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25. Impact of RV-PA Shunt on Ventricular Function
Shunji Sano, Kozo Ishino, Masaaki Kawada, Kouichi Kataoka, Shin-ichi Ohtsuki; Okayama, Japan
Objective:
The right ventricle-to-pulmonary artery(RV-PA) shunt created by stage I reconstructions provides stable hemodynamics without requiring extensive postoperative medical interventions. Recently this procedure has been performed in many institutions with good result, however the impact of RV incision on ventricular function is not known yet. We evaluated our surgical result of the RV- PA shunt and compared it with that of classic Norwood procedure in particular reference to RV Ejection fraction (EF) and RV Segmental fractional shortening (s- FS) .
Methods:
Between February 1998 and August 2004, 40 consecutive infants with HLHS underwent a modified Norwood procedure using a RV-PA shunt. Twenty-three patients out of 36 survivors underwent cardiac catheterization in our hospital. Right ventricular (RV)Ejection fraction (EF) and segmental fractional shortening(s-FS) were assessed by RV grams. RV gram was obtained in the orthogonal views (A- P and lateral). RV volume was calculated by Simpson’s method and RV function was analyzed by CAW 2000. Segmental-FS was analyzed in 10 segments using centerline method. These parameters measured in 23 patients were compared with those in the preceding 5 patients who underwent a classic Norwood procedure. The size of the shunt used in group-R was 4mm in 1 patient,5mm in 21 and 6mm in one. In group-B, 3.5mm graft was used in all patients.
Results:
Average RVEF was 60 % in group-R and 56% in group-B. RVEDP was 5mmHg in group-R and 7mmHg in Group-B. S-FS was significantly impaired in antero-lateral segment in Group-R compaired to Group-B(0.1% vs 2.3%)However s-FS in postero-basal segment was significantly higher in Group-R than Group-B (3.7 vs 1.3%)Segmental wall motion in each segment was showen in Table 1 and 2.
Conclusions:
In RV-PA shunt, the antero-lateral wall motion was impaired due to RV tomy, however, postero-basal wall motion compensated and global RV function was maintained normally.   
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