Right Ventricle-to-Pulmonary Artery Shunt as the First Stage Palliative Operation for Patients with Pulmonary　Atresia with Ventricular Septal Defect_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

Atresia with Ventricular Septal Defect ZHANG Hao , WANG De , HUA Zhongdong , YANG Keming , WANG Xu , YAN Fuxia , LIU Jinping , LI Shoujun.

State Key Laboratory of Cardiovascular Disease，Fu Wai Hospital，National Center for Cardiovascular Diseases，Chinese Academy of Medical Sciences &;
Peking Union Medical College，Beijing 100037，P. R. China;

Corresponding author：

Keywords：

Sano shunt; Pulmonary atresia; Right ventricle; Pulmomary artery growth

DOI：

10.7507/1007-4848.20130044

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Objective To summarize clinical outcomes of right ventricle-to-pulmonary artery shunt （Sano shunt）as the first stage palliative operation for patients with pulmonary atresia with ventricular septal defect （PA/VSD）. Methods　Between September 2009 and May 2011，17 PA/VSD patients underwent Sano shunt in Fu Wai Hospital. There were 10 male patients and 7 female patients with their median age of 9.7 （2.5-73.8） months and average weight of （8.3±3.4）kg. Preoperative McGoon ratio was 1.04±0.29 and Nakata index was （102.0±56.9） mm2/m2. Five children had severe intrapericardial left pulmonary aretery stenosis，11 patients had patent ductus arteriosus （PDA），and 1 patient had major aorto-pulmonary collateral arteries. Preoperative transcutaneous oxygen saturation （SpO2） was 72.6%±11.6%. Results　All the patients received Sano shunt placement successfully. Eleven patients underwent concomitant PDA ligation，and 7 patients underwent concomitant left pulmonary artery plasty. The Sano shunts were constructed with glutaraldehyde-fixed autologous pericardium in 10 patients，fresh autologous pericardium in 1 patient and Gore-Tex graft in 6 patients. All the patients underwent reconstruction of the right ventricular outflow tract via the right ventricular incision. The average cardiopulmonary bypass time was （75.0±30.0） min. Postoperative SpO2 was 89.8%±5.3% and significantly higher than preoperative SpO2 （P＜0.05）. All the patients were discharged alive and followed up for （12.1±6.7） months. During follow-up，8 patients underwent angiography study whose McGoon ratio and Nakata index improved to 2.05±0.37 and （304.8±51.3） mm2/m2 respectively，both of which were significantly higher than preoperative values（P＜0.05）. Four patients successful　underwent second stage total correction. Conclusion Sano shunt is a comparatively safe procedure as the first stage　palliative operation for PA/VSD patients，and can significant improve their pulmonary artery growth.

Citation： Atresia with Ventricular Septal Defect ZHANG Hao,WANG De,HUA Zhongdong,YANG Keming,WANG Xu,YAN Fuxia,LIU Jinping,LI Shoujun.. Right Ventricle-to-Pulmonary Artery Shunt as the First Stage Palliative Operation for Patients with Pulmonary　Atresia with Ventricular Septal Defect. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(2): 135-138. doi: 10.7507/1007-4848.20130044 Copy

1.	邓喜成，李守军. 肺动脉闭锁合并室间隔缺损的外科治疗策略. 中国胸心血管外科临床杂志， 2010， 17 （1）：50-54.
2.	Rome JJ， Mayer JE， Castaneda AR， et al. Tetralogy of fallot with pulmonary atresia. rehabilitation of diminutive pulmonary arteries. Circulation， 1993， 88 （4 Pt 1）：1691-1698.
3.	Sano S， Ishino K， Kawada M， et al. Right ventricle-pulmonary artery　shunt in first-stage palliation of hypoplastic left heart syndrome. Semin　Thorac Cardiovasc Surg Pediatr Card Surg Annu， 2004， 7：22-31.
4.	郑景浩，徐志伟，苏肇伉，等. 小儿肺动脉闭锁伴室间隔缺损右室流出道重建方法. 中华胸心血管外科杂志， 2005， 21 （5）：257-259.
5.	Amark KM， Karamlou T， O′carroll A， et al. Independent factors associated with mortality， reintervention， and achievement of complete repair in children with pulmonary atresia with ventricular septal defect. J Am Coll Cardiol， 2006， 47 （7）：1448-1456.
6.	Caspi J， Pettitt TW， Mulder T， et al. Development of the pulmonary arteries after the Norwood procedure：comparison between Blalock-Taussig shunt and right ventricular-pulmonary artery conduit. Ann Thorac Surg， 2008， 86 （4）：1299-1304.
7.	Bradley SM， Erdem CC， Hsia TY， et al. Right ventricle-to-pulmonary artery shunt：alternative palliation in infants with inadequate pulmonary blood flow prior to two-ventricle repair. Ann Thorac Surg， 2008， 86 （1）：183-188.
8.	Brizard CP， Liava’a M， d'Udekem Y. Pulmonary atresia， VSD and Mapcas：repair without unifocalization. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu， 2009， 139-144.
9.	祝忠群，刘锦纷，郑景浩，等. 肺动脉闭锁伴室间隔缺损的分期手术治疗. 中华医学杂志， 2010， 90 （13）：898-901.
10.	Pruetz JD， Badran S， Dorey F， et al. 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. J Thorac Cardiovasc Surg， 2009， 137 （6）：1342-1348.
11.	Nigro JJ， Bart RD， Derby CD， et al. Proximal conduit obstruction after Sano modified Norwood procedure. Ann Thorac Surg， 2005， 80 （5）：1924-1928.
12.	邓喜成，沈向东，郭少先，等. 姑息手术在肺动脉闭锁合并室间隔缺损分期矫治中的应用. 中国胸心血管外科临床杂志， 2011， 18 （2）：104-108.

1. 　邓喜成，李守军. 肺动脉闭锁合并室间隔缺损的外科治疗策略. 中国胸心血管外科临床杂志， 2010， 17 （1）：50-54.
2. 　Rome JJ， Mayer JE， Castaneda AR， et al. Tetralogy of fallot with pulmonary atresia. rehabilitation of diminutive pulmonary arteries. Circulation， 1993， 88 （4 Pt 1）：1691-1698.
3. 　Sano S， Ishino K， Kawada M， et al. Right ventricle-pulmonary artery　shunt in first-stage palliation of hypoplastic left heart syndrome. Semin　Thorac Cardiovasc Surg Pediatr Card Surg Annu， 2004， 7：22-31.
4. 　郑景浩，徐志伟，苏肇伉，等. 小儿肺动脉闭锁伴室间隔缺损右室流出道重建方法. 中华胸心血管外科杂志， 2005， 21 （5）：257-259.
5. 　Amark KM， Karamlou T， O′carroll A， et al. Independent factors associated with mortality， reintervention， and achievement of complete repair in children with pulmonary atresia with ventricular septal defect. J Am Coll Cardiol， 2006， 47 （7）：1448-1456.
6. 　Caspi J， Pettitt TW， Mulder T， et al. Development of the pulmonary arteries after the Norwood procedure：comparison between Blalock-Taussig shunt and right ventricular-pulmonary artery conduit. Ann Thorac Surg， 2008， 86 （4）：1299-1304.
7. 　Bradley SM， Erdem CC， Hsia TY， et al. Right ventricle-to-pulmonary artery shunt：alternative palliation in infants with inadequate pulmonary blood flow prior to two-ventricle repair. Ann Thorac Surg， 2008， 86 （1）：183-188.
8. 　Brizard CP， Liava’a M， d'Udekem Y. Pulmonary atresia， VSD and Mapcas：repair without unifocalization. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu， 2009， 139-144.
9. 　祝忠群，刘锦纷，郑景浩，等. 肺动脉闭锁伴室间隔缺损的分期手术治疗. 中华医学杂志， 2010， 90 （13）：898-901.
10. 　Pruetz JD， Badran S， Dorey F， et al. 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. J Thorac Cardiovasc Surg， 2009， 137 （6）：1342-1348.
11. 　Nigro JJ， Bart RD， Derby CD， et al. Proximal conduit obstruction after Sano modified Norwood procedure. Ann Thorac Surg， 2005， 80 （5）：1924-1928.
12. 　邓喜成，沈向东，郭少先，等. 姑息手术在肺动脉闭锁合并室间隔缺损分期矫治中的应用. 中国胸心血管外科临床杂志， 2011， 18 （2）：104-108.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Right Ventricle-to-Pulmonary Artery Shunt as the First Stage Palliative Operation for Patients with Pulmonary　Atresia with Ventricular Septal Defect

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Right Ventricle-to-Pulmonary Artery Shunt as the First Stage Palliative Operation for Patients with Pulmonary Atresia with Ventricular Septal Defect

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Right Ventricle-to-Pulmonary Artery Shunt as the First Stage Palliative Operation for Patients with Pulmonary　Atresia with Ventricular Septal Defect