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Ann Thorac Surg 2007;83:1231-1232
© 2007 The Society of Thoracic Surgeons

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Correspondence

Reply

Saint Joseph’s Hospital and Medical Center, Director, Congenital Heart Center, Cardiothoracic Surgery, 500 W Thomas Road, Suite 500, Phoenix, AZ 85013

(Email: john.nigro{at}chw.edu).

To the Editor:

The Munich group [1] has proposed a modification of the technique described by Sano [2–4] for neonatal palliation of hypoplastic left heart syndrome in which an externally supported Gore-Tex conduit (W.L. Gore & Assoc, Flagstaff, AZ) is used to create right ventricle to pulmonary artery continuity. This modification is intended to reduce the likelihood of conduit obstruction and improve conduit durability.

Right ventricle to pulmonary artery conduit obstruction can occur at three levels: (1) at the proximal anastamosis, (2) inside the conduit, and (3) at the distal anastamosis (the pulmonary artery confluence). Distal obstruction is probably related to the pulmonary confluence patch and seems to be avoided by the use of a Gore-Tex patch (W.L. Gore & Assoc) as described by Sano [2–4]. Proximal conduit obstruction that we have previously described is related to fibro-intimal hyperplasia, which emanates from the ventricular myocardium [5]; this type of obstruction may be an intrinsic reaction to prosthetic right ventricle to conduit continuity, much like the neointimal peel that has been previously described to occur after prosthetic reconstruction of the right ventricular outflow tract [6]. It is unlikely that the externally reinforced conduit will completely address this type of proximal conduit obstruction; however it will provide for a conduit that is less likely to be externally compressed and possibly less vulnerable to obstruction within the conduit itself.

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1. Schreiber C, Prodan Z, Eicken A, Rüdiger L. Novel modification of right ventricle to pulmonary artery shunt in palliation of hypoplastic left heart syndrome(letter) Ann Thorac Surg 2007;83:1231.[Free Full Text]
2. Sano S, Ishino K, Kawada M, et al. Right ventricle-pulmonary artery shunt in first-stage palliation of hypoplastic left heart syndrome J Thorac Cardiovasc Surg 2003;126:504-509.[Abstract/Free Full Text]
3. Sano S, Ishino K, Kawada M, Honjo O. Right ventricle-pulmonary artery shunt in first-stage palliation of hypoplastic left heart syndrome Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2004;7:22-31.[Medline]
4. 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]
5. 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]
6. Kobayashi J, Backer CL, Zales VR, Crawford SE, Muster AJ, Mavroudis C. Failure of the Hemashield extension in right ventricle-to-pulmonary artery conduits Ann Thorac Surg 1993;56:277-281.[Abstract]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): John J. Nigro Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Nigro, J. J. Search for Related Content PubMed Articles by Nigro, J. J. Related Collections Related Article