Right Ventricle to Pulmonary Artery Conduit Improves Outcome After Stage I Norwood for Hypoplastic Left Heart Syndrome

Pizarro, Christian; Malec, Edward; Maher, Kevin; Januszewska, Katarzyna; Gidding, Samuel S.; Murdison, Kenneth A.; Baffa, Jeanne M.; Norwood, William I.

doi:10.1161/01.cir.0000087390.94142.1d

Cited by 132 publications

(113 citation statements)

References 17 publications

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“…Additionally, the need for right ventriculotomy theoretically increases the risk of cardiac arrhythmias and reduced ventricular function in these patients with single-ventricle physiology. The modified Blalock-Taussig shunt, in turn, provides forward flow through the conduit during all the cardiac cycle, and it is controversial whether it provides greater pulmonary artery growth 7,23 , but the lower diastolic pressures in the aorta affect the coronary blood flow 7,8 and, possibly, the cardiac function due to low subendocardial perfusion.…”

Section: Discussionmentioning

confidence: 99%

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Síndrome da hipoplasia do coração esquerdo: a influência da estratégia cirúrgica nos resultados

Silva¹,

Fonseca²,

Baumgratz³

et al. 2007

Arq. Bras. Cardiol.

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SummaryObjectives: To report a surgical strategy for the Norwood procedure in the hypoplastic left heart syndrome (HLHS) that enables short hypothermic circulatory arrest time and aortic arch reconstruction with autologous pericardium patch, and to compare the results of the modified Blalock- Taussig Results: In-hospital survival for the entire cohort was 74.64%, or 67.57% and 82.35% for the mBT shunt and RV-PA conduit groups, respectively (p=0.1808). Mortality rates between the first and second palliation stages were 40% and 4.4% for the mBT shunt and RV-PA conduit groups, respectively (p=0.0054). Hypothermic circulatory arrest times were 45.79±1.99 min and 36.62±1.62min (p=0.0012), respectively. Late coarctation of the aorta occurred in five patients (7.2%).Conclusions: This surgical strategy resulted in short circulatory arrest time, low mortality and favorable morphology of the neoaorta, with low incidence of late coarctation of the aorta. The higher rate of survival to first palliation stage with the RV-PA conduit was not significant, but interstage mortality was statistically lower when compared with the modified Blalock-Taussig shunt procedure.

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Section: Discussionmentioning

confidence: 99%

“…Other reports showing improvement of survival with the RV-PA conduit also used historical series of patients with mBT as controls 7,8,23 .…”

Section: Discussionmentioning

confidence: 99%

Síndrome da hipoplasia do coração esquerdo: a influência da estratégia cirúrgica nos resultados

Silva¹,

Fonseca²,

Baumgratz³

et al. 2007

Arq. Bras. Cardiol.

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“…In our clinical experience after the RV-PA conduit modification, there has been a diminished need for measures to control pulmonary blood flow as well as improved survival. 15 Patients with the RV-PA conduit are less susceptible to adverse consequences on pulmonary vascular resistance of increased oxygen concentration as a result of the absence of diastolic runoff from the systemic to pulmonary circulation. Ventilation-perfusion mismatch resulting in pulmonary venous desaturation can adversely affect oxygen delivery in the HLHS patient after the Norwood procedure.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic Profile After the Norwood Procedure With Right Ventricle to Pulmonary Artery Conduit

Maher¹,

Pizarro²,

Gidding³

et al. 2003

Circulation

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103

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Background-The balance of systemic, pulmonary, and coronary blood flow after the Norwood operation for hypoplastic left heart syndrome (HLHS) is critical to early survival. We hypothesized that a right ventricle to pulmonary artery conduit (instead of a systemic to pulmonary artery shunt) would result in hemodynamic changes consistent with a more stable balance of systemic, pulmonary, and coronary perfusion. Methods and Results-Hemodynamic data were obtained during cardiac catheterization before the hemi-Fontan procedure from 24 patients with HLHS; the first 10 had a Norwood operation with a systemic to pulmonary artery shunt, and the latter 14 had the Norwood operation with a right ventricle to pulmonary artery conduit. Significant differences were present, with the right ventricle to pulmonary artery conduit group having a higher aortic diastolic pressure (55 versus 42 mm Hg), a narrowed systemic pulse pressure (43 versus 64 mm Hg), a lower Qp:Qs (0.92 versus 1.42), a higher coronary perfusion pressure (46 versus 32 mm Hg), and a higher ratio of pulmonary artery diameter to descending aorta diameter (1.51 versus 1.37). Conclusions-We conclude that, in HLHS after the Norwood operation, the right ventricle to pulmonary artery conduit modification produces hemodynamic changes consistent with improved coronary perfusion and a more favorable distribution of systemic, pulmonary, and coronary blood flow.

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“…However, mBT provides anterograde flow through the tube during the entire cardiac cycle. It is controversial if this technique causes more growth of the pulmonary arteries [10,24], but the lower diastolic pressures in the aorta affect the coronary artery blood flow [10,11] and, possibly, the heart function by subendocardial hypoperfusion.…”

Section: Braz J Cardiovasc Surg 2007; 22(2): 160-168mentioning

confidence: 99%

“…Moreover, other reports showing improved survival rates using the RV-PA tube utilized the history of patients with mBT as the control series [10,11,24]. Studies that proved that there is no impact on the survival rate in respect to the type of tube used, apart from comparing non-concurrent groups, had very small populations of newborns [25,26].…”

Section: Braz J Cardiovasc Surg 2007; 22(2): 160-168mentioning

confidence: 99%

Síndrome do coração esquerdo hipoplásico: estratégia cirúrgica e comparação de resultados com técnicas de Norwood x Sano

Silva¹,

Fonseca²,

Baumgratz³

et al. 2007

Rev Bras Cir Cardiovasc

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Right Ventricle to Pulmonary Artery Conduit Improves Outcome After Stage I Norwood for Hypoplastic Left Heart Syndrome

Cited by 132 publications

References 17 publications

Síndrome da hipoplasia do coração esquerdo: a influência da estratégia cirúrgica nos resultados

Síndrome da hipoplasia do coração esquerdo: a influência da estratégia cirúrgica nos resultados

Hemodynamic Profile After the Norwood Procedure With Right Ventricle to Pulmonary Artery Conduit

Síndrome do coração esquerdo hipoplásico: estratégia cirúrgica e comparação de resultados com técnicas de Norwood x Sano

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