The Journal of Thoracic and Cardiovascular Surgery
Volume 137, Issue 6 , Pages 1342-1348 , June 2009

Differential branch pulmonary artery growth after the Norwood procedure with right ventricle–pulmonary artery conduit versus modified Blalock–Taussig shunt in hypoplastic left heart syndrome

  • Jay D. Pruetz, MD

      Affiliations

    • Heart Institute, Children's Hospital Los Angeles, Los Angeles, Calif. Division of Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif
    • Corresponding Author InformationAddress for reprints: Jay D. Pruetz, MD, Division of Cardiology MS#34, 4650 Sunset Blvd, Los Angeles, CA 90027.
    • ,
  • Sarah Badran, MD

      Affiliations

    • Heart Institute, Children's Hospital Los Angeles, Los Angeles, Calif. Division of Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif
    • ,
  • Fred Dorey, PhD

      Affiliations

    • Heart Institute, Children's Hospital Los Angeles, Los Angeles, Calif. Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, Calif
    • ,
  • Vaughn A. Starnes, MD

      Affiliations

    • Heart Institute, Children's Hospital Los Angeles, Los Angeles, Calif. Division of Cardiothoracic Surgery, Department of Cardiothoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
    • ,
  • Alan B. Lewis, MD

      Affiliations

    • Heart Institute, Children's Hospital Los Angeles, Los Angeles, Calif. Division of Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif

Received 5 June 2008 ,Revised 17 October 2008 ,Accepted 9 March 2009.

  • Image Result

    Flow chart of outcomes after the stage I NP with mBTS (group A) compared with RV–PA (group B) between January 2000 and September 2005. These data are expressed as total number of patients (% of total

    Flow chart of outcomes after the stage I NP with mBTS (group A) compared with RV–PA (group B) between January 2000 and September 2005. These data are expressed as total number of patients (% of total study group). The lowest row of boxes denotes the primary study group (n = 32 in each group). Cath, Catheterization; LTF, lost to follow-up; mBTS, modified Blalock–Taussig shunt; NP, Norwood procedure; RV–PA, right ventricle–pulmonary artery conduit.

  • Image Result
    Angiograms performed at the pre-Glenn cardiac catheterization in a patient after stage I NP with mBTS (A) and RV–PA (B). Individual branch PA diameters were measured just before the takeoff of the upp

    Angiograms performed at the pre-Glenn cardiac catheterization in a patient after stage I NP with mBTS (A) and RV–PA (B). Individual branch PA diameters were measured just before the takeoff of the upper lobe branch (white arrows). Note the central PA hypoplasia and shunt-related PA stenosis in panel B for the patient with RV–PA NP. mBTS, Modified Blalock–Taussig shunt; NP, Norwood procedure; PA, pulmonary artery; RV–PA, right ventricle–pulmonary artery conduit.

  • Image Result
    Kaplan–Meier reintervention curve for patients who underwent stage I NP with either mBTS versus RV–PA. Starting point is the day of stage I NP. No reinterventions occurred later than 6 months from the

    Kaplan–Meier reintervention curve for patients who underwent stage I NP with either mBTS versus RV–PA. Starting point is the day of stage I NP. No reinterventions occurred later than 6 months from the time of stage I NP. A stratified actuarial table displays the number of patients at risk in each group (n) with 95% CI over 2-month intervals after stage I NP. CI, Confidence interval; mBTS, modified Blalock–Taussig shunt; mo, months; NP, Norwood procedure; RV–PA, right ventricle–pulmonary artery conduit.

  • Image Result
    Cumulative incidence curve for time to Glenn before death (survival to Glenn with competing risk of death) for patients who underwent stage I NP with either mBTS versus RV–PA. By 6 months, over 50% of

    Cumulative incidence curve for time to Glenn before death (survival to Glenn with competing risk of death) for patients who underwent stage I NP with either mBTS versus RV–PA. By 6 months, over 50% of RV–PA NP patients had completed the Glenn versus only ∼20% of mBTS NP patients. A stratified actuarial table displays the number of patients at risk in each group (n) with 95% CI over 3-month intervals after stage I NP. CI, Confidence interval; mBTS, modified Blalock–Taussig shunt; mo, months; NP, Norwood procedure; RV–PA, right ventricle–pulmonary artery conduit.

 Supported by the Paige Bronchick Clinical Scholar Fellowship Award.

 Read at the Thirty-fourth Annual Meeting of The Western Thoracic Surgical Association, Kona, Hawaii, June 25–28, 2008.

PII: S0022-5223(09)00417-6

doi: 10.1016/j.jtcvs.2009.03.019

The Journal of Thoracic and Cardiovascular Surgery
Volume 137, Issue 6 , Pages 1342-1348 , June 2009

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