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Ann Thorac Surg 2004;78:1965-1971
© 2004 The Society of Thoracic Surgeons

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Original Article: Cardiovascular

Midterm Ventricular Performance After Norwood Procedure With Right Ventricular–Pulmonary Artery Conduit

Department of Cardiovascular Surgery and Pediatric Cardiology, Fukuoka Children's Hospital Medical Center, Fukuoka, Japan

Accepted for publication June 2, 2004.

^* Address reprint requests to Dr Tanoue, Department of Cardiovascular Surgery, Kyushu University, 3–1–1 Maidashi, Higashi-ku, Fukuoka 812–8582, Japan (E-mail: tanoue{at}heart.med.kyushu-u.ac.jp).

BACKGROUND: Midterm and long-term results of patients who underwent a Norwood procedure with a right ventricular–pulmonary artery conduit remain unclear. This study aimed to compare the midterm ventricular performance of the Norwood procedure with right ventricular–pulmonary artery conduit and the Norwood procedure with systemic–pulmonary shunt.

METHODS: Twenty-one patients who underwent both a bidirectional Glenn procedure and a total cavopulmonary connection after Norwood palliation at Fukuoka Children's Hospital Medical Center were divided into two groups: the systemic–pulmonary shunt group (n = 11) and the right ventricular–pulmonary artery conduit group (n = 10). End-systolic elastance (contractility), effective arterial elastance (afterload), and ventriculoarterial coupling and the ratio of stroke work and pressure-volume area (ventricular efficiency) were measured on the basis of cardiac catheterization data before the bidirectional Glenn procedure, before and after the total cavopulmonary connection, and at approximately 1 year after total cavopulmonary connection.

RESULTS: After bidirectional Glenn procedure and total cavopulmonary connection, end-systolic elastance of the right ventricular–pulmonary artery conduit group was lower than that of the systemic–pulmonary shunt group, whereas effective arterial elastance of the right ventricular–pulmonary artery conduit group was lower than that of the systemic–pulmonary shunt group. Consequently, there was no difference in ventricular efficiency in both groups 1 year after total cavopulmonary connection.

CONCLUSIONS: The midterm ventricular performance of the right ventricular–pulmonary artery conduit group was comparable with the systemic–pulmonary shunt group in terms of ventricular efficiency. However, after bidirectional Glenn procedure and total cavopulmonary connection, contractility in patients who underwent a Norwood procedure with a right ventricular–pulmonary artery conduit was inferior to that of patients who underwent a Norwood procedure with a systemic–pulmonary shunt.

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