Midterm ventricular performance after Norwood procedure with right ventricular-pulmonary artery conduit.
BACKGROUND
Midterm and long-term results of patients who underwent a Norwood procedure with a right ventricular-pulmonary artery conduit remain unclear. This study aimed to compare the midterm ventricular performance of the Norwood procedure with right ventricular-pulmonary artery conduit and the Norwood procedure with systemic-pulmonary shunt.


METHODS
Twenty-one patients who underwent both a bidirectional Glenn procedure and a total cavopulmonary connection after Norwood palliation at Fukuoka Children's Hospital Medical Center were divided into two groups: the systemic-pulmonary shunt group (n = 11) and the right ventricular-pulmonary artery conduit group (n = 10). End-systolic elastance (contractility), effective arterial elastance (afterload), and ventriculoarterial coupling and the ratio of stroke work and pressure-volume area (ventricular efficiency) were measured on the basis of cardiac catheterization data before the bidirectional Glenn procedure, before and after the total cavopulmonary connection, and at approximately 1 year after total cavopulmonary connection.


RESULTS
After bidirectional Glenn procedure and total cavopulmonary connection, end-systolic elastance of the right ventricular-pulmonary artery conduit group was lower than that of the systemic-pulmonary shunt group, whereas effective arterial elastance of the right ventricular-pulmonary artery conduit group was lower than that of the systemic-pulmonary shunt group. Consequently, there was no difference in ventricular efficiency in both groups 1 year after total cavopulmonary connection.


CONCLUSIONS
The midterm ventricular performance of the right ventricular-pulmonary artery conduit group was comparable with the systemic-pulmonary shunt group in terms of ventricular efficiency. However, after bidirectional Glenn procedure and total cavopulmonary connection, contractility in patients who underwent a Norwood procedure with a right ventricular-pulmonary artery conduit was inferior to that of patients who underwent a Norwood procedure with a systemic-pulmonary shunt.
Tanoue
Yoshihisa
Y
Department of Cardiovascular Surgery and Pediatric Cardiology, Fukuoka Children's Hospital Medical Center, Fukuoka, Japan. tanoue@heart.med.kyushu-u.ac.jp
Kado
Hideaki
H
Shiokawa
Yuichi
Y
Fusazaki
Naoki
N
Ishikawa
Shiro
S
D001011:Aorta / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002675:Child, Preschool; D005260:Female; 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*; D012189:Retrospective Studies; D016896:Treatment Outcome; D016276:Ventricular Function