Document Detail

In hypoplastic left heart patients is Sano shunt compared with modified Blalock-Taussig shunt associated with deleterious effects on ventricular performance?
MedLine Citation:
PMID:  20053699     Owner:  NLM     Status:  MEDLINE    
A best evidence topic in congenital cardiac surgery was written according to a structured protocol. The question addressed was: in hypoplastic left heart patients is Sano shunt compared with modified Blalock-Taussig (mBT) shunt associated with deleterious effects on ventricular performance? Sano shunt modification of Norwood procedure involves construction of a right ventricle to pulmonary artery (RV-PA) conduit as an alternative source of pulmonary blood flow. Compared with the mBT shunt, the RV-PA conduit provides a more stable haemodynamic state in the immediate postoperative period and is reported to be associated with lower interstage mortality. However, concerns regarding the impact of ventriculotomy on short- and long-term performance of single ventricle have been expressed. Altogether 101 papers were found using the reported search terms, from which seven represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. None of the echocardiographic or clinical outcome studies showed poor ventricular performance after ventriculotomy of the systemic RV for construction of Sano shunt. A small autopsy study of 11 patients showed greater remodelling of the ventricular myocardial extracellular matrix in patients with RV-PA conduit with potential implications for poor ventricular performance. We conclude that the current available evidence, although weak, does not show any adverse effects of ventriculotomy on ventricular performance in patients with Sano shunt in the short- and medium-term. However, all the existing studies are limited by small numbers, non-randomised design and retrospective nature with failure of correlation of echocardiographic indices to clinical outcomes. It is expected that the Pediatric Heart Network randomised controlled trial will address this important issue.
Shahzad G Raja; Iryna Atamanyuk; Martin Kostolny; Victor Tsang
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Publication Detail:
Type:  Journal Article; Review     Date:  2010-01-06
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  10     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-03-25     Completed Date:  2010-06-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  620-3     Citation Subset:  IM    
Department of Paediatric Cardiothoracic Surgery, Great Ormond Street Hospital, London WC1N 3JH, UK.
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MeSH Terms
Cardiac Surgical Procedures* / adverse effects,  mortality
Coronary Circulation
Evidence-Based Medicine
Heart Ventricles / physiopathology,  surgery
Hypoplastic Left Heart Syndrome / mortality,  physiopathology,  surgery*
Pulmonary Artery / physiopathology,  surgery
Pulmonary Circulation
Time Factors
Treatment Outcome
Ventricular Function*
Ventricular Remodeling
Comment In:
Interact Cardiovasc Thorac Surg. 2010 Apr;10(4):623-4   [PMID:  20335397 ]

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

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