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Erschienen in: Pediatric Cardiology 4/2013

01.04.2013 | Original Article

Intact Right Ventricle–Pulmonary Artery Shunt After Stage 2 Palliation in Hypoplastic Left Heart Syndrome Improves Pulmonary Artery Growth

verfasst von: Mariel E. Turner, Marc E. Richmond, Jan M. Quaegebeur, Amee Shah, Jonathan M. Chen, Emile A. Bacha, Julie A. Vincent

Erschienen in: Pediatric Cardiology | Ausgabe 4/2013

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Abstract

For patients with hypoplastic left heart syndrome who have undergone the Norwood procedure with a right ventricle–pulmonary artery (RV-PA) shunt, the shunt can either be removed or left intact at the time of the stage 2 procedure. This study aimed to determine the effects of an intact shunt on pulmonary artery growth and clinical outcomes after the stage 2 procedure. A retrospective review of patients who underwent Norwood with an RV-PA shunt from 2005 to 2010 was performed. Catheterization data, echocardiographic data, postoperative outcome variables, and mortality data were collected. Pulmonary artery size was measured at pre-stage 2 and pre-Fontan catheterizations using the Nakata Index and the McGoon Ratio. Of the 68 patients included in the study, 48 had the shunt removed at the time of stage 2 (group 1), and 20 had the shunt left intact (group 2). The two groups did not differ in terms of pre-stage 2 hemodynamics or pulmonary artery size. After stage 2, group 2 had higher oxygen saturations. The two groups did not differ regarding duration of chest tube drainage, length of hospital stay, need for unplanned interventions, or mortality. Before Fontan, the group 2 patients had higher superior vena cava (SVC) pressures and more venovenous collaterals closed. There was increased pulmonary artery growth between the pre-stage 2 and pre-Fontan catheterizations in group 2 using both the Nakata Index (+148.5 vs −52.4 mm2/m2; p = 0.01) and the McGoon Ratio (+0.36 vs +0.01; p = 0.01). These findings indicate that patients with an intact RV-PA shunt after stage 2 have greater pulmonary artery growth than patients with the shunt removed, with no increased risk of complications.
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Metadaten
Titel
Intact Right Ventricle–Pulmonary Artery Shunt After Stage 2 Palliation in Hypoplastic Left Heart Syndrome Improves Pulmonary Artery Growth
verfasst von
Mariel E. Turner
Marc E. Richmond
Jan M. Quaegebeur
Amee Shah
Jonathan M. Chen
Emile A. Bacha
Julie A. Vincent
Publikationsdatum
01.04.2013
Verlag
Springer-Verlag
Erschienen in
Pediatric Cardiology / Ausgabe 4/2013
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-012-0576-1

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