Document Detail


Right ventricle to pulmonary artery conduit improves outcome after stage I Norwood for hypoplastic left heart syndrome.
MedLine Citation:
PMID:  12970225     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Diastolic run off into the pulmonary circulation and labile coronary perfusion are thought to contribute to morbidity and mortality after the Norwood procedure (NP). We compared outcomes from the use of a RV to PA conduit (RV/PA) or a modified Blalock-Taussig shunt (BTS), physiologically distinct sources of pulmonary blood flow. METHODS AND RESULTS: Review of 56 consecutive patients who underwent a Norwood procedure with a RV/PA (n=36) or a BTS (n=20) between 2000 and 2002. Median age was 4.5 days (range 1 to 40) and median weight was 3.1 kg (range 1.8 to 4.1). The RV/PA was constructed with a 5-mm conduit. Patients in the BTS group received a 4-mm shunt. Comparisons between RV/PA and BTS groups showed no difference for weight, gestational age, prenatal diagnosis, HLHS variant, associated diagnoses, ascending aortic size, ventricular function, AV valve function, and pulmonary venous obstruction. Operative survival was higher with RV/PA [33/36 (92%) versus 14/20 (70%); P=0.05]. Patients with RV/PA had less need for ventilatory manipulations to balance the Qp/Qs (1/36 v/s 8/20; P=0.001), delayed sternal closure (6/36 v/s 7/20; P=0.001), and extracorporeal support (5/36 v/s 7/20; P=0.036). RV/PA patients had more favorable postoperative hemodynamics: higher diastolic blood pressure without changes in systolic blood pressure at 1, 8, 24, 48 hours after the NP (46.3 v/s 39.5; 47.2 v/s 42.1; 46.1 v/s 37.1; and 47.1 v/s 40.2; all P=0.001). CONCLUSIONS: RV/PA simplifies postoperative management and improves hospital survival after NP for HLHS.
Authors:
Christian Pizarro; Edward Malec; Kevin O Maher; Katarzyna Januszewska; Samuel S Gidding; Kenneth A Murdison; Jeanne M Baffa; William I Norwood
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Controlled Clinical Trial; Journal Article; Multicenter Study    
Journal Detail:
Title:  Circulation     Volume:  108 Suppl 1     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2003 Sep 
Date Detail:
Created Date:  2003-09-12     Completed Date:  2003-09-30     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  II155-60     Citation Subset:  AIM; IM    
Affiliation:
Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, DE, USA. cpizarro@nemours.org
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MeSH Terms
Descriptor/Qualifier:
Anastomosis, Surgical
Blood Pressure
Blood Vessel Prosthesis Implantation
Cohort Studies
Echocardiography, Doppler
Heart Ventricles / surgery*
Humans
Hypoplastic Left Heart Syndrome / diagnosis,  surgery*,  ultrasonography
Infant, Newborn
Postoperative Period
Pulmonary Artery / surgery*
Treatment Outcome

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


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