Stage 1 of single ventricle repair

Modified BT shunt & arch repair (pulm artery to aorta anastomosis)

  •  BT shunt – Subclavian artery to Pulm artery
  •  Atrial septectomy
  •  Pulmonary blood flow all comes from the BT shunt
  •  Systemic blood flow from aorta

Norwood-sano

  •  Aorta and Pulm artery joined w/ patch homograft
  • Sano – RV to PA conduit
  • Atrial septectomy

Post-operative problems

Low cardiac output

  • Typically first 24-48 hrs
  • Sx: Tachycardia, hypotension, oliguria, acidosis
  • May be caused by globally decreased ventricular output (poor pump performance), elevated pulmonary flow compared to systemic flow, AV valve regurg and rhythm disturbances

Cyanosis

  • Pulmonary venous desaturation ( pneumothorax, pleural effusion, pulmonary edema, infection)
  • Decreased pulmonary blood flow ( elevated PVR, pulm venous HTN, restrictive atrial septal defect, PA distortion, small shunt

Low SVO2

  • Inadequate oxygen delivery (anemia, low CO) or increased  consumption (fever, agitation, sepsis)

Elevated oxygen saturation

  •  Too pink, sats ~90%
  • Typically has low PVR and pulmonary blood flow in excess of systemic blood flow
  • May lead to inadequate perfusion, renal dysfxn, inability to wean from vent

*Concern for coronary hypoperfusion w/ BT shunt if excess pulmonary steal

Important physical exam findings

  • Shunt murmur – systolic, diastolic, harshness
  • New murmur – concern for AV valve regurg
  • Hepatomegaly
  • Edema – ascites, pulm edema on CXR

Anticoagulation is important 24-48 hrs post surgery