Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-26T23:02:33.062Z Has data issue: false hasContentIssue false
  • English
  • Français

Does a ventriculotomy have deleterious effects following palliation in the Norwood procedure using a shunt placed from the right ventricle to the pulmonary arteries?

Published online by Cambridge University Press:  23 January 2007

Eric M. Graham ,
Andrew M. Atz ,
Scott M. Bradley ,
Mark A. Scheurer ,
Varsha M. Bandisode ,
Antonio Laudito  and
Girish S. Shirali
Eric M. Graham
Affiliation:
Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina, United States of America
Andrew M. Atz
Affiliation:
Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina, United States of America
Scott M. Bradley
Affiliation:
Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina, United States of America
Mark A. Scheurer
Affiliation:
Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina, United States of America
Varsha M. Bandisode
Affiliation:
Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina, United States of America
Antonio Laudito
Affiliation:
Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina, United States of America
Girish S. Shirali
Affiliation:
Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina, United States of America
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction: A recent modification to the Norwood procedure involving a shunt placed directly from the right ventricle to the pulmonary arteries may improve postoperative haemodynamics. Concerns remain, however, about the potential problems produced by the required ventriculotomy. Methods: We compared 76 patients with hypoplastic left heart syndrome who underwent the Norwood procedure, 35 receiving a modified Blalock-Taussig shunt and the remaining 41 a shunt placed directly from the right ventricle to the pulmonary arteries. We reviewed their subsequent progress through the second stage of palliation. A single observer graded right ventricular function, and the severity of tricuspid regurgitation, based on blinded review of the most recent echocardiograms prior to the second stage of palliation. Results: At the time of catheterization prior to the second stage, patients with a shunt placed from the right ventricle to the pulmonary arteries, rather than a modified Blalock-Taussig shunt, had higher arterial diastolic blood pressure, at 44 versus 40 millimetres of mercury, p equal to 0.02, lower ventricular end diastolic pressures, at 8 versus 11 millimetres of mercury, p equal to 0.0002, and larger pulmonary arteries as judged using the Nakata index, at 270 versus 188 millimetres squared per metres squared, p equal to 0.009. There was no difference in qualitative ventricular systolic function or tricuspid regurgitation between groups. No differences were found between groups during the hospitalization following the second stage of palliation. A trend towards improved survival to the second stage was seen following the construction of a shunt from the right ventricle to the pulmonary arteries. Conclusions: Construction of a shunt from the right ventricle to the pulmonary arteries is associated with lower right ventricular end diastolic pressures, larger pulmonary arterial size, and higher systemic arterial diastolic pressures. No apparent deleterious effects of the right ventriculotomy were observed in terms of qualitative ventricular systolic function or tricuspid regurgitation.

Keywords

Hypoplasia of the left heartcardiac surgeryechocardiography
Type
Original Article
Information
Cardiology in the Young , Volume 17 , Issue 2 , April 2007 , pp. 145 - 150
Copyright
© 2007 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Kishimoto H, Kawahira Y, Kawata H, Miura T, Iwai S, Mori T. The modified Norwood palliation on a beating heart. J Thorac Cardiovasc Surg 1999; 118: 1130–1132.Google Scholar
Imoto Y, Kado H, Shiokawa Y, Minami K, Yasui H. Experience with the Norwood procedure without circulatory arrest. J Thorac Cardiovasc Surg 2001; 122: 879–882.Google Scholar
Sano S, Ishino K, Kawada M, et al. Right ventricle-pulmonary artery shunt in first-stage palliation of hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 2003; 126: 504–510.Google Scholar
Pizarro C, Norwood WI. Right ventricle to pulmonary artery conduit has a favorable impact on postoperative physiology after Stage I Norwood: preliminary results. Eur J Cardiothorac Surg 2003; 23: 991–995.Google Scholar
Bradley SM, Simsic JM, McQuinn TC, Habib DM, Shirali GS, Atz AM. Hemodynamic status after the Norwood procedure: a comparison of right ventricle-to-pulmonary artery connection versus modified Blalock-Taussig shunt. Ann Thorac Surg 2004; 78: 933–941.Google Scholar
Mair R, Tulzer G, Sames E, et al. Right ventricular to pulmonary artery conduit instead of modified Blalock-Taussig shunt improves postoperative hemodynamics in newborns after the Norwood operation. J Thorac Cardiovasc Surg 2003; 126: 1378–1384.Google Scholar
Mahle WT, Cuadrado AR, Tam VK. Early experience with a modified Norwood procedure using right ventricle to pulmonary artery conduit. Ann Thorac Surg 2003; 76: 1084–1089.Google Scholar
Malec E, Januszewska K, Kolcz J, Mroczek T. Right ventricle- to-pulmonary artery shunt versus modified Blalock-Taussig shunt in the Norwood procedure for hypoplastic left heart syndrome – influence on early and late haemodynamic status. Eur J Cardiothorac Surg 2003; 23: 728–734.Google Scholar
Graham EM, Forbus GA, Bradley SM, Shirali GS, Atz AM. Incidence and outcome of cardiopulmonary resuscitation in shunted single ventricle patients: advantage of right ventricle to pulmonary artery shunt. J Thorac Cardiovasc Surg 2006; 131: e7–e8.Google Scholar
Maher KO, Pizarro C, Gidding SS, et al. Hemodynamic profile after the Norwood procedure with right ventricle to pulmonary artery conduit. Circulation 2003; 108: 782–784.Google Scholar
Pizarro C, Malec E, Maher KO, et al. Right ventricle to pulmonary artery conduit improves outcome after stage I Norwood for hypoplastic left heart syndrome. Circulation 2003; 108: II155–II160.Google Scholar
Sano S, Ishino K, Kado H, et al. Outcome of right ventricle- to-pulmonary artery shunt in first-stage palliation of hypoplastic left heart syndrome: a multi-institutional study. Ann Thorac Surg 2004; 78: 1951–1958.Google Scholar
Azakie A, Martinez D, Sapru A, Fineman J, Teitel D, Karl TR. Impact of right ventricle to pulmonary artery conduit on outcome of the modified Norwood procedure. Ann Thorac Surg 2004; 77: 1727–1733.Google Scholar
Pizarro C, Mroczek T, Malec E, Norwood WI. Right ventricle to pulmonary artery conduit reduces interim mortality after stage 1 Norwood for hypoplastic left heart syndrome. Ann Thorac Surg 2004; 78: 1959–1964.Google Scholar
Altmann K, Printz BF, Solowiejczyk DE, Gersony WM, Quaegebeur J, Apfel HD. Two-dimensional echocardiographic assessment of right ventricular function as a predictor of outcome in hypoplastic left heart syndrome. Am J Cardiol 2000; 86: 964–968.Google Scholar
Hughes ML, Shekerdemian LS, Brizard CP, Penny DJ. Improved early ventricular performance with a right ventricle to pulmonary artery conduit in stage 1 palliation for hypoplastic left heart syndrome: evidence from strain Doppler echocardiography. Heart 2004; 90: 191–194.Google Scholar
Ballweg JA, Dominguez TE, Ravishankar C, et al. A comtemporary comparison of the impact of shunt type in hypoplastic left heart syndrome on the hemodynamics and outcomes at the stage 2 reconstruction. Circulation 2005; 112: II–385. (abstr)Google Scholar
Scheurer M, Vasuki N, Maurer S, et al. Survival after bidirectional cavopulmonary anastomosis: a risk factor analysis. Circulation 2005; 112: II732–II733. (abstr)Google Scholar
Rumball EM, McGuirk SP, Stumper O, et al. The RV-PA conduit stimulates better growth of the pulmonary arteries in hypoplastic left heart syndrome. Eur J Cardiothorac Surg 2005; 27: 801–806.Google Scholar