Usefulness of balloon angioplasty for the right ventricle-pulmonary artery shunt with the modified norwood procedure

Naoki Ohno, Shin-ichi Ohtsuki, Koichi Kataoka, Kenji Baba, Yoshio Okamoto, Maiko Kondo, Shunji Sano, Shingo Kasahara, Osami Honjo, Tsuneo Morishima

Research output: Contribution to journalArticle

Abstract

Objective: We sought to evaluate the efficacy of balloon angioplasty (BA) for severely desaturated patients due to a stenotic right ventricle (RV) to pulmonary artery (PA) shunt following modified Norwood procedure. Methods: Of 87 patients who underwent a Norwood procedure with the RV-PA shunt between February 1998 through March 2010, 22 (25%) patients underwent BA. The efficacy of BA was assessed by angiographic measurement of the changes in the internal diameters of the stenotic portions of the shunt, changes in arterial saturation and clinical outcomes. Results: BA was performed for stenotic RV-PA shunts following stage I palliation (n = 17, 77%), or those placed as an additional blood source (n = 5, 23%, 3 patients awaiting biventricular repair, 2 patients following stage II palliation). The location of the BA was at the distal anastomosis in 12 (54.5%), proximal anastomosis in 21 (95.4%) and in the mid-portion of the shunt in 11 (50%) cases. The diameters of these three shunt portions were measured from the anterior-posterior and lateral angiographic images, increasing significantly after BA (p > 0.0001) in all. Arterial saturation significantly improved after BA in all cases (66.5 ± 4.3% to 79.4 ± 3.4%, p > 0.0001). Freedom from reintervention was 100%. All patients underwent subsequent elective planned surgery at an appropriate age with no mortality. Conclusions: A BA-alone strategy for a stenotic RV-PA shunt was effective for all three shunt portions, minimizing shunt-related premature surgical intervention.

Original languageEnglish
Pages (from-to)837-842
Number of pages6
JournalCatheterization and Cardiovascular Interventions
Volume81
Issue number5
DOIs
Publication statusPublished - 2013

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Norwood Procedures
Balloon Angioplasty
Pulmonary Artery
Heart Ventricles

Keywords

  • Balloon angioplasty
  • Hypoplastic left heart syndrome
  • Norwood
  • Rv-pa shunt

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

Usefulness of balloon angioplasty for the right ventricle-pulmonary artery shunt with the modified norwood procedure. / Ohno, Naoki; Ohtsuki, Shin-ichi; Kataoka, Koichi; Baba, Kenji; Okamoto, Yoshio; Kondo, Maiko; Sano, Shunji; Kasahara, Shingo; Honjo, Osami; Morishima, Tsuneo.

In: Catheterization and Cardiovascular Interventions, Vol. 81, No. 5, 2013, p. 837-842.

Research output: Contribution to journalArticle

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abstract = "Objective: We sought to evaluate the efficacy of balloon angioplasty (BA) for severely desaturated patients due to a stenotic right ventricle (RV) to pulmonary artery (PA) shunt following modified Norwood procedure. Methods: Of 87 patients who underwent a Norwood procedure with the RV-PA shunt between February 1998 through March 2010, 22 (25{\%}) patients underwent BA. The efficacy of BA was assessed by angiographic measurement of the changes in the internal diameters of the stenotic portions of the shunt, changes in arterial saturation and clinical outcomes. Results: BA was performed for stenotic RV-PA shunts following stage I palliation (n = 17, 77{\%}), or those placed as an additional blood source (n = 5, 23{\%}, 3 patients awaiting biventricular repair, 2 patients following stage II palliation). The location of the BA was at the distal anastomosis in 12 (54.5{\%}), proximal anastomosis in 21 (95.4{\%}) and in the mid-portion of the shunt in 11 (50{\%}) cases. The diameters of these three shunt portions were measured from the anterior-posterior and lateral angiographic images, increasing significantly after BA (p > 0.0001) in all. Arterial saturation significantly improved after BA in all cases (66.5 ± 4.3{\%} to 79.4 ± 3.4{\%}, p > 0.0001). Freedom from reintervention was 100{\%}. All patients underwent subsequent elective planned surgery at an appropriate age with no mortality. Conclusions: A BA-alone strategy for a stenotic RV-PA shunt was effective for all three shunt portions, minimizing shunt-related premature surgical intervention.",
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AU - Ohno, Naoki

AU - Ohtsuki, Shin-ichi

AU - Kataoka, Koichi

AU - Baba, Kenji

AU - Okamoto, Yoshio

AU - Kondo, Maiko

AU - Sano, Shunji

AU - Kasahara, Shingo

AU - Honjo, Osami

AU - Morishima, Tsuneo

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N2 - Objective: We sought to evaluate the efficacy of balloon angioplasty (BA) for severely desaturated patients due to a stenotic right ventricle (RV) to pulmonary artery (PA) shunt following modified Norwood procedure. Methods: Of 87 patients who underwent a Norwood procedure with the RV-PA shunt between February 1998 through March 2010, 22 (25%) patients underwent BA. The efficacy of BA was assessed by angiographic measurement of the changes in the internal diameters of the stenotic portions of the shunt, changes in arterial saturation and clinical outcomes. Results: BA was performed for stenotic RV-PA shunts following stage I palliation (n = 17, 77%), or those placed as an additional blood source (n = 5, 23%, 3 patients awaiting biventricular repair, 2 patients following stage II palliation). The location of the BA was at the distal anastomosis in 12 (54.5%), proximal anastomosis in 21 (95.4%) and in the mid-portion of the shunt in 11 (50%) cases. The diameters of these three shunt portions were measured from the anterior-posterior and lateral angiographic images, increasing significantly after BA (p > 0.0001) in all. Arterial saturation significantly improved after BA in all cases (66.5 ± 4.3% to 79.4 ± 3.4%, p > 0.0001). Freedom from reintervention was 100%. All patients underwent subsequent elective planned surgery at an appropriate age with no mortality. Conclusions: A BA-alone strategy for a stenotic RV-PA shunt was effective for all three shunt portions, minimizing shunt-related premature surgical intervention.

AB - Objective: We sought to evaluate the efficacy of balloon angioplasty (BA) for severely desaturated patients due to a stenotic right ventricle (RV) to pulmonary artery (PA) shunt following modified Norwood procedure. Methods: Of 87 patients who underwent a Norwood procedure with the RV-PA shunt between February 1998 through March 2010, 22 (25%) patients underwent BA. The efficacy of BA was assessed by angiographic measurement of the changes in the internal diameters of the stenotic portions of the shunt, changes in arterial saturation and clinical outcomes. Results: BA was performed for stenotic RV-PA shunts following stage I palliation (n = 17, 77%), or those placed as an additional blood source (n = 5, 23%, 3 patients awaiting biventricular repair, 2 patients following stage II palliation). The location of the BA was at the distal anastomosis in 12 (54.5%), proximal anastomosis in 21 (95.4%) and in the mid-portion of the shunt in 11 (50%) cases. The diameters of these three shunt portions were measured from the anterior-posterior and lateral angiographic images, increasing significantly after BA (p > 0.0001) in all. Arterial saturation significantly improved after BA in all cases (66.5 ± 4.3% to 79.4 ± 3.4%, p > 0.0001). Freedom from reintervention was 100%. All patients underwent subsequent elective planned surgery at an appropriate age with no mortality. Conclusions: A BA-alone strategy for a stenotic RV-PA shunt was effective for all three shunt portions, minimizing shunt-related premature surgical intervention.

KW - Balloon angioplasty

KW - Hypoplastic left heart syndrome

KW - Norwood

KW - Rv-pa shunt

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