Acute interventions for stenosed right ventricle-pulmonary artery conduit following the right-sided modification of Norwood-Sano procedure.
BACKGROUND
The Norwood stage 1 procedure was modified by Sano with right ventricle-pulmonary artery (RV-PA) conduit replacing BT shunt. In our institution, this has been further modified by placing the conduit from the RV outflow tract to the right side of the neo-aorta.


METHODS
Between April 2002 and October 2008, 227 modified Norwood procedures were performed. Eighteen had the Sano modification with the conduit to the left of the neo-aorta whereas 209 had the right-sided modification, which is the study population. A total of 18 (8.6%) patients presented with cyanosis due to conduit stenosis with median age 4 months and median weight 6.3 kg.


RESULTS
Twelve patients underwent transcatheter stent placement in stenosed RV-PA conduit. A total of 16 coronary stents were implanted in 12 patients with 4 patients each receiving 2 stents. The mean saturations increased from 60% to 74%. There was one late mortality which was non-procedure related. Five patients treated with surgical take down of the RV-PA conduit and creation of a cavo-pulmonary shunt, whilst one patient had replacement of RV-PA conduit. There were no early postoperative deaths. The mean saturations improved from 54% to 75%.


CONCLUSIONS
The RV-PA conduit stenosis is a life-threatening complication after the modified Norwood Stage I procedure. This may require urgent surgery to replace the conduit or to perform a cavo-pulmonary shunt but as an alternative, transcatheter stent placement can be used with equal effectiveness and with a low risk of complications. The catheter approach is less invasive and the results show that it is an excellent option to relieve the stenosis even in the right-sided RV-PA conduit.
Desai
Tarak
T
Birmingham Children's Hospital NHS Foundation Trust, The Heart Unit, Birmingham, UK.
Stumper
Oliver
O
Miller
Paul
P
Dhillon
Rami
R
Wright
John
J
Barron
David
D
Brawn
William
W
Jones
Tim
T
DeGiovanni
Joseph
J
D000208:Acute Disease; D006328:Cardiac Catheterization / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D003251:Constriction, Pathologic / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000628:therapy*; D011651:Pulmonary Artery / Q000601:surgery; D015607:Stents