We have experienced an increasing number of thrombotic shunt occlusions after Norwood surgery for HLHS and other hearts with single ventricle physiology. Our first thought was that this might be related to the introduction of the Sano modification in 2002. However none of 12 newborns with classical HLHS that had a Sano shunt 2002-2004 developed shunt occlusion compared to 4 of 9 operated 2005-2007.
Objective
To test if pulse oximetry home monitoring prevents death from shunt occlusion.
Methods
Newborns with single ventricle physiology and a BT or Sano shunt were included. Parents were taught to make one measurement daily while the baby was calm and if the saturation was 70% or less, confirmed on a repeat measurement, contact the local hospital.
Results
Eight of the 10 first patients on the programme had Norwood surgery and 7 had a Sano shunt. Four patients had saturations below 70%. One had a distal Sano narrowing and therefore an early bidirectional Glenn (101 d). Another had a partial thrombotic shunt occlusion and the shunt was replaced the same day as the low saturation reading (59 d). Two patients had no apparent cause and saturations normalized without surgical intervention. One patient with good saturations died suddenly a few hours after a reading above 90%. Autopsy showed thrombotic shunt occlusion.
Conclusions
Home monitoring may have prevented 1-2 deaths from shunt occlusion in these first 10 patients on the home monitoring programme. Rapid development of thrombosis in one patient resulted in death in spite of home monitoring.