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Interact CardioVasc Thorac Surg 2008;7:328-330. doi:10.1510/icvts.2007.164806
© 2008 European Association of Cardio-Thoracic Surgery
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Shin Takabayashi
Hideto Shimpo
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Right arrow Cardiac - physiology
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Case report - Congenital

Pulmonary artery growth after Norwood and bidirectional Glenn procedure

Shin Takabayashia,*, Yoshihide Mitanib, Kazuto Yokoyamaa and Hideto Shimpoa

a Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie 514-8507, Japan
b Department of Pediatrics, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie 514-8507, Japan

*Corresponding author. Tel.: +81-59232-1111, (5503); fax: +81-59231-5145.

E-mail address: shin1111{at}clin.medic.mie-u.ac.jp (S. Takabayashi).

A 19-day-old boy diagnosed with hypoplastic left heart syndrome underwent stage I bilateral pulmonary artery banding and main pulmonary artery-to-descending aorta shunt. A restrictive atrial septal defect existing before stage I recurred after balloon atrioseptostomy. After stage II Norwood and bidirectional Glenn procedure at age nine months, the Nakata index decreased to 73 mm2/m2 (pulmonary artery mean pressure: 15 mmHg) and multiple systemic venous collaterals developed. Thus, we instituted oral sildenafil medication, and undertook surgical chest subcutaneous venous ligation and coil embolizations. Three years later, the Nakata index had increased to 117 mm2/m2 (pulmonary artery mean pressure: 13 mmHg) and a Fontan procedure was successfully performed.

Key Words: Hypoplastic left heart syndrome; Restrictive atrial septal defect; Pulmonary artery growth; Bilateral pulmonary artery banding; Norwood and bidirectional Glenn procedure

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