Adjustable tourniquet to manipulate pulmonary blood flow after Norwood operations

Schmid, Franz X.; Kampmann, Christoph; Kuroczynski, Wlodimierz; Choi, Yeong‐Hoon; Knuf, Markus; Tzanova, Irene; Oelert, H.

doi:10.1016/s0003-4975(99)00819-x

Cited by 25 publications

(15 citation statements)

References 10 publications

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“…Techniques have included the addition of carbon dioxide to the inspired gas mixture, 7,8 use of hypoxic gas, 9,10 controlled hypoventilation, 11 pharmacological manipulation of systemic vascular resistance, 12,13 and manipulation of shunt size. 14 The RV-PA conduit modification created a hemodynamic profile characterized by a higher aortic diastolic pressure, a decreased Qp:Qs, a narrowed systemic pulse pressure, and a higher coronary perfusion pressure. The RV-PA modification was effective in improving coronary blood flow by the limitation of pulmonary blood flow, particularly in diastole.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic Profile After the Norwood Procedure With Right Ventricle to Pulmonary Artery Conduit

Maher¹,

Pizarro²,

Gidding³

et al. 2003

Circulation

102

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Background-The balance of systemic, pulmonary, and coronary blood flow after the Norwood operation for hypoplastic left heart syndrome (HLHS) is critical to early survival. We hypothesized that a right ventricle to pulmonary artery conduit (instead of a systemic to pulmonary artery shunt) would result in hemodynamic changes consistent with a more stable balance of systemic, pulmonary, and coronary perfusion. Methods and Results-Hemodynamic data were obtained during cardiac catheterization before the hemi-Fontan procedure from 24 patients with HLHS; the first 10 had a Norwood operation with a systemic to pulmonary artery shunt, and the latter 14 had the Norwood operation with a right ventricle to pulmonary artery conduit. Significant differences were present, with the right ventricle to pulmonary artery conduit group having a higher aortic diastolic pressure (55 versus 42 mm Hg), a narrowed systemic pulse pressure (43 versus 64 mm Hg), a lower Qp:Qs (0.92 versus 1.42), a higher coronary perfusion pressure (46 versus 32 mm Hg), and a higher ratio of pulmonary artery diameter to descending aorta diameter (1.51 versus 1.37). Conclusions-We conclude that, in HLHS after the Norwood operation, the right ventricle to pulmonary artery conduit modification produces hemodynamic changes consistent with improved coronary perfusion and a more favorable distribution of systemic, pulmonary, and coronary blood flow.

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Section: Discussionmentioning

confidence: 99%

Hemodynamic Profile After the Norwood Procedure With Right Ventricle to Pulmonary Artery Conduit

Maher¹,

Pizarro²,

Gidding³

et al. 2003

Circulation

102

View full text Add to dashboard Cite

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“…It was particularly useful for the left‐sided shunts, either classic or modified, as it was suitable for a sternotomy approach. Placement of an adjustable tourniquet around a modified right B‐T shunt was also attempted 28 . The snare‐controlled systemic‐to‐pulmonary shunt provides hemodynamic stability and tolerance by reducing the risk of pulmonary overcirculation.…”

Section: Modifications To Surgical Techniquementioning

confidence: 99%

“…Placement of an adjustable tourniquet around a modified right B-T shunt was also attempted. 28 The snare-controlled systemic-to-pulmonary shunt provides hemodynamic stability and tolerance by reducing the risk of pulmonary overcirculation. Moreover, a temporary shunt resize technique with a removable metallic clip was another alternative to the above techniques with satisfactory results.…”

Section: Modifications To Surgical Techniquementioning

confidence: 99%

The Blalock-Taussig Shunt

Yuan

Shinfeld

Raanani

2009

Journal of Cardiac Surgery

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Background and aim of the study: Even though the Blalock-Taussig (B-T) shunt, either classic or modified, has been advocated and successfully employed in clinical practice for more than half a century, a systemic review on this procedure is still scanty. This warrants us a zest in making a comprehensive survey on this subject. Methods: Articles were extensively retrieved from the MEDLINE database of National Library of Medicine USA if the abstract contained information relevant to the B-T shunt in terms of the conduit options, modified surgical techniques, surgical indications, short-and long-term results, complications, and prognosis. Further retrieval was undertaken by manually searching the reference list of relevant papers. Results: Classical or modified B-T shunts, either on ipsilateral or contralateral side to the aortic arch, can be performed on patients of any age with minimum postoperative complications and low operative mortality. Expended polytetrafluoroethylene has gained satisfactory long-term patency rate in the construction of the modified B-T shunt. Excellent pulmonary artery growth was observed in the patients with a modified B-T shunt, and it has shown superb prognosis over the classic with regard to hemodynamics, patency rate, and survival. Conclusions: The modified B-T shunt that was developed on basis of the classic fashion remains the preferable palliative procedure aiming at enhancing pulmonary blood flow for neonates and infants with complicated cyanotic congenital heart defects. The modified B-T shunt is technically simpler with less dissection, and blood flow to the respective arm is not jeopardized. It has been proved to be of low risk, excellent palliation, and is associated with excellent pulmonary artery growth, has become the most effective palliative shunt procedure of today. doi: 10.1111/j.1540-8191.2008.00758.x (J Card Surg 2009;24:101-108) Complex cyanotic congenital heart disease may occasionally be unsuitable for surgical correction, but for palliative procedure only. 1 In 1945, prior

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“…Schmid et al [3] described an adjustable tourniquet placed around the shunt, left in situ beneath the linea alba; in small neonates it can lead to problems.…”

Section: Discussionmentioning

confidence: 99%

Adjustable aorto-pulmonary shunt to prevent temporary pulmonary over-circulation

Napoleone

Oppido

Angeli

et al. 2006

European Journal of Cardio-Thoracic Surgery

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Adjustable tourniquet to manipulate pulmonary blood flow after Norwood operations

Cited by 25 publications

References 10 publications

Hemodynamic Profile After the Norwood Procedure With Right Ventricle to Pulmonary Artery Conduit

Hemodynamic Profile After the Norwood Procedure With Right Ventricle to Pulmonary Artery Conduit

The Blalock-Taussig Shunt

Adjustable aorto-pulmonary shunt to prevent temporary pulmonary over-circulation

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