Modification of ventricular-to-pulmonary shunt to minimize proximal conduit obstruction after stage I Norwood reconstruction.

The use of right ventricle-to-pulmonary artery conduit improved postoperative hemodynamics and survival in hypoplastic left heart syndrome patients. Proximal conduit anastomosis obstruction prompts hypercyanosis and early bidirectional Glenn connection. We describe modification of the proximal right ventricle-to-pulmonary artery conduit anastomosis to eliminate this complication. Outcomes after Norwood operation using standard Sano (group II) versus modified (group I) right ventricle-to-pulmonary artery conduit anastomosis were evaluated. Group II patients had more hospital readmissions for cyanosis (19 vs 1; p < or = 0.05), the Glenn operation at younger age (4.4 vs 5.6 months), and more proximal stenosis (3 [20%] vs zero; p < or = 0.05) than group I. This modification may eliminate progressive proximal stenosis.