Desai Tarak, Stumper Oliver, Miller Paul, Dhillon Rami, Wright John, Barron David, Brawn William, Jones Tim, DeGiovanni Joseph
Birmingham Children's Hospital NHS Foundation Trust, The Heart Unit, Birmingham, UK.
Congenit Heart Dis. 2009 Nov-Dec;4(6):433-9. doi: 10.1111/j.1747-0803.2009.00347.x.
The Norwood stage 1 procedure was modified by Sano with right ventricle-pulmonary artery (RV-PA) conduit replacing BT shunt. In our institution, this has been further modified by placing the conduit from the RV outflow tract to the right side of the neo-aorta.
Between April 2002 and October 2008, 227 modified Norwood procedures were performed. Eighteen had the Sano modification with the conduit to the left of the neo-aorta whereas 209 had the right-sided modification, which is the study population. A total of 18 (8.6%) patients presented with cyanosis due to conduit stenosis with median age 4 months and median weight 6.3 kg.
Twelve patients underwent transcatheter stent placement in stenosed RV-PA conduit. A total of 16 coronary stents were implanted in 12 patients with 4 patients each receiving 2 stents. The mean saturations increased from 60% to 74%. There was one late mortality which was non-procedure related. Five patients treated with surgical take down of the RV-PA conduit and creation of a cavo-pulmonary shunt, whilst one patient had replacement of RV-PA conduit. There were no early postoperative deaths. The mean saturations improved from 54% to 75%.
The RV-PA conduit stenosis is a life-threatening complication after the modified Norwood Stage I procedure. This may require urgent surgery to replace the conduit or to perform a cavo-pulmonary shunt but as an alternative, transcatheter stent placement can be used with equal effectiveness and with a low risk of complications. The catheter approach is less invasive and the results show that it is an excellent option to relieve the stenosis even in the right-sided RV-PA conduit.
诺伍德一期手术由佐野进行了改良，采用右心室-肺动脉（RV-PA）管道取代了布劳-陶西格分流术。在我们机构，这一手术又进一步改良，将管道从右心室流出道连接至新主动脉右侧。
2002年4月至2008年10月期间，共进行了227例改良诺伍德手术。18例采用佐野改良术，管道连接至新主动脉左侧，而209例采用右侧改良术，这209例构成研究人群。共有l8例（8.6%）患者因管道狭窄出现发绀，中位年龄4个月，中位体重6.3千克。
12例患者在狭窄的RV-PA管道内行经导管支架置入术。12例患者共植入l6枚冠状动脉支架，4例患者各植入2枚支架。平均血氧饱和度从60%升至74%。有1例晚期死亡，与手术无关。5例患者接受了RV-PA管道手术拆除并建立腔肺分流术，1例患者接受了RV-PA管道置换术。术后无早期死亡病例发生。平均血氧饱和度从54%升至75%。
RV-PA管道狭窄是改良诺伍德一期手术后的一种危及生命的并发症。这可能需要紧急手术来更换管道或进行腔肺分流术，但作为一种替代方法，经导管支架置入术具有同等疗效且并发症风险较低。导管介入方法侵入性较小，结果表明，即使对于右侧RV-PA管道狭窄，它也是缓解狭窄的极佳选择。
