Document Detail

Acute interventions for stenosed right ventricle-pulmonary artery conduit following the right-sided modification of Norwood-Sano procedure.
MedLine Citation:
PMID:  19925536     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: 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.
PATIENTS AND 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.
Tarak Desai; Oliver Stumper; Paul Miller; Rami Dhillon; John Wright; David Barron; William Brawn; Tim Jones; Joseph DeGiovanni
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Congenital heart disease     Volume:  4     ISSN:  1747-0803     ISO Abbreviation:  Congenit Heart Dis     Publication Date:    2009 Nov-Dec
Date Detail:
Created Date:  2009-11-20     Completed Date:  2010-02-05     Revised Date:  2011-05-05    
Medline Journal Info:
Nlm Unique ID:  101256510     Medline TA:  Congenit Heart Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  433-9     Citation Subset:  IM    
Birmingham Children's Hospital NHS Foundation Trust, The Heart Unit, Birmingham, UK.
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MeSH Terms
Acute Disease
Cardiac Surgical Procedures / adverse effects*,  methods
Constriction, Pathologic / therapy
Follow-Up Studies
Heart Catheterization / methods*
Heart Ventricles / surgery
Hypoplastic Left Heart Syndrome / surgery*
Postoperative Complications / therapy*
Pulmonary Artery / surgery

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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