Department of Surgery, University of Virginia, Charlottesville, VA, USA.
Ann Thorac Surg. 2011 Oct;92(4):1483-9; discussion 1489. doi: 10.1016/j.athoracsur.2011.04.120. Epub 2011 Aug 26.
There is a high incidence of cardiovascular reinterventions in patients undergoing a Norwood procedure (NP). The goal of this study was to analyze the rate of pulmonary artery (PA) and conduit stenosis using the right ventricle (RV)-to-PA modification of the NP.
Patients who underwent a NP January 2005 to December 2009 were included. The procedure was performed with a ringed conduit sutured to a membrane to form a patch. The patch was sutured to the PA confluence, and the spatulated conduit was anastomosed to an appropriately sized right ventriculotomy. Rates of PA and conduit stenosis requiring reintervention were calculated based on cardiac catheterization data.
Thirty-three patients with hypoplastic left heart syndrome underwent a NP. Perioperative mortality was 6% (2 of 33). Twenty-eight patients (85%) had a Glenn procedure 5 ± 1 months later, and 12 patients (36%) had a Fontan procedure 34 ± 2 months after the Glenn. Pulmonary artery stenosis occurred in 11 patients (33%), and RV-PA conduit stenosis occurred only in 2 patients (6%). One-year and 3-year actuarial survival rates were 82% and 77%, respectively. Both branch PAs showed good and symmetric growth at cardiac catheterization before Glenn.
The NP with RV-PA conduit using a ringed graft and a pulmonary patch is a technique associated with a low rate of PA and conduit stenosis, and good outcomes.
行 Norwood 手术（NP）的患者心血管再干预发生率较高。本研究旨在分析右心室-肺动脉（RV-PA）改良 NP 术式中肺动脉（PA）和管道狭窄的发生率。
纳入 2005 年 1 月至 2009 年 12 月行 NP 的患者。该手术采用环状移植物与膜缝合形成补片。补片缝合至 PA 汇合处，锥形移植物与适当大小的右心室切开吻合。根据心导管检查数据计算 PA 和管道狭窄需再次干预的发生率。
33 例左心发育不全综合征患者行 NP。围手术期死亡率为 6%（2/33）。28 例患者（85%）在 5±1 个月后行 Glenn 手术，12 例患者（36%）在 Glenn 术后 34±2 个月行 Fontan 手术。11 例患者（33%）出现 PA 狭窄，仅 2 例患者（6%）出现 RV-PA 管道狭窄。1 年和 3 年的生存率分别为 82%和 77%。Glenn 前心导管检查时两支 PA 均显示良好且对称生长。
采用环状移植物和肺动脉补片的 RV-PA 导管 NP 技术与较低的 PA 和管道狭窄发生率以及良好的结局相关。
