Pulmonary artery growth after Norwood and bidirectional Glenn procedure.
A 19-day-old boy diagnosed with hypoplastic left heart syndrome underwent stage I bilateral pulmonary artery banding and main pulmonary artery-to-descending aorta shunt. A restrictive atrial septal defect existing before stage I recurred after balloon atrioseptostomy. After stage II Norwood and bidirectional Glenn procedure at age nine months, the Nakata index decreased to 73 mm(2)/m(2) (pulmonary artery mean pressure: 15 mmHg) and multiple systemic venous collaterals developed. Thus, we instituted oral sildenafil medication, and undertook surgical chest subcutaneous venous ligation and coil embolizations. Three years later, the Nakata index had increased to 117 mm(2)/m(2) (pulmonary artery mean pressure: 13 mmHg) and a Fontan procedure was successfully performed.
Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie 514-8507, Japan. shin1111@clin.medic.mie-u.ac.jp
Shin
S
Takabayashi
Yoshihide
Y
Mitani
Kazuto
K
Yokoyama
Hideto
H
Shimpo
D000284:Administration, Oral; D000714:Anastomosis, Surgical; D001013:Aorta, Thoracic / Q000601:surgery; D001794:Blood Pressure; D006348:Cardiac Surgical Procedures; D002404:Catheterization; D003097:Collateral Circulation; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D018729:Fontan Procedure; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D007231:Infant, Newborn; D008026:Ligation; D008297:Male; D010166:Palliative Care; D010879:Piperazines / Q000008:administration & dosage; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000187:drug effects / Q000254:growth & development* / Q000601:surgery; D011652:Pulmonary Circulation; D011687:Purines / Q000008:administration & dosage; D011859:Radiography; D012086:Reoperation; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000008:administration & dosage; D013909:Thorax / Q000098:blood supply; D016896:Treatment Outcome; D014655:Vascular Resistance; D014665:Vasodilator Agents / Q000008:administration & dosage; D014680:Veins / Q000503:physiopathology / Q000601:surgery
D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014665:Vasodilator Agents; D000068677:Sildenafil Citrate