Acute Interventions for Stenosed Right Ventricle‐Pulmonary Artery Conduit Following the Right‐Sided Modification of Norwood‐Sano Procedure

Introduction. The Norwood stage 1 procedure was modified by Sano with right ventricle‐pulmonary artery (RV–PA) conduit replacing BT shunt. In our institution, this has been further modified by placing the conduit from the RV outflow tract to the right side of the neo‐aorta. Patients and Methods. Between April 2002 and October 2008, 227 modified Norwood procedures were performed. Eighteen had the Sano modification with the conduit to the left of the neo‐aorta whereas 209 had the right‐sided modification, which is the study population. A total of 18 (8.6%) patients presented with cyanosis due to conduit stenosis with median age 4 months and median weight 6.3 kg. Results. Twelve patients underwent transcatheter stent placement in stenosed RV–PA conduit. A total of 16 coronary stents were implanted in 12 patients with 4 patients each receiving 2 stents. The mean saturations increased from 60% to 74%. There was one late mortality which was non‐procedure related. Five patients treated with surgical take down of the RV–PA conduit and creation of a cavo‐pulmonary shunt, whilst one patient had replacement of RV–PA conduit. There were no early postoperative deaths. The mean saturations improved from 54% to 75%. Conclusions. The RV–PA conduit stenosis is a life‐threatening complication after the modified Norwood Stage I procedure. This may require urgent surgery to replace the conduit or to perform a cavo‐pulmonary shunt but as an alternative, transcatheter stent placement can be used with equal effectiveness and with a low risk of complications. The catheter approach is less invasive and the results show that it is an excellent option to relieve the stenosis even in the right‐sided RV–PA conduit.