Sameh Said Stage I Yasui (Modified Norwood_Sano) for Interrupted Aortic Arch type A and Hypoplastic LVOT with a VSD in a 2-kg Neonate.mov (1.08 GB)
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posted on 2021-02-08, 22:39 authored by Sameh Said, Gustavo OrellanThe authors present a stage I Yasui procedure in the form of a modified
Norwood/Sano for a 2 kg, 6-day-old neonate with interrupted aortic arch
type A, large posterior malalignment ventricular septal defect, and
severely hypoplastic left ventricular outflow tract (Z-score = - 4.5).
The goal was to achieve two-ventricle repair considering he had two
good-sized ventricles. In order to achieve this, either a Ross-Konno or a
modified Yasui procedure was needed. Due to the patient’s small size,
the authors elected to proceed with a Yasui procedure in a staged
fashion.
Their preference was to modify the Sano conduit prior to initiation
of cardiopulmonary bypass (CPB) by suturing the end of a 5 mm ringed
Gore-Tex graft to a 7 mm aortic/pulmonary homograft valve. They believe
this minimizes, if not eliminates, any additional volume overload as a
result of free pulmonary regurgitation compared to the typical
non-valved Sano conduits.
References
- Reinhartz O,
Reddy VM, Petrossian E, MacDonald M, Lamberti JJ, Roth SJ, et al.
Homograft valved right ventricle to pulmonary artery conduit as a
modification of the Norwood procedure. Circulation. 2006 Jul 4;114(1 Suppl):I594-1599.
- Said SM, Dearani JA. Norwood valved Sano shunt: Early reward versus late penalty? J Thorac Cardiovasc Surg. 2018 Apr;155(4):7.
- Mascio CE, Spray TL. Distal Dunk for Right Ventricle to Pulmonary Artery Shunt in Stage 1 Palliation. Ann Thorac Surg. 2015 Dec;100(6):2381-2382.