Pulmonary artery growth after Norwood and bidirectional Glenn procedure

Abstract

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. © 2008 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.