Acute interventions for stenosed right ventricle-pulmonary artery conduit following the right-sided modification of Norwood-Sano procedure.

Abstract

INTRODUCTION:

The Norwood stage 1 procedure was modified by Sano with right ventricle-pulmonary artery (RV-PA) conduit replacing BT shunt. In our institution, this has been further modified by placing the conduit from the RV outflow tract to the right side of the neo-aorta.

PATIENTS AND METHODS:

Between April 2002 and October 2008, 227 modified Norwood procedures were performed. Eighteen had the Sano modification with the conduit to the left of the neo-aorta whereas 209 had the right-sided modification, which is the study population. A total of 18 (8.6%) patients presented with cyanosis due to conduit stenosis with median age 4 months and median weight 6.3 kg.

RESULTS:

Twelve patients underwent transcatheter stent placement in stenosed RV-PA conduit. A total of 16 coronary stents were implanted in 12 patients with 4 patients each receiving 2 stents. The mean saturations increased from 60% to 74%. There was one late mortality which was non-procedure related. Five patients treated with surgical take down of the RV-PA conduit and creation of a cavo-pulmonary shunt, whilst one patient had replacement of RV-PA conduit. There were no early postoperative deaths. The mean saturations improved from 54% to 75%.

CONCLUSIONS:

The RV-PA conduit stenosis is a life-threatening complication after the modified Norwood Stage I procedure. This may require urgent surgery to replace the conduit or to perform a cavo-pulmonary shunt but as an alternative, transcatheter stent placement can be used with equal effectiveness and with a low risk of complications. The catheter approach is less invasive and the results show that it is an excellent option to relieve the stenosis even in the right-sided RV-PA conduit.

• Authors: Tarak Desai, Oliver Stumper, Paul Miller, Rami Dhillon, John Wright, David Barron, William Brawn, Tim Jones, Joseph DeGiovanni
• Journal: Congenital heart disease (Congenit Heart Dis) 2009 Nov-Dec Vol. 4 Issue 6 Pg. 433-9 ISSN: 1747-0803 [Electronic] United States
• PMID: 19925536 (Publication Type: Journal Article)

Topics

• Acute Disease
• Cardiac Catheterization (methods)
• Cardiac Surgical Procedures (adverse effects, methods)
• Constriction, Pathologic (therapy)
• Female
• Follow-Up Studies
• Heart Ventricles (surgery)
• Humans
• Hypoplastic Left Heart Syndrome (surgery)
• Infant
• Male
• Postoperative Complications (therapy)
• Pulmonary Artery (surgery)
• Stents