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Ann Thorac Surg 2007;83:1231
© 2007 The Society of Thoracic Surgeons

Correspondence

Novel Modification of Right Ventricle to Pulmonary Artery Shunt in Palliation of Hypoplastic Left Heart Syndrome

Christian Schreiber, MD, PhDa, Zsolt Prodan, MDa, Andreas Eicken, MDb, Lange Rüdiger, MD, PhDb

a Clinic of Cardiovascular Surgery, Congenital Heart Disease, German Heart Center, Munich Technical University, Munich, Lazarettstrasse 36, Munich, 80636 Germany
b Department of Paediatric Cardiology, Congenital Heart Disease, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636 Germany

(Email: schreiber{at}dhm.mhn.de).

To the Editor:

Recent reports suggest that the right ventricle to pulmonary artery conduit results in improved outcome of first stage palliation for hypoplastic left heart syndrome [1, 2]. However, Nigro and colleagues [3] described sudden death due to proximal conduit obstruction. We also encountered a proximally stenosed shunt and have subsequently stented the shunt successfully [4]. With the potential drawback of proximal shunt compression in mind, we have now adopted a modification of the technique, using a 5-mm Gore-Tex stretch vascular graft (Gore-Tex, W. L. Gore & Assoc, Flagstaff, AZ) with removable rings. It is cut in an oblique fashion at the site of the right ventricle. The postoperative cardiac catheter image shows no obstruction of the tube (Figs 1, 2). Go The ring-enforced shunt avoids any sternal compression and may thus lead to improved results.


Figure 1
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  		Fig 1. Cardiac catheter—posteroanterior plane of conduit.

 

Figure 2
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  		Fig 2. Cardiac catheter—lateral plane of conduit.

 


   References
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 References
 

  1. Sano S, Ishino K, Kado H, et al. Outcome of right ventricle-to-pulmonary artery shunt in first-stage palliation of hypoplastic left heart syndrome: a multi-institutional study Ann Thorac Surg 2004;78:1951-1957.[Abstract/Free Full Text]
  2. Pizarro C, Mroczek T, Malec E, Norwood WI. Right ventricle to pulmonary artery conduit reduces interim mortality after stage 1 Norwood for hypoplastic left heart syndrome Ann Thorac Surg 2004;78:1959-1963.[Abstract/Free Full Text]
  3. Nigro JJ, Bart RD, Derby CD, Sklansky MS, Starnes VA. Proximal conduit obstruction after Sano modified Norwood procedure Ann Thorac Surg 2005;80:1924-1928.[Abstract/Free Full Text]
  4. Eicken A, Sebening W, Genz T, Schreiber C, Hess J. Stenting of a stenosed Sano shunt in a neonate with hypoplastic left heart syndrome Pediatr Cardiol 2005;26:877-878.[Medline]

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John J. Nigro
Ann. Thorac. Surg. 2007 83: 1231-1232. [Extract] [Full Text] [PDF]



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Ann. Thorac. Surg., March 1, 2007; 83(3): 1231 - 1232.
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