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Achieving optimal pulmonary blood flow in the first-stage of palliation in early infancy for complex cardiac defects with hypoplastic left ventricles

Published online by Cambridge University Press:  19 August 2008

Tetsuya Kitagawa ,
Itsuo Katoh ,
Yoshiaki Fukumura ,
Masanori Yoshizumi ,
Yutaka Masuda  and
Takaki Hori
Tetsuya Kitagawa*
Affiliation:
From the Department of Cardiovascular Surgery, School of Medicine, The University of Tokushima, Tokushima
Itsuo Katoh
Affiliation:
From the Department of Cardiovascular Surgery, School of Medicine, The University of Tokushima, Tokushima
Yoshiaki Fukumura
Affiliation:
From the Department of Cardiovascular Surgery, School of Medicine, The University of Tokushima, Tokushima
Masanori Yoshizumi
Affiliation:
From the Department of Cardiovascular Surgery, School of Medicine, The University of Tokushima, Tokushima
Yutaka Masuda
Affiliation:
From the Department of Cardiovascular Surgery, School of Medicine, The University of Tokushima, Tokushima
Takaki Hori
Affiliation:
From the Department of Cardiovascular Surgery, School of Medicine, The University of Tokushima, Tokushima
*
Dr. Tetsuya Kitagawa, Department of Cardiovascular Surgery, School of Medicine, The University of Tokushima, 2 Kuramoto, Tokushima, 770 Japan. Tel. 81 886-31-3111; Fax. 81 886-32-0243.
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Abstract

The aim of the study was to determine the optimal size and technique for construction of the systemic-to-pulmonary arterial shunt which will provide suitable pulmonary blood flow in first-stage Norwood palliation for hypoplastic left heart syndrome in neonates. Our clinical experience suggested that an arterial oxygen tension of about 30 mm Hg immediately after cardiopulmonary bypass, with the patients being ventilated at the lowest possible mean airway pressure with an FiO2 of 1.0, provided a suitable pulmonary-to-systemic flow ratio. We also aimed to clarify the characteristics of pulmonary blood flow in accordance with the size of the shunt and the change in the pulmonary vascular resistance in a simplified rigid model of the Norwood procedure. A hole of2.0 mm diameter proved adequate to provide a suitable pulmonary blood flow of 200−300 mlx002F;min in the presence of a pressure gradient of 20−40 mm Hg between the systemic and pulmonary circulations in neonates weighing 3 kg. A short central shunt with a prosthesis of4 mm in diameter produced an excessive flow of pulmonary blood. Our data suggest that using a smaller shunt than that commonly used is necessary to decrease the early and intermediate postoperative mortality. A prosthesis of 3.0 or 3.5 mm in diameter arising from the brachiocephalic artery would be acceptable and can be recommended for first-stage Norwood palliation in small infants, especially in view of the operative difficulties encountered in taking down the shunt at the time of subsequent operations.

Keywords

Hypoplastic left heart syndromefirst-stage Norwood palliationpulmonary blood flowhydrodynamic experiment
Type
Original Articles
Information
Cardiology in the Young , Volume 5 , Issue 1 , January 1995 , pp. 21 - 27
Copyright
Copyright © Cambridge University Press 1995

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