiogram images obtained before transplant or death. All of these parameters were compared between the Sano and MBT shunt cohorts. A total of 14 specimens (7 Sano and 7 MBT shunt) were studied. Median age at transplant/death of Sano and MBT shunt cohorts was 11 (range 2-41) and 8 months (range 2-200), respectively. All Sano specimens had a scar at ventriculotomy site, and the mean scar area was 6.2 ± 3.3 cm(2). Compared with remote RV free wall, myocardium bordering the scar showed increased fibrosis (34 ± 16 % vs. 28 ± 14 %, p = 0.04) and thinning (0.8 ± 0.9 vs. 5.3 ± 0.8 mm; p < 0.001), which did not regress with time. The Sano ventriculotomy site showed significantly decreased velocity, strain, and strain rate compared with the corresponding contralateral segment. No focal scarring or regional hypokinesia was seen in the MBT shunt cohort. This is the first study to demonstrate histopathological features of ventriculotomy-associated RV myocardial scarring and myocardial thinning. The scarred ventriculotomy site showed decreased segmental myocardial deformation after Norwood with Sano shunt.

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Repair of Ventricular Aneurysm After Stage I Modified Sano-Norwood Procedure

Cited by 5 publications

References 11 publications

Periscopic technique in Norwood operation is associated with better preservation of early ventricular function

Periscopic technique in Norwood operation is associated with better preservation of early ventricular function

Mathematical Analysis and Physical Profile of Blalock-Taussig Shunt and Sano Modification Procedure in Hypoplastic Left Heart Syndrome: Review of the Literature and Implications for the Anesthesiologist

Effect of Ventriculotomy on Right-Ventricular Remodeling in Hypoplastic Left Heart Syndrome: A Histopathological and Echocardiography Correlation Study

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