Development of the pulmonary arteries after the Norwood procedure: comparison between Blalock-Taussig shunt and right ventricular-pulmonary artery conduit.
BACKGROUND
The Norwood-Sano procedure for hypoplastic left heart syndrome (HLHS) has been associated with improved postoperative hemodynamics and outcome. This study compared the effect of a Blalock-Taussig shunt with right ventricular-pulmonary artery (RV-PA) conduit before bidirectional Glenn on the development of the PAs.


METHODS
Between January 2000 and June 2007, 42 patients with HLHS underwent bidirectional Glenn: 19 (mean age, 7 +/- 1.5 months) had a Blalock-Taussig shunt (3.5 mm in 15; and 4 mm in 4); 23 patients (mean age, 5 +/- 1 month) had RV-PA conduit (5-mm tube). Patients underwent postoperative cardiac catheterization and echocardiograms.


RESULTS
Total PA (Nakata) index was 192 +/- 10 mm2/m2 in the Blalock-Taussig group and 238 +/- 18 mm2/m2 in the RV-PA conduit group (p = 0.03). In the RV-PA conduit patients, the left and right PAs had comparable diameters. In the Blalock-Taussig group, the left PA was smaller than the right (p = 0.02). The mean PA pressure at the end of the operation was 14 +/- 2 mm Hg in the Blalock-Taussig group and 11 +/-1 mm Hg in the RV-PA conduit group (p = 0.06). Persistent pleural effusion occurred in 4 Blalock-Taussig patients (21%) and in 1 (4%) with RV-PA conduit (p < 0.05). Postoperative arterial oxygen saturation was 80% +/- 2% in the RV-PA conduit group and 74% +/- 2% in the Blalock-Taussig group (p < 0.05).


CONCLUSIONS
The Norwood procedure with RV-PA conduit may have favorable effects on the development of the PA due to even distribution of pulmonary blood flow.
Caspi
Joseph
J
Division of Cardiothoracic Surgery and Pediatric Cardiology, Louisiana State University and Children's Hospital, New Orleans, Louisiana 70118, USA. caspij@aol.com
Pettitt
Timothy W
TW
Mulder
Theodorus
T
Stopa
Aluizio
A
D000714:Anastomosis, Surgical / Q000379:methods; D001166:Arteriovenous Shunt, Surgical / Q000379:methods; D001784:Blood Gas Analysis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002315:Cardiopulmonary Bypass / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000601:surgery*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010101:Oxygen Consumption; D011336:Probability; D011651:Pulmonary Artery / Q000254:growth & development / Q000601:surgery*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome; D014463:Ultrasonography