title: Usefulness of balloon angioplasty for the right ventricle-pulmonary artery shunt with the modified Norwood procedure.
abstract: OBJECTIVE
  We sought to evaluate the efficacy of balloon angioplasty (BA) for severely desaturated patients due to a stenotic right ventricle (RV) to pulmonary artery (PA) shunt following modified Norwood procedure.
  
  
  METHODS
  Of 87 patients who underwent a Norwood procedure with the RV-PA shunt between February 1998 through March 2010, 22 (25%) patients underwent BA. The efficacy of BA was assessed by angiographic measurement of the changes in the internal diameters of the stenotic portions of the shunt, changes in arterial saturation and clinical outcomes.
  
  
  RESULTS
  BA was performed for stenotic RV-PA shunts following stage I palliation (n = 17, 77%), or those placed as an additional blood source (n = 5, 23%, 3 patients awaiting biventricular repair, 2 patients following stage II palliation). The location of the BA was at the distal anastomosis in 12 (54.5%), proximal anastomosis in 21 (95.4%) and in the mid-portion of the shunt in 11 (50%) cases. The diameters of these three shunt portions were measured from the anterior-posterior and lateral angiographic images, increasing significantly after BA (p < 0.0001) in all. Arterial saturation significantly improved after BA in all cases (66.5 ± 4.3% to 79.4 ± 3.4%, p < 0.0001). Freedom from reintervention was 100%. All patients underwent subsequent elective planned surgery at an appropriate age with no mortality.
  
  
  CONCLUSIONS
  A BA-alone strategy for a stenotic RV-PA shunt was effective for all three shunt portions, minimizing shunt-related premature surgical intervention.
authors.affiliation: Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Ohno
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ohtsuki
authors.forename: Koichi
authors.initials: K
authors.lastname: Kataoka
authors.forename: Kenji
authors.initials: K
authors.lastname: Baba
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Okamoto
authors.forename: Maiko
authors.initials: M
authors.lastname: Kondo
authors.forename: Shunji
authors.initials: S
authors.lastname: Sano
authors.forename: Shingo
authors.initials: S
authors.lastname: Kasahara
authors.forename: Osami
authors.initials: O
authors.lastname: Honjo
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Morishima
mesh_terms: D000800:Angioplasty, Balloon / Q000009:adverse effects; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D003251:Constriction, Pathologic; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000503:physiopathology / Q000601:surgery*; D058327:Norwood Procedures / Q000009:adverse effects*; D010166:Palliative Care; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome