Norwood With Right-Ventricle-to-Pulmonary-Artery Conduit

2019-05-20T18:12:34Z (GMT) by James Scott Tweddell Alan O'Donnell

The first stage of hypoplastic left heart syndrome (HLHS) palliation typically occurs within the first week of life. There are three competing surgical strategies for this palliation: the Norwood procedure with modified Blalock-Taussig-Thomas shunt (innominate-artery-to-pulmonary-artery), the Norwood procedure with right-ventricle-to-pulmonary-artery (RV-to-PA, Sano) modification, and the hybrid procedure, which includes a stent across the ductus arteriosus and branch pulmonary artery bands. While there are three major surgical strategies, the objectives of each procedure are essentially the same: limit pulmonary blood flow, provide unobstructed systemic and coronary blood flow, and create a nonrestrictive atrial septal defect.

This video details the neonatal palliation of a 6-day-old, 3.18 kg boy with an antenatal diagnosis of HLHS (aortic atresia (AA)/mitral stenosis (MS)). Born at 38 weeks and 4 days gestation, the patient was transferred to Cincinnati Children’s Hospital Medical Center in Ohio, USA, on room air and a continuous infusion of 0.01 mcg/kg/min of prostaglandin. Postnatal echocardiography confirmed the diagnosis of HLHS (AA/MS) with normal right ventricular function, trivial tricuspid regurgitation, a 1.5 mm ascending aorta, a nonrestrictive fenestrated atrial septum, and a patent ductus arteriosus. The patient’s care had been previously discussed at surgical case conference and the decision was made to proceed with a Norwood procedure with RV-to-PA conduit modification (5 mm ring-reinforced Gore-Tex tube graft). Of note, this particular video covers in detail Dr James Tweddell’s technique of interdigitating aortic arch reconstruction and creation of the Damus-Kaye-Stansel connection.

References

  1. Tweddell JS, Mitchell ME, Woods RK, Spray TL, Quintessenza JA. Construction of the right ventricle-to-pulmonary artery conduit in the Norwood: the “Dunk” technique. Oper Tech Thorac Cardiovasc Surg. 2012; 17(2):81-98.
  2. Tweddell JS. The Norwood procedure with an innominate artery-to-pulmonary artery shunt. Oper Tech Thorac Cardiovasc Surg. 2005;10(2):123-140.