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Gupta A, Gunsaulus M, Erdmann A, Medina MC, Alsaied T, Kreutzer J. Persistent Patent Vertical Vein After Repair of Total Anomalous Pulmonary Venous Connection (TAPVR): A Rare Cause of Hypoxemia Post-Fontan Procedure. Pediatr Cardiol 2025; 46:222-226. [PMID: 38093114 DOI: 10.1007/s00246-023-03363-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 11/22/2023] [Indexed: 01/22/2025]
Abstract
Vertical vein (VV) ligation during total anomalous pulmonary venous return (TAPVR) repair is controversial. While some surgeons prefer ligation of the VV to prevent adverse sequelae of shunting across it and to promote flow through the newly created anastomosis, others leave it to serve as a "pop off valve" to the left heart structures, which are believed to be hypoplastic and noncompliant, presumably contributing to a more favorable post-operative outcome. We report two patients post-Fontan procedure, who underwent cardiac catheterization to explore the etiology of hypoxia and were found to have a persistent VV responsible for right to left shunting. Both patients underwent closure of the VV with improvement in the cyanosis and clinical course. These cases provide evidence supporting surgical ligation of the VV at the time of TAPVR repair, especially in patients with single ventricle.
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Affiliation(s)
- Aditi Gupta
- Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh, Heart Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Megan Gunsaulus
- Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh, Heart Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Alexandra Erdmann
- Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh, Heart Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Mario Castro Medina
- Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh, Heart Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Tarek Alsaied
- Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh, Heart Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Jacqueline Kreutzer
- Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh, Heart Institute, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
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Hogue SJ, Mehdizadeh-Shrifi A, Kulshrestha K, Cnota JF, Divanovic A, Ricci M, Ashfaq A, Lehenbauer DG, Cooper DS, Morales DLS. Birth in the Operating Room for Immediate Cardiac Surgery: A Rare but Effective Strategy. World J Pediatr Congenit Heart Surg 2024; 15:714-721. [PMID: 39252613 DOI: 10.1177/21501351241269881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Background: With significant advancements in fetal cardiac imaging, patients with complex congenital heart disease (CHD) carrying a high risk for postnatal demise are now being diagnosed earlier. We sought to assess an interdisciplinary strategy for delivering these children in an operating room (OR) adjacent to a cardiac OR for immediate surgery or stabilization. Methods: All children prenatally diagnosed with CHD at risk for immediate postnatal hemodynamic instability and cardiogenic shock who were delivered in the operating room (OR) between 2012 and 2023 in which the senior author was consulted were included. Results: Eight patients were identified. Six (75%) patients were operated on day-of-life zero, all requiring obstructed total anomalous pulmonary venous return (TAPVR) repair. Of these six patients, 2 (33%) required a simultaneous Norwood procedure, 2 (33%) required pulmonary artery unifocalization and modified Blalock-Taussig-Thomas shunt, and 2 (33%) patients had repair of obstructed mixed TAPVR. The remaining 2 patients potentially planned for immediate surgery had nonimmune hydrops fetalis and went into cardiogenic shock at 12 and 72 hours postnatally, requiring a novel Norwood procedure with left-ventricular exclusion for severe aortic/mitral valve insufficiency. The median ventilation and inpatient durations were 19 [IQR: 11-26] days and 41 [IQR: 32-128] days, respectively. Three(38%) patients required one or more in-hospital reoperations. Subsequent staged procedures included Glenn (n = 5), Fontan (n = 3), biventricular repair (n = 2), ventricular assist device placement (n = 1), and heart transplant (n = 1). Median follow-up was 5.7 [IQR:1.3-7.8] years. The five-year postoperative survival was 88% (n = 7/8). Conclusion: While children with these diagnoses have historically had poor survival, the strategy of birth in the OR adjacent to a cardiac OR where emergent surgery is planned is a potentially promising strategy with excellent clinical outcomes. However, this is a high-resource strategy whose feasibility in any program requires thoughtful assessment.
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Affiliation(s)
- Spencer J Hogue
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Kevin Kulshrestha
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - James F Cnota
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Allison Divanovic
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Marco Ricci
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Awais Ashfaq
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David G Lehenbauer
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David S Cooper
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David L S Morales
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Harada T, Nakano T, Ando Y, Hashimoto J. Sutureless Repair of Extracardiac Univentricular Total Anomalous Pulmonary Venous Connection. Ann Thorac Surg 2024; 117:990-997. [PMID: 37230275 DOI: 10.1016/j.athoracsur.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/18/2023] [Accepted: 05/14/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND This study aimed to evaluate the results of sutureless repair of extracardiac total anomalous pulmonary venous connection (TAPVC) with a functional single ventricle at a single institution, including changes in the anastomotic site over time. METHODS The database contained 98 patients with single-ventricle anatomy who underwent extracardiac TAPVC repair from 1996 to 2022. The median age and body weight at surgery were 59 days and 3.8 kg, respectively. Eighty-seven patients had heterotaxy syndrome, and 42 had preoperatively obstructed TAPVC. Primary sutureless repair was performed in 18 patients, 13 of whom were neonates. The cross-sectional area of the anastomotic site of the atrium and pericardium was divided by the body surface area, and the changes in this value over time were assessed. The median follow-up was 5.2 years (range, 0-19.4 years). RESULTS Operative mortality and late mortality occurred in 2 (2.0%) and 38 (38.8%) patients, respectively. The actuarial survival rate at 5 years postoperatively was 56.2%. Multivariate analysis identified preoperatively obstructed TAPVC as a risk factor for mortality. Recurrent pulmonary venous stenosis (PVS) developed in 25 patients, thus giving a 5-year rate of freedom from PVS of 64.9%. Multivariate analysis revealed that sutureless repair significantly decreased the incidence of recurrent PVS. The cross-sectional anastomotic area tended to grow in accordance with the patients' growth. CONCLUSIONS Sutureless repair of extracardiac TAPVC with univentricular anatomy achieved acceptable results. The anastomotic site tended to grow over time and contributed to a decline in the rate of recurrent PVS.
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Affiliation(s)
- Takeaki Harada
- Department of Cardiovascular Surgery, Fukuoka Children's Hospital, Fukuoka, Japan.
| | - Toshihide Nakano
- Department of Cardiovascular Surgery, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Yusuke Ando
- Department of Cardiovascular Surgery, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Joji Hashimoto
- Department of Radiology, Fukuoka Children's Hospital, Fukuoka, Japan
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Artem G, Denis M, Alina I, Igor' A, Dmitriy Z, Aleksei P, Ilya S, Evgeniy G, Mikhail C. A clinical case of successful palliative endovascular treatment of a patient with a single ventricle, mitral valve atresia, an intact atrial septum and persistent cardinal vein. Egypt Heart J 2023; 75:41. [PMID: 37199897 DOI: 10.1186/s43044-023-00368-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/14/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Treatment of newborns with univentricular hemodynamics in combination with an anomaly of pulmonary venous return has the worst correction results in modern cardiac surgical papers. According to the data obtained by different authors, postoperative mortality in this cohort of patients varies from 41.7 to 53%. The presence of the venous outflow tract obstruction, as well as the serious condition of a newborn, is one of the main factors that increase the risk of death in the postoperative period. CASE PRESENTATION This article reveals a clinical case of a patient with a combined heart disease prenatally diagnosed in the form of a functionally single ventricle with a double outlet of the main vessels from it, mitral valve atresia, an intact atrial septum and an anomaly of venous return, when the blood outflow from the left atrium was carried out through a single fetal communication such as stenotic cardinal vein. In order to stabilize the patient's condition, the newborn urgently underwent stenting of the stenotic section of the cardinal vein. However, due to the lack of positive dynamics in the postoperative period, the child underwent repeated endovascular intervention and stenting of the intraoperatively created interatrial communication was performed. Taking into account the absence of obstruction of the outflow tract to the pulmonary artery, it was necessary to perform an open surgical intervention in a short time such as pulmonary artery banding. CONCLUSIONS Thus, palliative endovascular intervention in critically ill neonates with univentricular hemodynamics and anomalous pulmonary venous return can be considered as a method of choice that can become a new safer strategy for managing infants in order to stabilize the condition before the main stage of surgical intervention comes.
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Affiliation(s)
- Gorbatykh Artem
- Almazov National Medical Research Centre, Akkuratova Str. 2, Saint-Petersburg, Russian Federation, 197341
| | - Manannikov Denis
- Almazov National Medical Research Centre, Akkuratova Str. 2, Saint-Petersburg, Russian Federation, 197341.
| | - Ivanilova Alina
- Almazov National Medical Research Centre, Akkuratova Str. 2, Saint-Petersburg, Russian Federation, 197341
| | - Averkin Igor'
- Almazov National Medical Research Centre, Akkuratova Str. 2, Saint-Petersburg, Russian Federation, 197341
| | - Zubarev Dmitriy
- Almazov National Medical Research Centre, Akkuratova Str. 2, Saint-Petersburg, Russian Federation, 197341
| | - Prokhorikhin Aleksei
- Almazov National Medical Research Centre, Akkuratova Str. 2, Saint-Petersburg, Russian Federation, 197341
| | - Soynov Ilya
- E.N. Meshalkin National Medical Research Centre, Rechkunovskaya Str. 15, Novosibirsk, Russian Federation, 630055
| | - Grekhov Evgeniy
- Almazov National Medical Research Centre, Akkuratova Str. 2, Saint-Petersburg, Russian Federation, 197341
| | - Chernyavskiy Mikhail
- Almazov National Medical Research Centre, Akkuratova Str. 2, Saint-Petersburg, Russian Federation, 197341
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Swartz MF, Meagher C, Yoshitake S, Atallah-Yunes N, Angona R, Cholette JM, Alfieris GM. Pulmonary Venous Gradients in Healthy Controls and Following the Repair of Total Anomalous Pulmonary Venous Return. Pediatr Cardiol 2023; 44:325-332. [PMID: 35986764 DOI: 10.1007/s00246-022-02986-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/08/2022] [Indexed: 02/07/2023]
Abstract
The percent of children who can achieve a normal and physiologic pulmonary venous gradient and flow following the repair of Total Anomalous Pulmonary Venous Return (TAPVR) is not known. Pulmonary venous confluence gradients from infants with supra-, infra-, or mixed TAPVR, repaired using a direct anastomotic connection were measured. Data from age, weight, and gender-matched controls established the normal pulmonary venous gradient range (0.30-0.94 mmHg). TAPVR subjects were divided into three groups: (I) pulmonary venous gradient < 2 × normal with multiphasic flow (II) pulmonary venous gradient > 2 × normal with multiphasic flow, and (III) pulmonary venous gradient > 2 × normal with monophasic flow. From 63 children following TAPVR repair and 63 matched controls, pulmonary venous gradients were significantly lower [0.5 mmHg (IQR:0.4, 0.6) vs 1.6 mmHg (IQR:1.0, 2.4); p < 0.001], and multiphasic flow more frequent (100 vs. 84.1%; p = 0.001) within the control group. There were 38 children (60.3%) in group I, 15 (23.8%) in group II, and 10 (15.8%) in group III. Children in Group I were significantly older at the time of repair, had shorter cardiopulmonary bypass times, and did not utilize deep hypothermic circulatory arrest (DHCA). Multivariate analysis confirmed that avoiding DHCA [Odds Ratio 0.931 (0.913,0.994; p = 0.002)] and shorter cardiopulmonary bypass times [Odds Ratio 0.962 (0.861,0.968; p = 0.02)] during repair were associated with the lowest pulmonary venous gradients and multiphasic flow. Following TAPVR repair with a direct anastomosis, the majority of children can achieve a gradient two times normal or less with multiphasic pulmonary venous flow.
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Affiliation(s)
- Michael F Swartz
- Pediatric Cardiac Consortium of Central New York, Rochester, USA.
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave Box Card/Surg, Rochester, NY, 14642, USA.
| | - Cecilia Meagher
- Pediatric Cardiac Consortium of Central New York, Rochester, USA
- Department of Pediatrics, University of Rochester Medical Center, Rochester, USA
| | - Shuichi Yoshitake
- Pediatric Cardiac Consortium of Central New York, Rochester, USA
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave Box Card/Surg, Rochester, NY, 14642, USA
| | - Nader Atallah-Yunes
- Pediatric Cardiac Consortium of Central New York, Rochester, USA
- Department of Pediatrics, University of Rochester Medical Center, Rochester, USA
| | - Ron Angona
- Pediatric Cardiac Consortium of Central New York, Rochester, USA
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave Box Card/Surg, Rochester, NY, 14642, USA
| | - Jill M Cholette
- Pediatric Cardiac Consortium of Central New York, Rochester, USA
- Department of Pediatrics, University of Rochester Medical Center, Rochester, USA
| | - George M Alfieris
- Pediatric Cardiac Consortium of Central New York, Rochester, USA
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave Box Card/Surg, Rochester, NY, 14642, USA
- Department of Pediatrics, University of Rochester Medical Center, Rochester, USA
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Kang L, Andersen ND. Commentary: Obstructed single ventricle total veins: Perhaps emergency surgery is not always the best answer. JTCVS OPEN 2022; 10:320-321. [PMID: 36004224 PMCID: PMC9390501 DOI: 10.1016/j.xjon.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 11/22/2021] [Accepted: 12/08/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Lillian Kang
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Nicholas D. Andersen
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
- Duke Children's Pediatric & Congenital Heart Center, Duke Children's Hospital, Durham, NC
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Surgical Outcomes of Total Anomalous Pulmonary Venous Connection Repair. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58050687. [PMID: 35630104 PMCID: PMC9145912 DOI: 10.3390/medicina58050687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/16/2022] [Accepted: 05/20/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Over the years, surgical repair of total anomalous pulmonary venous connection (TAPVC) outcomes have improved, however, morbidity and mortality still remain significant. This study aims to assess the early and long-term outcomes of surgical treatment of TAPVC children, operated on between 2006 and 2016, in one pediatric center in Poland. Materials and Methods: Diagnostics, surgical treatment, and follow-up data from 83 patients were collected. In addition, survival and risk factor analyses, control echocardiographic, and electrocardiographic examinations were performed. Results: In the analyzed group (n = 83), there were seven hospital deaths (within 30 days after the operation) (8.4%) and nine late deaths (10.8%). The mean follow-up time was 5.5 years, and, for patients who survived, it was 7.1 years. The mean survival time in patients with completed follow-up (n = 70) was 10.3 years; the overall five-year survival rate was 78.4%. Independent mortality risk factors were type I TAPVC, single ventricle physiology, time from admission to operation, intensive care unit stay, postoperative hospital stay, and temporary kidney insufficiency requiring dialysis. Conclusions: The presence of single ventricle physiology and the supracardiac subtype of TAPVC might be negative prognostic factors, while normal heart physiology presents with good post-repair results. This study indicates that cardiac arrhythmias may occur. Morbidity and mortality, related to surgical TAPVC correction, still remain significant.
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Vasquez Choy AL, Adebo DA, John S, Greenleaf CE, Salazar JD, Corno AF. Essential role of cardiac computed tomography for surgical decision making in children with total anomalous pulmonary venous connection and single ventricle. J Card Surg 2022; 37:1544-1549. [PMID: 35315129 DOI: 10.1111/jocs.16427] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/23/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Total anomalous pulmonary venous connection (TAPVC) is a major risk factor in infants with single ventricle (SV). Exact definition of TAPVC anatomy is crucial for surgical planning. AIM To evaluate the role of cardiac computed tomography (CT) in this setting. METHODS Retrospective review of 13 infants who underwent TAPVC repair associated with SV from May 2016 to October 2021. Anatomy, incidence, and mechanisms of pulmonary venous obstruction (PVO) were described. Cardiac CT diagnostic yield was compared to echocardiography (echo). RESULTS Of 13 infants, median age and weight were 24 days (range 2-303 days) and 3.2 (range 2.6-9.1) kg, 8 (62%) were male, 4 (31%) premature, and 11 (85%) had heterotaxy syndrome. All infants had pre- and postoperative echo; 13 had preoperative and 8 (62%) had postoperative cardiac CT. Type of TAPVC: six (46%) supracardiac, two (15%) intracardiac, one (8%) infracardiac, and four (31%) mixed, with pulmonary veins draining in >1 confluence in nine (69%). PVO was present in 6/13 (46%) preoperatively and 5/13 (31%) postoperatively. Mechanisms of PVO: 9/11 (82%) stenosis, 1/9 (9%) membrane formation, and 1/9 (9%) external compression. The sensitivity to diagnose PVO was 45.5% for echo and 100% for cardiac CT, the specificity was 100% for both. No discrepancy was found between cardiac CT and intraoperative findings, but echo had a complete preoperative diagnosis in 1/13 (8%) (p < .00001, Fisher exact test). CONCLUSIONS Cardiac CT is essential to evaluate pre- and postoperative TAPVC in SV for surgical decision making and long term follow up.
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Affiliation(s)
- Ana L Vasquez Choy
- Division of Pediatric Cardiology, Children's Heart Institute, University of Texas Medical School at Houston, Houston, Texas, USA
| | - Dilachew A Adebo
- Division of Pediatric Cardiology, Children's Heart Institute, University of Texas Medical School at Houston, Houston, Texas, USA
| | - Sheba John
- Division of Pediatric Cardiology, Children's Heart Institute, University of Texas Medical School at Houston, Houston, Texas, USA
| | - Christopher E Greenleaf
- Division of Pediatric and Congenital Heart Surgery, Memorial Hermann Hospital, Children's Heart Institute, University of Texas Health McGovern Medical School, Houston, Texas, USA
| | - Jorge D Salazar
- Division of Pediatric and Congenital Heart Surgery, Memorial Hermann Hospital, Children's Heart Institute, University of Texas Health McGovern Medical School, Houston, Texas, USA
| | - Antonio F Corno
- Division of Pediatric and Congenital Heart Surgery, Memorial Hermann Hospital, Children's Heart Institute, University of Texas Health McGovern Medical School, Houston, Texas, USA
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Ishidou M, Ota K, Watanebe K, Koshiyama H, Kanno K, Ito H, Murata M, Hirose K, Ikai A, Sakamoto K. Impact of intrapulmonary-artery septation to pulmonary vein obstruction for two-lung Fontan. Eur J Cardiothorac Surg 2020; 58:177-185. [PMID: 32053189 DOI: 10.1093/ejcts/ezaa035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/06/2020] [Accepted: 01/06/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Patients with unbalanced pulmonary artery (PA) growth and decreased unilateral pulmonary circulation are considered unsuitable candidates for the Fontan procedure. Following our previous study on the utility of intrapulmonary-artery septation for patients with PA hypoplasia, we investigated its use in patients with pulmonary venous obstruction (PVO). METHODS We recruited 42 patients who underwent intrapulmonary-artery septation for unilateral PA hypoplasia and/or PVO between 1998 and 2018 and classified them into no PVO or PVO group. We analysed overall survival, success of the Fontan procedure and data from catheterization and echocardiography. In PVO, we evaluated the functional lung area before the Fontan procedure and the relevance of this parameter to operative outcomes. RESULTS The PVO and no-PVO group included 24 and 18 patients, respectively. One patient in the no-PVO and 6 patients in the PVO group died during follow-up; this difference was statistically significant (log-rank P = 0.040). In the no-PVO group, 15 (83%) patients achieved two-lung Fontan circulation. In the PVO group, 12 (50%) patients achieved two-lung Fontan circulation. Multivariate analysis revealed that functional lung area and shunt size [significantly larger in patients with functional lung area ≥50% in affected lung (P = 0.040)] were significant factors for successful two-lung Fontan procedure (P = 0.030). CONCLUSIONS Intrapulmonary-artery septation may contribute to increase functional lung area after PVO release to establish two-lung Fontan circulation in patients with PVO who have unbalanced PA growth and/or decreased unilateral pulmonary circulation.
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Affiliation(s)
- Motonori Ishidou
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Keisuke Ota
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Kentaro Watanebe
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Hiroshi Koshiyama
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Kazuyoshi Kanno
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Hiroki Ito
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Masaya Murata
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Keiichi Hirose
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Akio Ikai
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Kisaburo Sakamoto
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
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