| Right ventricular to pulmonary artery conduit instead of modified Blalock-Taussig shunt improves postoperative hemodynamics in newborns after the Norwood operation. | |
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MedLine Citation:
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PMID: 14666009 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Perioperative mortality, prolonged postoperative recovery after the Norwood procedure, and mortality between stage I and stage II might be related to shunt physiology. A right ventricular to pulmonary artery conduit offers a banded physiology in contrast to a Blalock-Taussig shunt. The purpose of this study was to assess the hemodynamic differences and their consequences in the postoperative course between Norwood patients with a Blalock-Taussig shunt and those with a right ventricular to pulmonary artery conduit. METHODS: From October 1999 until May 2002, 32 unselected consecutive patients underwent a Norwood procedure at the General Hospital Linz. The first 18 patients received a Blalock-Taussig shunt. In the remaining 14 patients we performed a right ventricular to pulmonary artery conduit. Both groups were compared. RESULTS: The diastolic blood pressure was significantly higher in the right ventricular to pulmonary artery conduit group (P <.001). Despite a higher FIO(2), PO(2) levels tended to be lower in the first 5 postoperative days. At the age of 3 months, catheterization laboratory data showed a lower Qp/Qs ratio in the same group (0.86 [0.78; 1] versus 1.55 [1.15; 1.6]; P =.005) and a higher dp/dt (955 [773; 1110] vs 776 [615; 907]; P =.018). (Descriptive data reflect medians and quartiles [in brackets].) Hospital survival was 72% in the Blalock-Taussig shunt group versus 93% in the right ventricular to pulmonary artery conduit group. Mortality between stage I and stage II was 23% in the Blalock-Taussig shunt group versus 0% in the right ventricular to pulmonary artery conduit group. CONCLUSIONS: A higher diastolic blood pressure and a lower Qp/Qs ratio were associated with a more stable and efficient circulation in patients with a right ventricular to pulmonary artery conduit. More intensive ventilatory support was necessary during the first postoperative days. We did not note any adverse effects of the ventriculotomy on ventricular performance. |
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Authors:
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Rudolf Mair; Gerald Tulzer; Eva Sames; Roland Gitter; Evelyn Lechner; Jürgen Steiner; Anna Hofer; Gertraud Geiselseder; Christoph Gross |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: The Journal of thoracic and cardiovascular surgery Volume: 126 ISSN: 0022-5223 ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2003 Nov |
Date Detail:
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Created Date: 2003-12-10 Completed Date: 2004-01-14 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 1378-84 Citation Subset: AIM; IM |
Affiliation:
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Department of Cardiac Surgery, General Hospital Linz, Austria. rudolf.mair@akh.linz.at |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Anastomosis, Surgical
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methods Cardiac Surgical Procedures / methods*, mortality Female Heart Septal Defects, Ventricular / diagnosis, mortality, surgery* Heart Ventricles / surgery Hemodynamics* Humans Hypoplastic Left Heart Syndrome / diagnosis, mortality, surgery* Infant, Newborn Male Postoperative Complications / prevention & control Probability Prognosis Pulmonary Artery / surgery Retrospective Studies Risk Assessment Sampling Studies Statistics, Nonparametric Survival Analysis Treatment Outcome |
| Comments/Corrections | |
Comment In:
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J Thorac Cardiovasc Surg. 2003 Nov;126(5):1268-70
[PMID:
14665995
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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