Cardiovascular magnetic resonance of pulmonary artery growth and ventricular function after Norwood procedure with Sano modificationReport as inadecuate

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Journal of Cardiovascular Magnetic Resonance

, 10:34

First Online: 06 July 2008Received: 25 March 2008Accepted: 06 July 2008


For hypoplastic left heart syndrome HLHS, there have been concerns regarding pulmonary artery growth and ventricular dysfunction after first stage surgery consisting of the Norwood procedure modified with a right ventricle-to-pulmonary artery conduit. We report our experience using cardiovascular magnetic resonance CMR to determine and follow pulmonary arterial growth and ventricular function in this cohort.

Following first stage palliation, serial CMR was performed at 1 and 10 weeks post-operatively, followed by cardiac catheterization at 4 – 6 months. Thirty-four of 47 consecutive patients with HLHS or its variations underwent first stage palliation. Serial CMR was performed in 20 patients. Between studies, ejection fraction decreased 58 ± 9% vs. 50 ± 5%, p < 0.05. Pulmonary artery growth occurred on the left 6 ± 1 mm vs. 4 ± 1 mm at baseline, p < 0.05 but not significantly in the right. This trend continued to cardiac catheterization 4–6 months post surgery, with the left pulmonary artery of greater size than the right 8.8 ± 2.2 mm vs. 6.7 +- 1.9 mm, p < 0.05. By CMR, 5 had pulmonary artery stenoses initially, and at 2 months, 9 had stenoses. Three of the 9 underwent percutaneous intervention prior to the second stage procedure.

In this cohort, reasonable growth of pulmonary arteries occurred following first stage palliation with this modification, although that growth was preferential to the left. Serial studies demonstrate worsening of ventricular function for the cohort. CMR was instrumental for detecting pulmonary artery stenosis and right ventricular dysfunction.

AbbreviationsHLHSHypoplastic left heart syndrome

CMRCardiac magnetic resonance imaging.

Electronic supplementary materialThe online version of this article doi:10.1186-1532-429X-10-34 contains supplementary material, which is available to authorized users.

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Author: D Scott Lim - Benjamin B Peeler - G Paul Matherne - Christopher M Kramer


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