Modification of Ventricular-to-Pulmonary Shunt to Minimize Proximal Conduit Obstruction After Stage I Norwood Reconstruction

Hasaniya, Nahidh; Shattuck, Howard F.; Razzouk, Anees J.; Bailey, Leonard L.

doi:10.1016/j.athoracsur.2009.08.079

Cited by 9 publications

(5 citation statements)

References 8 publications

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“…However, this minor, yet significant, loss of ventricular myocardial tissue carries the risk of ventricular dysfunction. 4 In contrast, our technique allows sparing of the myocardial tissue by using a Nelaton catheter as a dilator; stenosis is unlikely to occur in patients treated using this method because the intake port should prevent myocardial tissue involvement at the proximal end, both in the early and midterm stages after operation. The Loma Linda group recently proposed a modification involving ventricular fixation.…”

Section: Discussionmentioning

confidence: 98%

Right ventricle–pulmonary artery conduit with intake port in the Norwood procedure

Aeba

Yozu

2012

The Journal of Thoracic and Cardiovascular Surgery

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The surgical management of hypoplastic left heart syndrome has been evolving rapidly over recent years. Norwood stage I palliation using a right ventricle-pulmonary artery (RV-PA) conduit instead of the modified Blalock-Taussig shunt has a theoretic advantage: The higher diastolic pressure and coronary perfusion pressure in the right ventricle compared with the systemic artery may result in more stable early postoperative hemodynamics. 1 However, several ventriculotomy-related complications may occur with this technique, including impaired ventricular function, reobstruction, pseudoaneurysm formation, and arrhythmia. 2 To prevent this, we developed a novel method for proximal conduit anastomosis, involving the use of an intake port, without the need for myocardial resection.

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Section: Discussionmentioning

confidence: 98%

Right ventricle–pulmonary artery conduit with intake port in the Norwood procedure

Aeba

Yozu

2012

The Journal of Thoracic and Cardiovascular Surgery

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“…Second, Schreiber et al reported the interposition of ring‐reinforced conduits between the RV and PA in patients undergoing stage 1 palliation for HLHS. Hasaniya et al modified this original technique, whereby the proximal portion of the RV‐PA ringed conduit was placed in full thickness into the RV instead of an epicardial insertion. Baird et al reviewed 29 neonates who underwent a modified stage 1 Norwood procedure with an RV‐PA conduit using a ringed PTFE graft inserted with the dunked technique.…”

Section: Commentmentioning

confidence: 99%

Early results of ring‐reinforced conduit and curved porcine patch in Sano‐Norwood procedure

Yildirim¹,

Bakhshaliyev²,

Kilercik³

et al. 2019

J Card Surg

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Background Patch augmentation of the aortic arch as well as construction of an unobstructed pulmonary blood supply are two important surgical targets in patients with hypoplastic left heart syndrome. In this report, we aimed to present our preliminary results with a combination of two relatively new approaches in Norwood‐Sano procedure. Methods A retrospective analysis was performed in 10 newborns with the diagnosis of hypoplastic left heart syndrome. Our surgical approach incorporated the interposition of a 6.0‐mm ring‐reinforced tube graft with the “dunked technique” between the right ventricle and the pulmonary artery; and reconstruction of the aortic arch using a curved porcine pericardial patch which is specifically designed for the Norwood procedure. Results Mean age and body weight at the time of the Sano‐Norwood operation were 7.3 ± 2.4 days and 3164 ± 406 g, respectively. We encountered 1 (10%) early and 1 (10%) late mortality. All of the patients were discharged without any residual gradients at the aortic arch. Four out of eight patients underwent stage 2 bidirectional cavopulmonary anastomosis at a median age of 5 months (range, 4‐6 months). Pericardial patch augmentation of the left pulmonary artery was deemed mandatory in one of our patients. Conclusions The dunked technique of interposing a ring‐reinforced conduit between the right ventricle and pulmonary artery along with the utilization of a curved porcine pericardial patch specifically designed for aortic arch reconstruction are promising modifications of the Sano‐Norwood procedure in newborns with hypoplastic left heart syndrome.

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“…After some initial experience, it was clear that this type of prosthesis may be extremely helpful in managing the proximal anastomotic stenosis. Independently of Tweddell et al [13] and Hasaniya et al [14], we developed our own technique of "dunking" and proximal fixation of the RVPAc with three single sutures through full thickness of the RV wall, including the endocardium, and the additional superficial purse-string haemostatic suture. The role of three single sutures is not only to fix the shunt, but also to keep the injured myocardium away from the lumen of the RVPAc, which -we believe -may prevent scar tissue migration into the lumen of the shunt.…”

Section: Proximal Aspect Of the Rvpacmentioning

confidence: 99%

The “double dunk” technique for a right ventricle to pulmonary artery conduit implantation during the Norwood procedure reduces unintended shunt-related events

Mroczek¹,

Sacharczuk²,

Żurek³

et al. 2018

Kardiol Pol

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Modification of Ventricular-to-Pulmonary Shunt to Minimize Proximal Conduit Obstruction After Stage I Norwood Reconstruction

Cited by 9 publications

References 8 publications

Right ventricle–pulmonary artery conduit with intake port in the Norwood procedure

Right ventricle–pulmonary artery conduit with intake port in the Norwood procedure

Early results of ring‐reinforced conduit and curved porcine patch in Sano‐Norwood procedure

The “double dunk” technique for a right ventricle to pulmonary artery conduit implantation during the Norwood procedure reduces unintended shunt-related events

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