Norwood procedure for hypoplastic left heart syndrome: BT shunt or RV-PA conduit?

Linda Edwards ¹, Kevin P Morris ^1*, Ameen Siddiqui ¹, Deborah Harrington ¹, David Barron ¹ and William Brawn ¹

¹ Birmingham Children's Hospital, United Kingdom

^* To whom correspondence should be addressed. E-mail: kevin.morris{at}bch.nhs.uk.

Accepted 18 September 2006

Abstract

Background: The Norwood procedure is the first stage palliative procedure for hypoplastic left heart syndrome (HLHS). Traditionally the pulmonary circulation has been supplied via a modified Blalock Taussig (BT) shunt but a recent modification, adopted in some UK centres, substitutes a conduit between right ventricle and pulmonary arteries (RV-PA conduit). It is argued that this will result in a more favourable balance between pulmonary and systemic circulations.

Aim: To compare the early postoperative haemodynamic profile between patients undergoing a BT shunt or an RV-PA conduit.

Methods: Retrospective review in a tertiary referral PICU of 51 children with HLHS undergoing the Norwood procedure with either a BT shunt (Group 1; n=23) or an RV-PA conduit (Group 2; n=28). Data items were extracted at 10 set time points in the initial 96 hours postoperatively.

Results: Diastolic BP was significantly lower in Group 1 (p<0.001) with a trend towards a higher systolic BP and no difference in mean BP. No between-group differences were found in markers of pulmonary blood flow (PaO2, PaCO2, PaO2 / FiO2 ratio), or in markers of systemic blood flow (blood lactate, oxygen extraction ratio), or in estimated ratio of pulmonary:systemic blood flow (Qp:Qs). Despite lower diastolic blood pressure in Group 1 renal and hepatic function did not differ over five post-operative days between groups.

Conclusions: With the exception of a higher diastolic blood pressure in the RV-PA conduit group, we found no difference in the early haemodynamic profile between patients undergoing an RV-PA conduit or a BT shunt.

Keywords: BT shunt, HLHS, Norwood, RV-PA conduit, haemodynamics

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