Document Detail


The modified Norwood procedure for hypoplastic left heart syndrome: early to intermediate results of 120 patients with particular reference to aortic arch repair.
MedLine Citation:
PMID:  10220686     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Classic first-stage Norwood repair of hypoplastic left heart syndrome uses a homograft patch enlargement to obtain an unobstructed aorta and coronary arteries. Because of possible disadvantages of the homograft, such as lack of growth, degeneration and calcification, and availability, we have tried to repair the aorta without patch supplementation. METHODS: Between February 1993 and September 1997, 120 patients, aged birth to 47 days (median 4 days) and weighing 1.7 to 4.4 kg (median 3.1 kg), underwent first-stage palliation for hypoplastic left heart syndrome. The diameter of the ascending aorta ranged from 1.5 to 8.0 mm (median 3.0 mm). Eight patients had an aberrant right subclavian artery arising from the descending thoracic aorta. In 95 patients (group I), all duct tissue was excised and the descending aorta was anastomosed to the aortic arch, which had been opened back into the ascending aorta. Then to this confluence was anastomosed the proximal main pulmonary artery. In the remaining 25 patients (group II), continuity of the aortic arch was maintained and the repair was performed with a Damus-Kaye-Stansel anastomosis. The size of the systemic-to-pulmonary shunt was 3 mm in 48 patients, 3.5 mm in 70, and 4.0 mm in 2. RESULTS: Circulatory arrest time ranged from 19 to 105 minutes (median 54 minutes). A homograft patch was necessary for the arch reconstruction in 18 patients (15%); 9 group I patients (10%) and 9 group II (36%) (P =.001). There were 82 hospital survivors (68%); 69 group I patients (73%) and 13 group II (52%) (P =.04), 71 patients without a patch (70%) and 11 with a patch (61%) (P >.2). By multiple logistic regression, the aberrant right subclavian artery was a significant risk factor for hospital death (P =.008). There were 6 late deaths. Sixteen of 71 patients (23%) who underwent second-stage palliation had a neoaortic arch obstruction develop, with a peak gradient greater than 10 mm Hg; 14 group I patients (23%) and 2 group II (22%) ( P >.2), 15 without a patch (23%) and 1 with a patch (17%) (P >.2). Overall survivals were 57% at 1 year and 55% at 2 years. CONCLUSION: The modified Norwood procedure for first-stage palliation of hypoplastic left heart syndrome is possible in the majority of patients without the use of exogenous materials and does not result in an increased incidence of neoaortic arch obstruction. Repair of the aorta without patch supplementation may improve the potential for long-term growth of the new aorta.
Authors:
K Ishino; O Stümper; J J De Giovanni; E D Silove; J G Wright; B Sethia; W J Brawn; M de Leval
Related Documents :
14683746 - Prognostic value of clinical and morphologic findings in short-term evolution of aortic...
20542466 - Contemporary results following surgical repair of acute type a aortic dissection (aaad)...
17599876 - Aortic valve-sparing repair with autologous pericardial leaflet extension has low long-...
10872696 - Management of extensive lesions of the aortic arch: review of 42 consecutive cases.
23975566 - Double-lumen tube tracheal intubation using a rigid video-stylet: a randomized controll...
22963186 - Oral cyclophosphamide without corticosteroids to treat mucous membrane pemphigoid.
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  117     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  1999 May 
Date Detail:
Created Date:  1999-05-18     Completed Date:  1999-05-18     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  920-30     Citation Subset:  AIM; IM    
Affiliation:
Heart Unit, Birmingham Children's Hospital, Birmingham, United Kingdom.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Anastomosis, Surgical
Aorta, Thoracic / surgery*
Biocompatible Materials
Blood Vessel Prosthesis Implantation / methods*,  mortality
Cardiac Surgical Procedures
Female
Follow-Up Studies
Humans
Hypoplastic Left Heart Syndrome / mortality,  surgery*
Infant
Infant, Newborn
Male
Palliative Care / methods
Polytetrafluoroethylene
Pulmonary Artery / surgery*
Retrospective Studies
Survival Rate
Treatment Outcome
Chemical
Reg. No./Substance:
0/Biocompatible Materials; 9002-84-0/Polytetrafluoroethylene

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


Previous Document:  On-line assessment of regional ventricular wall motion by transesophageal echocardiography with colo...
Next Document:  A detailed histologic analysis of pulmonary arteriovenous malformations in children with cyanotic co...