title: 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.
abstract: OBJECTIVE
  The aim of this study was to assess changes in early and late haemodynamic status after the Norwood procedure (NP), caused by the implementation of right ventricle-to-pulmonary artery shunt (RV-PA).
  
  
  METHODS
  A consecutive series of 68 children with hypoplastic left heart syndrome underwent NP: Group 1 (n=31) with the application of a modified Blalock-Taussig shunt and Group 2 (n=37) with RV-PA. Haemodynamic data from the early postoperative period (72 h after the operation) and cardiac catheterisation data, as well as blood tests before the hemi-Fontan procedure (HF) were analysed. Univariate (chi(2) test, Mann-Whitney's and Student's t-tests) and multiple regression analysis were carried out.
  
  
  RESULTS
  In Group 1, circulatory collapse requiring resuscitation occurred in 15 (48.4%) children, within 72 h after the procedure. The resuscitation was unsuccessful in nine (29%) cases. The operative mortality (30 days) was 35%. In Group 2, two (5%) children died within the early and two (5%) within the late postoperative period. The postoperative course in the remaining children from Group 2 was uneventful. In Group 2 there was a significantly higher mean diastolic pressure after NP (P<0.05). The arterial pulse pressure after NP was significantly lower in Group 2 (P<0.05). Before HF, the application of RV-PA was associated with a lower Qp:Qs ratio (P=0.020), lower aortic pulse pressure (P=0.004) and lower aortic oxygen saturation (P=0.039).
  
  
  CONCLUSIONS
  A stable haemodynamic status due to independent coronary perfusion, higher diastolic and lower pulse pressure is the most advantageous effect of RV-PA, resulting in a lower mortality and morbidity after NP. A lower Qp:Qs ratio eliminates the danger of the ventricular volume overload and ensures good conditions for the development of the pulmonary circulation before HF.
authors.affiliation: Department of Paediatric Cardiac Surgery, Collegium Medicum, Jagiellonian University, Cracow, Poland. mimalec@cyf-kr.edu.pl
authors.forename: Edward
authors.initials: E
authors.lastname: Malec
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Januszewska
authors.forename: Jacek
authors.initials: J
authors.lastname: Kolcz
authors.forename: Tomasz
authors.initials: T
authors.lastname: Mroczek
mesh_terms: D000714:Anastomosis, Surgical; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000503:physiopathology / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011651:Pulmonary Artery / Q000601:surgery*