title: Norwood procedure with non-valved right ventricle to pulmonary artery shunt improves ventricular energetics despite the presence of diastolic regurgitation: a theoretical analysis.
abstract: When the Norwood procedure is conducted for the hypoplastic left heart syndrome using a non-valved right ventricle (RV) to pulmonary artery (PA) shunt, diastolic regurgitation from PA to RV may have an adverse effect on postoperative hemodynamics. In this study, we examined the impact of the diastolic regurgitation on ventricular energetics by computational analysis using a combination of a time-varying elastance chamber model and a modified three-element Windkessel vascular model. This study revealed that use of the valved or non-valved RV-PA shunt eliminated pulmonary over-circulation which was observed when using the systemic to pulmonary artery shunt (modified Blalock-Taussig shunt). Although the valved RV-PA shunt improved pulmonary blood supply and consequently increased pulmonary artery flow and oxygen saturation compared to the non-valved RV-PA shunt, the non-valved RV-PA shunt improved ventricular energetics in spite of the presence of PA to RV regurgitation.
authors.affiliation: Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan. shujismz@ri.ncvc.go.jp
authors.forename: Shuji
authors.initials: S
authors.lastname: Shimizu
authors.forename: Dai
authors.initials: D
authors.lastname: Une
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Shishido
authors.forename: Atsunori
authors.initials: A
authors.lastname: Kamiya
authors.forename: Toru
authors.initials: T
authors.lastname: Kawada
authors.forename: Shunji
authors.initials: S
authors.lastname: Sano
authors.forename: Masaru
authors.initials: M
authors.lastname: Sugimachi
mesh_terms: D058366:Blalock-Taussig Procedure / Q000379:methods; D003971:Diastole / Q000502:physiology; D006321:Heart / Q000502:physiology* / Q000503:physiopathology; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery; D006439:Hemodynamics / Q000502:physiology; D018636:Hypoplastic Left Heart Syndrome / Q000503:physiopathology / Q000601:surgery; D008168:Lung / Q000503:physiopathology / Q000601:surgery; D008955:Models, Cardiovascular; D058327:Norwood Procedures / Q000379:methods*; D010100:Oxygen / Q000378:metabolism; D011651:Pulmonary Artery / Q000503:physiopathology / Q000601:surgery*; D011652:Pulmonary Circulation / Q000502:physiology*; D012039:Regional Blood Flow / Q000502:physiology
chemical_list: D010100:Oxygen