Proximal Conduit Obstruction After Sano Modified Norwood Procedure

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Presentation transcript:

Proximal Conduit Obstruction After Sano Modified Norwood Procedure John J. Nigro, MD, Robert D. Bart, MD, Christopher D. Derby, MD, Mark S. Sklansky, MD, Vaughn A. Starnes, MD The Annals of Thoracic Surgery Volume 80, Issue 5, Pages 1924-1928 (November 2005) DOI: 10.1016/j.athoracsur.2004.06.054 Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Black arrow (top image) marks the endomyocardial orifice of the proximal right ventricle to pulmonary artery conduit viewed from “inside” the right ventricular chamber. In the bottom image the ventricular wall surrounding the proximal conduit origin (black arrow) has been removed from the heart and photographed from its endocardial surface. The “whitish” tissue surrounding the orifice emanated from endomyocardium and obstructed the proximal conduit. This tissue was found to be fibrointimal hyperplasia on histology. The Annals of Thoracic Surgery 2005 80, 1924-1928DOI: (10.1016/j.athoracsur.2004.06.054) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Longitudinal section of the proximal right ventricle to pulmonary artery conduit through the ventricular origin. The black arrow marks the conduit. The fibrointimal hyperplasia that obstructed the proximal conduit is outlined (black dots). The Annals of Thoracic Surgery 2005 80, 1924-1928DOI: (10.1016/j.athoracsur.2004.06.054) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) First stage palliation with modified Blalock-Taussig shunt for pulmonary connection. (B) First stage palliation with right ventricle to pulmonary artery conduit as described by Sano and colleagues [1]. The Annals of Thoracic Surgery 2005 80, 1924-1928DOI: (10.1016/j.athoracsur.2004.06.054) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Stenosis of the proximal right ventricle to pulmonary artery conduit (white arrows) in an angiogram obtained from another patient who underwent evaluation for cyanosis after the Sano modified Norwood procedure. The asterisk (*) marks the mid-portion of the right ventricle to pulmonary artery conduit and the V marks the ventricular chamber. The Annals of Thoracic Surgery 2005 80, 1924-1928DOI: (10.1016/j.athoracsur.2004.06.054) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 These images were obtained from another patient who had hypercyanotic spells after the Sano modified Norwood procedure. The conduit is marked with an asterisk (*) and the ventricular chamber is outlined with white dots in both images (top and bottom) (ventriculograms). The concavity present in the top image (systole) represents dynamic obstruction within the ventricular myocardium below the origin of the right ventricle to pulmonary artery conduit (restricting pulmonary blood flow). The Annals of Thoracic Surgery 2005 80, 1924-1928DOI: (10.1016/j.athoracsur.2004.06.054) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions