Choice of Conduit Size and Material for Palliative Right Ventricle-to-Pulmonary Artery Shunt_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Kun , LI Shoujun , GONG Bing , YANG Keming.

Department of Pediatric Cardiovascular Surgery，Fu Wai Cardiovascular Hospital，Chinese Academy of Medical Science &;
Peking Union Medical College，Beijing100037，P. R. China;

Corresponding author：

Keywords：

Right ventricle-to-pulmonary artery shunt; 　Autologous pericardium; 　Gore-Tex synthetic graft; 　Bovine jugular vein; 　Conduit size

DOI：

10.7507/1007-4848.20130201

Video：

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Objective To assess clinical results of three different conduit materials （Gore-Tex synthetic graft，bovinejugular vein and autologous pericardium）for palliative right ventricle-to-pulmonary artery （RV-PA） shunt，and explore the correlation between suitable conduit size and patients’ body weight and McGoon ratio. Methods We retrospectively analyzed clinical data of 24 patients with congenital heart diseases who underwent palliative RV-PA shunt in Department of Pediatric Cardiovascular Surgery of Fu Wai Cardiovascular Hospital from July 2010 to July 2012. There were 11 males and 13 females with their age ranging from 60 days to 6 years and body weight of 10.22±7.41 kg. There were 22 patients with pulmonary atresia and ventricular septal defect （PAVSD），1 patient with tetralogy of Fallot （TOF） and 1 patient with doubleoutlet right ventricle （DORV）. Among different conduit materials，autologous pericardium was used for 17 patients，Gore-Texsynthetic graft was used for 5 patients，and bovine jugular vein was used for 2 patients. Conduit size and children’s body weight were analyzed with linear regression，then the equation was corrected with McGoon ratio. Results There was no perioperative death. Postoperative percutaneous saturation （SpO2）of the 24 children was 20.37%±28.33% higher than preoperative SpO2 . Electrocardiogram showed sinus rhythm in all the patients. Twenty-three patients were NYHA classⅡ，and 1 patient was NYHA classⅢ. Postoperative mechanical ventilation time of patients with autologous pericardium were significantly shorter than those of patients with other 2 materials （P=0.017）. Sixteen patients were followed up from 10 months to 2 years after discharge，including 12 patients with autologous pericardium，3 patients with Gore-Tex synthetic graft and 1 patient with bovine jugular vein. During follow-up，McGoon ratio of patients with autologous pericardium，Gore-Tex synthetic graft and bovine jugular vein were 1.98±0.46，1.83±0.33 and 1.68 respectively，all of which weresignificantly higher than preoperative McGoon ratio （P＜0.05）. Six patients underwent radical corrective surgery，including5 patients with autologous pericardium and 1 patient with Gore-Tex synthetic graft. There was no complication directly related to surgery during follow-up. Linear regression was performed to form an equation between suitable conduit size and patients’ body weight：conduit diameter （mm）=0.327×body weight （kg）＋4.599. McGoon ratio，conduit size and equationresult were compared to find a practical choice of conduit size. If McGoon ratio＜0.8，the first integer greater than the equation result could be chosen. If McGoon ratio＞1.2，the first integer less than the equation result could be chosen. If 1.2＞McGoon ratio＞0.8，the first integer either less or greater than the equation result could be chosen. Group analysis showed that patients who recovered better postoperatively were those whose conduit sizes were closer to equation results as well as equation results corrected with McGoon ratio. Conclusion All the 3 materials can be conventionally chosen for RV-PA shunt. Appropriate conduit size can be decided upon patients’ body weight and McGoon ratio for RV-PA shunt.

Citation： LI Kun,LI Shoujun,GONG Bing,YANG Keming.. Choice of Conduit Size and Material for Palliative Right Ventricle-to-Pulmonary Artery Shunt. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(6): 632-636. doi: 10.7507/1007-4848.20130201 Copy

1.	Rabinovitch M， Herrera-deLeon V， Castaneda A R， et al. Growth and development of the pulmonary vascular bed in patients with tetralogy of Fallot with or without pulmonary atresia. Circulation， 1981， 64 （6）：1234-1249.
2.	Reid LM. Lung growth in health and disease. Br J Dis Chest， 1984， 78 （2）： 113-134.
3.	Carotti A， Albanese SB， Minniti G， et al. Increasing experience with integrated approach to pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries. Eur JCardiothorac Surg， 2003， 23 （5）： 719-726．.
4.	Gill CC， Moodie DS， McGoon DC. Staged surgical management of pulmonary atresia with diminutive pulmonary arteries. J ThoracCardiovasc Surg，1977， 73 （3）： 436-442 .
5.	Piehler JM， Danielson GK， McGoon DC， et al. Management of pulmonary atresia with ventricular septal defect and hypoplastic pulm-onary arteries by right ventricular outflow construction . J Thorac Cardiovasc Surg， 1980， 80 （4）：552-567.
6.	Barron D J. The Norwood procedure：in favor of the RV-PA conduit. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu， 2013， 16 （1）， 52-58.
7.	张浩，王德，花中东，等. 姑息性右心室肺动脉连接术在肺动脉闭锁合并室间隔缺损治疗中的应用. 中国胸心血管外科临床杂志， 2013， 20 （2）：135-138．.
8.	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.
9.	Brizard CP， Liava'a M， d'Udekem Y. Pulmonary atresia， VSD and mapcas：repair withoutunifocalization. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu， 2009， 139-144.
10.	Murtuza B， Stumper O， Wall D， et al. The effect of morphologic subtype on outcomes following the sano-norwood procedure. Eur J Cardiothorac Surg， 2012， 42 （5）： 787-793.
11.	Ohye RG， Sleeper LA， Mahony L， et al. Comparison of shunt types in the Norwood procedure for single-ventricle lesions. N Engl J Med， 2010， 362 （21）：1980-1992.
12.	Fiore AC， Tobin C， Jureidini S， et al. A comparison of the modifiedBlalock-Taussig shunt with the right ventricle-to-pulmonary artery conduit. Anna Thorac Surg， 2011， 91 （5）： 1479-1484.
13.	Malec E， Januszewska K ， Kolcz J， et al. Right ventricle-to-pulmo-nary artery shunt versus modified Blalock-Taussig shunt in the Norwoodprocedure for hypoplastic left heart syndrome-influence on early and late haemodynamic status. Eur J Cardiothorac Surg， 2003， 23 （5）：728-733.
14.	Raja S G， Atamanyuk I， Kostolny M， et al. In hypoplastic left heartpatients is Sano shunt compared with modified Blalock-Taussig shunt associated with deleterious effects on ventricular performance ?Interact Cardiovasc Thorac Surg， 2010， 10 （4）： 620-623.
15.	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．.
16.	Spiewak M， Malek LA， Petryka J， et al. Stable right ventricular sizeand function during short-term follow-up in patients with pulmonary regurgitation after tetralogy of Fallot repair. Clin Radiol， 2013， 9260 （13）：350-354.
17.	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.
18.	Pearl JM， Cooper DS， Bove KE， et al. Early failure of the Shelhigh pulmonary valve conduit in infants. Ann Thorac Surg， 2002， 74 （2）： 542-549.
19.	Scavo VA Jr， Turrentine MW， Aufiero TX， et al. Valved bovine jugular venous conduits for right ventricular to pulmonary arteryreconstruction. ASAIO J， 1999， 45 （5）：482-487.
20.	Pruetz J D， Badran S， Dorey F， et al. Differential branch pulmonaryartery 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.
21.	Nigro J， Bart RD， Derby CD， et al. Proximal conduit obstruction after Sano modified Norwood procedure. Anna Thorac Surg， 2005， 80 （5）：1924-1928.
22.	Perron J， Moran AM， Gauvreau K， et al. Valved homograft conduit repair of the right heart in early infancy. Ann Thorac Surg， 1999， 68 （2）：542-548.
23.	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. Anna Thorac Surg， 2008， 86 （1）：183-188.
24.	Watanabe N， Anagnostopoulos PV， Shinkawa T， et al. Size of theright ventricle-to-pulmonary artery conduit impacts mid-term outcomeafter the Norwood procedure in patients weighing less than 3 kg. J Thorac Cardiovasc Surg， 2012， 144 （5）：1091-1094.
25.	刘锦纷，陈会文，苏肇伉，等. Gore -tex 管道重建前向性肺循环姑息性治疗法洛四联症合并肺动脉闭锁. 中华胸心血管外科杂志， 2006， 22 （2）：73-75.

1. 　Rabinovitch M， Herrera-deLeon V， Castaneda A R， et al. Growth and development of the pulmonary vascular bed in patients with tetralogy of Fallot with or without pulmonary atresia. Circulation， 1981， 64 （6）：1234-1249.
2. 　Reid LM. Lung growth in health and disease. Br J Dis Chest， 1984， 78 （2）： 113-134.
3. 　Carotti A， Albanese SB， Minniti G， et al. Increasing experience with integrated approach to pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries. Eur JCardiothorac Surg， 2003， 23 （5）： 719-726．.
4. 　Gill CC， Moodie DS， McGoon DC. Staged surgical management of pulmonary atresia with diminutive pulmonary arteries. J ThoracCardiovasc Surg，1977， 73 （3）： 436-442 .
5. 　Piehler JM， Danielson GK， McGoon DC， et al. Management of pulmonary atresia with ventricular septal defect and hypoplastic pulm-onary arteries by right ventricular outflow construction . J Thorac Cardiovasc Surg， 1980， 80 （4）：552-567.
6. 　Barron D J. The Norwood procedure：in favor of the RV-PA conduit. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu， 2013， 16 （1）， 52-58.
7. 　张浩，王德，花中东，等. 姑息性右心室肺动脉连接术在肺动脉闭锁合并室间隔缺损治疗中的应用. 中国胸心血管外科临床杂志， 2013， 20 （2）：135-138．.
8. 　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.
9. 　Brizard CP， Liava'a M， d'Udekem Y. Pulmonary atresia， VSD and mapcas：repair withoutunifocalization. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu， 2009， 139-144.
10. 　Murtuza B， Stumper O， Wall D， et al. The effect of morphologic subtype on outcomes following the sano-norwood procedure. Eur J Cardiothorac Surg， 2012， 42 （5）： 787-793.
11. 　Ohye RG， Sleeper LA， Mahony L， et al. Comparison of shunt types in the Norwood procedure for single-ventricle lesions. N Engl J Med， 2010， 362 （21）：1980-1992.
12. 　Fiore AC， Tobin C， Jureidini S， et al. A comparison of the modifiedBlalock-Taussig shunt with the right ventricle-to-pulmonary artery conduit. Anna Thorac Surg， 2011， 91 （5）： 1479-1484.
13. 　Malec E， Januszewska K ， Kolcz J， et al. Right ventricle-to-pulmo-nary artery shunt versus modified Blalock-Taussig shunt in the Norwoodprocedure for hypoplastic left heart syndrome-influence on early and late haemodynamic status. Eur J Cardiothorac Surg， 2003， 23 （5）：728-733.
14. 　Raja S G， Atamanyuk I， Kostolny M， et al. In hypoplastic left heartpatients is Sano shunt compared with modified Blalock-Taussig shunt associated with deleterious effects on ventricular performance ?Interact Cardiovasc Thorac Surg， 2010， 10 （4）： 620-623.
15. 　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．.
16. 　Spiewak M， Malek LA， Petryka J， et al. Stable right ventricular sizeand function during short-term follow-up in patients with pulmonary regurgitation after tetralogy of Fallot repair. Clin Radiol， 2013， 9260 （13）：350-354.
17. 　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.
18. 　Pearl JM， Cooper DS， Bove KE， et al. Early failure of the Shelhigh pulmonary valve conduit in infants. Ann Thorac Surg， 2002， 74 （2）： 542-549.
19. 　Scavo VA Jr， Turrentine MW， Aufiero TX， et al. Valved bovine jugular venous conduits for right ventricular to pulmonary arteryreconstruction. ASAIO J， 1999， 45 （5）：482-487.
20. 　Pruetz J D， Badran S， Dorey F， et al. Differential branch pulmonaryartery 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.
21. 　Nigro J， Bart RD， Derby CD， et al. Proximal conduit obstruction after Sano modified Norwood procedure. Anna Thorac Surg， 2005， 80 （5）：1924-1928.
22. 　Perron J， Moran AM， Gauvreau K， et al. Valved homograft conduit repair of the right heart in early infancy. Ann Thorac Surg， 1999， 68 （2）：542-548.
23. 　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. Anna Thorac Surg， 2008， 86 （1）：183-188.
24. 　Watanabe N， Anagnostopoulos PV， Shinkawa T， et al. Size of theright ventricle-to-pulmonary artery conduit impacts mid-term outcomeafter the Norwood procedure in patients weighing less than 3 kg. J Thorac Cardiovasc Surg， 2012， 144 （5）：1091-1094.
25. 　刘锦纷，陈会文，苏肇伉，等. Gore -tex 管道重建前向性肺循环姑息性治疗法洛四联症合并肺动脉闭锁. 中华胸心血管外科杂志， 2006， 22 （2）：73-75.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Choice of Conduit Size and Material for Palliative Right Ventricle-to-Pulmonary Artery Shunt

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