title: Diagnosis and catheter treatment of innominate artery stenosis following stage I Norwood procedure.
abstract: Four infants aged 20-115 days (mean, 57.8 days) who had undergone stage I Norwood procedure for hypoplastic left heart syndrome came to early cardiac catheterization (6-112; mean, 47.3 days) following surgery because of significant arterial desaturation (pulse oximetry indicating oxygen saturations consistently in the 40%-70% range). Cardiac catheterization demonstrated a significant systolic pressure gradient between the ascending aorta and innominate artery (30-65; mean, 51 mm Hg) as the likely cause of diminished pulmonary blood flow in these patients. Routine angiography by itself was not conclusive in identifying a discrete area of obstruction, but selective angiography coupled with a knowledge of the obstruction did reveal the stenosis. All patients were successfully treated with balloon dilatation of the stenotic area, with the pressure gradient being reduced to 7-25 (mean, 17 mm Hg) immediately following dilatation. On follow-up catheterization in three patients, the systolic gradients were 3, 6, and 9 mm Hg. Arterial oxygen saturations rose from 63.5% predilatation to 77.3% immediately postdilatation and 81% on follow-up evaluation. In conclusion, innominate artery stenosis is an important cause of diminished blood flow through a modified right Blalock-Taussig shunt. Routine angiography will often miss the diagnosis. Pressure gradients and selective angiograms are necessary in order to make the diagnosis, although careful noninvasive assessment should also be diagnostic of this problem. Catheter dilatation is therapeutic in this situation and can be performed early after surgery in the absence of a fresh suture line.
authors.affiliation: Children's Heart Center and Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA. vincentr@kidsheart.com
authors.forename: R N
authors.initials: RN
authors.lastname: Vincent
authors.forename: A G
authors.initials: AG
authors.lastname: Porter
authors.forename: V K
authors.initials: VK
authors.lastname: Tam
authors.forename: K R
authors.initials: KR
authors.lastname: Kanter
mesh_terms: D000792:Angiography; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D016122:Brachiocephalic Trunk / Q000000981:diagnostic imaging / Q000293:injuries; D005260:Female; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000000981:diagnostic imaging / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008168:Lung / Q000098:blood supply; D008297:Male; D010100:Oxygen / Q000097:blood; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy*
chemical_list: D010100:Oxygen