Document Detail


Does size matter? Larger Blalock-Taussig shunt in the modified Norwood operation correlates with better hemodynamics.
MedLine Citation:
PMID:  15939595     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Excess pulmonary to systemic blood flow ratio (Qp/Qs) correlates with hemodynamic instability and mortality after modified Norwood operation. Studies suggest that maximal oxygen delivery occurs at a Qp/Qs of around 1. The use of a rather small modified Blalock-Taussig shunt (MBTS) is believed to achieve this goal. However, optimal MBTS size with respect to postoperative hemodynamics remains unclear. METHODS: Between 2/2002 and 2/2004, 20 consecutive patients underwent Norwood operation; there were 19 operative survivors: nine with a normalized MBTS area (NSA) > or = 3.3 mm2/kg (group 1) and 10 with NSA < 3.3 mm2/kg (group 2). Mean arterial pressure (MAP) and common atrial pressures (CAP), arterial and superior vena cava oxygen saturations, urinary output and inotropes recorded for the postoperative hours 0, 6, 12, 18, 24 and 48 were analyzed. RESULTS: Hospital mortality was 11.1% (1/9) in group 1 and 30% (3/10) in group 2 (P = 0.6). For group 1 significantly higher MAP of 52+/-1.3 versus 46+/-0.8 mmHg (P < 0.001), higher urinary output of 6.2+/-0.5 versus 4.2+/-0.5 ml/kg per h (P < 0.01), lower CAP of 8+/-0.3 versus 10+/-0.4 mmHg (P < 0.001), and lower heart rate of 145+/-2.6 versus 160+/-1.6 bpm were recorded than for group 2. In group 1, lower doses of adrenaline (0.03+/-0.01 versus 0.15+/-0.01 microg/kg per min, P < 0.05) and noradrenaline (0.01+/-0.01 versus 0.13+/-0.04 microg/kg per min, P < 0.01) were needed. Although Qp/Qs was more often calculated to be > 1.5 in group 1 (51 versus 31%), arteriovenous oxygen difference and oxygen excess factor were not significantly different, indicating similar oxygen delivery. CONCLUSIONS: Monitoring of the central venous oxygen saturations and application of afterload reduction in cases of high Qp/Qs allows the insertion of a larger MBTS without association with lower oxygen delivery. In fact, better hemodynamic status with less inotropic support was noted with a larger MBTS early after Norwood operation.
Authors:
Joachim Photiadis; Michael Hübler; Nicodème Sinzobahamvya; Stanislav Ovroutski; Brigitte Stiller; Roland Hetzer; Andreas E Urban; Boulos Asfour
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Multicenter Study    
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  28     ISSN:  1010-7940     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2005 Jul 
Date Detail:
Created Date:  2005-06-28     Completed Date:  2005-10-17     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  56-60     Citation Subset:  IM    
Affiliation:
German Pediatric Heart Institute, Sankt Augustin, Germany. photiadis@gmx.de
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MeSH Terms
Descriptor/Qualifier:
Anastomosis, Surgical / methods
Hemodynamics*
Hospital Mortality
Humans
Hypoplastic Left Heart Syndrome / physiopathology,  surgery*
Infant
Infant, Newborn
Oxygen / blood
Postoperative Care / methods
Postoperative Period
Pulmonary Artery / surgery
Retrospective Studies
Risk Factors
Subclavian Artery / surgery
Treatment Outcome
Chemical
Reg. No./Substance:
7782-44-7/Oxygen

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


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