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Ann Thorac Surg 2008;86:1299-1304. doi:10.1016/j.athoracsur.2008.06.016
© 2008 The Society of Thoracic Surgeons
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Joseph Caspi
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Original Articles: Pediatric Cardiac

Development of the Pulmonary Arteries After the Norwood Procedure: Comparison Between Blalock-Taussig Shunt and Right Ventricular–Pulmonary Artery Conduit

Joseph Caspi, MD*, Timothy W. Pettitt, MD, Theodorus Mulder, MD, Aluizio Stopa, MD

Division of Cardiothoracic Surgery and Pediatric Cardiology, Louisiana State University and Children's Hospital, New Orleans, Louisiana

Accepted for publication June 2, 2008.

* Address correspondence to Dr Caspi, Children's Hospital, 200 Henry Clay Ave, New Orleans, LA 70118 (Email: caspij{at}aol.com).

Background: The Norwood-Sano procedure for hypoplastic left heart syndrome (HLHS) has been associated with improved postoperative hemodynamics and outcome. This study compared the effect of a Blalock-Taussig shunt with right ventricular-pulmonary artery (RV-PA) conduit before bidirectional Glenn on the development of the PAs.

Methods: Between January 2000 and June 2007, 42 patients with HLHS underwent bidirectional Glenn: 19 (mean age, 7 ± 1.5 months) had a Blalock-Taussig shunt (3.5 mm in 15; and 4 mm in 4); 23 patients (mean age, 5 ± 1 month) had RV-PA conduit (5-mm tube). Patients underwent postoperative cardiac catheterization and echocardiograms.

Results: Total PA (Nakata) index was 192 ± 10 mm2/m2 in the Blalock-Taussig group and 238 ± 18 mm2/m2 in the RV-PA conduit group (p = 0.03). In the RV-PA conduit patients, the left and right PAs had comparable diameters. In the Blalock-Taussig group, the left PA was smaller than the right (p = 0.02). The mean PA pressure at the end of the operation was 14 ± 2 mm Hg in the Blalock-Taussig group and 11 ±1 mm Hg in the RV-PA conduit group (p = 0.06). Persistent pleural effusion occurred in 4 Blalock-Taussig patients (21%) and in 1 (4%) with RV-PA conduit (p < 0.05). Postoperative arterial oxygen saturation was 80% ± 2% in the RV-PA conduit group and 74% ± 2% in the Blalock-Taussig group (p < 0.05).

Conclusions: The Norwood procedure with RV-PA conduit may have favorable effects on the development of the PA due to even distribution of pulmonary blood flow.






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