title: [Reconstruction of pulmonary blood flow in the Norwood procedure; Blalock-Taussig shunt; from bench to surgery].
abstract: Although the right-ventricle to pulmonary artery( RV-PA) shunt as a source of pulmonary blood supply of Norwood procedure has improved early outcomes, disadvantages including right ventricular dysfunction or arrhythmias have been reported. So it has been still remained controversial whether BT shunt or RV-PA conduit should be selected. We examined the influence of Blalock-Taussig( BT) shunt size on regulation of the pulmonary blood flow in experimental model of a univentricular heart to determine the specific guidelines regarding suitable shunt size in the Norwood procedure. The canine univentricular heart model with the ratio of shunt size to body weight (SS/BW) of 0.8 to 1.1 showed significant negative correlation between the pulmonary/systemic blood flow ratio( Qp/Qs)and arterial PCo2, but those with SS/BW of 1.1 to 1.4 did not. Similar phenomena were shown with the grouped data on relationship between the Qp/Qs and inspired oxygen fraction. These findings imply that when SS/BW is 0.8 to 1.1, the Qp/Qs is controllable by physiologic respiratory manipulations. In the context of our clinical experiences, SS/BW of 0.9 to 1.0 is considered a useful index for suitable BT shunt in the Norwood procedure.
authors.affiliation: Department of Cardiovascular Surgery, The University of Tokushima, Tokushima, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kitaichi
authors.forename: Mikio
authors.initials: M
authors.lastname: Sugano
authors.forename: Hajime
authors.initials: H
authors.lastname: Kinoshita
authors.forename: Taisuke
authors.initials: T
authors.lastname: Nakayama
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Kurobe
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Kanbara
authors.forename: Eiki
authors.initials: E
authors.lastname: Fujimoto
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kitagawa
mesh_terms: D000818:Animals; D058366:Blalock-Taussig Procedure / Q000379:methods*; D004285:Dogs; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D058327:Norwood Procedures; D011652:Pulmonary Circulation / Q000502:physiology*