1
|
Chowdhury UK, George N, B. S, Chandhirasekar B, Goja S, Manjusha N, Pandey NN, Kapoor PM. Technical Details of Transwindow Fenestrated, Unidirectional, Valved, Aorticopulmonary Fabric Patch Closure of Aortopulmonary Window (UKC's Modification): A Video Presentation. JOURNAL OF CARDIAC CRITICAL CARE TSS 2022. [DOI: 10.1055/s-0042-1759805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
AbstractA 10-year-old female patient diagnosed with isolated type I aortopulmonary window and severe pulmonary arterial hypertension who underwent repair of the aortopulmonary window via Johansson's transwindow approach using a unidirectional, fenestrated, valved, aorticopulmonary patch. The preoperative pulmonary vascular resistance was 9.0 Woods units/m2 that reduced to 4.0 Woods units/m2 after oxygen (100%) and nitric oxide (80 ppm) administration. The postoperative recovery was uneventful.
Collapse
Affiliation(s)
- Ujjwal K. Chowdhury
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Niwin George
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sushamagayatri B.
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Balaji Chandhirasekar
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Shikha Goja
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Nagasai Manjusha
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj Nirmal Pandey
- Department of Cardiac Radiology, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Poonam Malhotra Kapoor
- Department of Cardiac Anaesthesia, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
2
|
Sildenafil's Early, Late Impact on Ventricular Septal Repair: Older Children Using the Double Patch. Ann Thorac Surg 2021; 114:818-825. [PMID: 34228973 DOI: 10.1016/j.athoracsur.2021.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Delayed diagnosis in children with a ventricular septal defect (VSD) is common in developing countries. Consequently, they present with elevated pulmonary vascular resistance (PVR) and pulmonary arterial hypertension (PAH). We introduced the double-flap valve VSD patch closure technique (DFV) in 1996 to reduce early post- operative risk. Long-term results are presented herein. METHODS This is a retrospective single-institution study on DFV patients performed between 5/1996 and 7/2015. Beginning in 2005 all candidates for DFV received sildenafil pre-and post-operatively. Pre-operative catheterization data, operative, post-operative, hospital and follow-up data were analyzed. RESULTS Forty patients received the DFV surgery. Patient demographics were comparable between sildenafil and non-sildenafil groups. Lost to follow up 1/39 (2.6%). Early mortality: 1/40 (2.5%), late mortality: 1/38 (2.6%). Sildenafil improved pre-op saturation, improved pre-operative hemodynamics as well as shortened prost-operative ventilation time. In both groups abnormal hemodynamic parameters improved with 100% oxygen challenge. The median age at late follow-up was 26.3 years (20.9; 29.9[25%; 75% Intra-quartile range]) and the median time since operation was 19.2 years (11.4; 22.7). Current discharge survival was 97.3%. Patients with severe PAH in late follow-up was 18%. Multi-variate analysis revealed only baseline PVR/SVR ≥ 0.8 as a significant predictor of late severe PAH. CONCLUSIONS Our long-term follow-up demonstrates that 60% of the patients will achieve normal or near normal PA pressures. Furthermore, we have demonstrated that sildenafil improves. pre-operative hemodynamics and post-operate management. Children with VSD, elevated PVR and PAH should not be denied operation.
Collapse
|
3
|
Afrasiabirad A, Samadi M, Vatani P, Faridvand Y. Valve patch technique for repair of ventricular septal defect: long-term results. Asian Cardiovasc Thorac Ann 2020; 29:161-164. [PMID: 32985226 DOI: 10.1177/0218492320962923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study aimed to show the long-term results in patients who underwent unidirectional valve patch repair of ventricular septal defect with pulmonary artery hypertension. METHODS Thirty-five acyanotic patients aged 2 to 26 years (mean 9.3 years) with a large ventricular septal defect and elevated pulmonary vascular resistance (mean 9.5 Wood units) underwent surgery in Madani Heart Hospital. The medical records and clinical outcomes were reviewed from March 1998 to March 2017. RESULTS Five patients died in the first postoperative week. In the long-term follow-up (mean 11 years), two patients were lost to follow-up. Pulmonary artery hypertension gradually decreased in 17 patients within 6-12 months with significant improvement in right ventricular end-diastolic diameter, New York Heart Association functional class, and tricuspid regurgitation. Eleven patients with persistent pulmonary artery hypertension were divided into tolerable and non-tolerable groups. Six patients in the tolerable group had satisfactory conditions compared to before the operation, and gained weight with improved functional class despite echocardiographic findings of persistent elevated pulmonary artery pressure. One had a full-term delivery by caesarean section in the fifth postoperative year. Five patients in the non-tolerable group gradually developed right heart failure and complications such as extremity edema, ascites, pleural effusions, and died after 10-30 months. CONCLUSION Although relatively high mortality occurred during long-term follow-up, surviving patients were in a better condition and functional class despite persistent pulmonary artery hypertension. Therefore, fear of persistent pulmonary artery hypertension should not prohibit surgery in this group of patients.
Collapse
Affiliation(s)
- Abbas Afrasiabirad
- Cardiovascular Research Center, 48432Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahmoud Samadi
- Cardiovascular Research Center, 48432Tabriz University of Medical Sciences, Tabriz, Iran
| | - Parisa Vatani
- Cardiovascular Research Center, 48432Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yousef Faridvand
- Cardiovascular Research Center, 48432Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
4
|
Fernández Carbonell A, Merino Cejas C, Rodríguez Guerrero E, Inga Tavara LI, Conejero Jurado MT, Muñoz Carvajal I. Comunicación interauricular y drenaje venoso anómalo parcial con sospecha de síndrome de Eisenmenger corregido con la técnica de Warden y parche de Dacron valvulado. CIRUGIA CARDIOVASCULAR 2019. [DOI: 10.1016/j.circv.2019.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
5
|
Talwar S, Keshri VK, Choudhary SK, Gupta SK, Ramakrishnan S, Juneja R, Saxena A, Kothari SS, Airan B. Surgical strategies for patients with congenital heart disease and severe pulmonary hypertension in low/middle-income countries. HEART ASIA 2015; 7:31-7. [PMID: 27326218 DOI: 10.1136/heartasia-2015-010645] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/02/2015] [Accepted: 09/18/2015] [Indexed: 11/04/2022]
Abstract
In this review, we discuss specific surgical strategies that are used in patients with congenital heart disease and severe pulmonary arterial hypertension. Our own experience, with the use of unidirectional valved patches in managing these patients, is also discussed in detail.
Collapse
Affiliation(s)
- Sachin Talwar
- Cardiothoracic Centre, All India Institute of Medical Sciences , New Delhi , India
| | - Vikas Kumar Keshri
- Cardiothoracic Centre, All India Institute of Medical Sciences , New Delhi , India
| | - Shiv Kumar Choudhary
- Cardiothoracic Centre, All India Institute of Medical Sciences , New Delhi , India
| | - Saurabh Kumar Gupta
- Cardiothoracic Centre, All India Institute of Medical Sciences , New Delhi , India
| | | | - Rajnish Juneja
- Cardiothoracic Centre, All India Institute of Medical Sciences , New Delhi , India
| | - Anita Saxena
- Cardiothoracic Centre, All India Institute of Medical Sciences , New Delhi , India
| | - Shyam Sunder Kothari
- Cardiothoracic Centre, All India Institute of Medical Sciences , New Delhi , India
| | - Balram Airan
- Cardiothoracic Centre, All India Institute of Medical Sciences , New Delhi , India
| |
Collapse
|
6
|
Talwar S, Keshri VK, Choudhary SK, Gupta SK, Ramakrishnan S, Saxena A, Kothari SS, Juneja R, Kumar G, Airan B. Unidirectional valved patch closure of ventricular septal defects with severe pulmonary arterial hypertension: hemodynamic outcomes. J Thorac Cardiovasc Surg 2014; 148:2570-5. [PMID: 24332111 DOI: 10.1016/j.jtcvs.2013.10.052] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 09/13/2013] [Accepted: 10/29/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of the present study was to study the midterm hemodynamic outcomes of unidirectional valved patch closure of ventricular septal defects (VSDs) in patients with VSD and pulmonary arterial hypertension (PAH). METHODS From January 2006 to January 2012, 20 patients with VSD with PAH and a pulmonary vascular resistance index >8 Wood units underwent VSD closure with a unidirectional valved patch using the technique previously described by us. Of these, 13 patients agreed to follow-up cardiac catheterization and were studied at a mean follow-up of 34.7 ± 18.6 months (range, 2-56). The mean age of these 13 patients was 8.5 ± 4.4 years (range, 2-19; median, 9), and the mean preoperative systemic saturation was 94.1% ± 3.4% (range, 87-99; median, 95.0) The mean preoperative pulmonary artery systolic pressure was 96.2 ± 13.6 mm Hg (range, 75-115; median, 103.0), and the mean preoperative pulmonary vascular resistance index was 10.0 ± 2.1 Wood units (range, 8.0-15.1; median, 9.3). RESULTS At follow-up cardiac catheterization, the mean systemic saturation had increased to 98.92%. The pulmonary vascular resistance index had decreased significantly to 5.8 ± 2.1 Wood units (P = .02). A significant decrease was seen in the pulmonary artery systolic, diastolic, and mean pressures (P = .000), and none of the patients had severe PAH. No patients died, and all patients were in New York Heart Association class I. CONCLUSIONS Unidirectional valved patch closure of VSD is a promising technique for patients with a large VSD and severe PAH. It had a favorable effect on the immediate, early, and midterm clinical outcomes and hemodynamic parameters.
Collapse
Affiliation(s)
- Sachin Talwar
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
| | - Vikas Kumar Keshri
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Shiv Kumar Choudhary
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kumar Gupta
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | | | - Anita Saxena
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam Sunder Kothari
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Rajnish Juneja
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Guresh Kumar
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Balram Airan
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
7
|
Sridhar A, Sahayaraj A, Lakshmi N, Farzana F, Subramanyan R, Pezzella AT, Cherian KM. Cruciate Fenestration in Ventricular Septal Defect Patch for High-Risk Patients With High Pulmonary Vascular Resistance. World J Pediatr Congenit Heart Surg 2014; 5:494-6. [DOI: 10.1177/2150135114526418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 02/06/2014] [Indexed: 11/15/2022]
Abstract
Late presentation of patients with large ventricular septal defect (VSD) and elevated pulmonary vascular resistance (PVR) is not uncommon in developing countries. Surgical VSD closure in these patients carries risks of persistent pulmonary hypertension, right ventricular failure, and mortality. Several techniques for creation of valved patches or fenestrated patches have been developed to address these issues. We have successfully used a simple and easily reproducible technique in which a cruciate fenestration is created in the patch used for VSD closure.
Collapse
Affiliation(s)
- Anuradha Sridhar
- Department of Paediatric Cardiology, Frontier Lifeline and Dr. K. M. Cherian Heart Foundation, Chennai, Tamil Nadu, India
| | - Anto Sahayaraj
- Cardiothoracic Surgery, Frontier Lifeline and Dr. K. M. Cherian Heart Foundation, Chennai, Tamil Nadu, India
| | - Nithya Lakshmi
- Department of Paediatric Cardiology, Frontier Lifeline and Dr. K. M. Cherian Heart Foundation, Chennai, Tamil Nadu, India
| | - Farida Farzana
- Department of Paediatric Cardiology, Frontier Lifeline and Dr. K. M. Cherian Heart Foundation, Chennai, Tamil Nadu, India
| | - Raghavan Subramanyan
- Department of Paediatric Cardiology, Frontier Lifeline and Dr. K. M. Cherian Heart Foundation, Chennai, Tamil Nadu, India
| | | | - Kotturathu Mammen Cherian
- Cardiothoracic Surgery, Frontier Lifeline and Dr. K. M. Cherian Heart Foundation, Chennai, Tamil Nadu, India
| |
Collapse
|
8
|
Talwar S, Choudhary SK, Garg S, Saxena A, Ramakrishnan S, Kothari SS, Juneja R, Airan B. Unidirectional valved patch closure of ventricular septal defects with severe pulmonary arterial hypertension. Interact Cardiovasc Thorac Surg 2012; 14:699-702. [PMID: 22402503 DOI: 10.1093/icvts/ivs044] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Delayed presentation of ventricular septal defect (VSD) is common in developing countries. Such patients often have severe pulmonary arterial hypertension (PAH), which increases post-operative morbidity and mortality. To address these problems, we used our technique of unidirectional valved patch (UVP) for closure of VSD. Between January 2006 and December 2010, 17 patients (age 2-23 years, median 9 years) with a large VSD and severe PAH underwent VSD closure with UVP. Pre-operative mean indexed pulmonary vascular resistance (PVRI) was 10.9 ± 2.2 Wood units and mean pre-operative systemic saturation was 93.4 ± 2.6%. Shunt was bidirectional in 15 patients and predominantly right to left in two. After VSD closure, intra-operative transoesophageal echocardiography revealed a right to left shunt across the patch in three patients 2, 7 and 9 years of age who had pre-operative PVRI of 9.5, 9.8 and 11.1 Wood units, respectively. There were no in-hospital deaths and all patients had uneventful recovery. Mean follow-up was 30 ± 14.7 months and all patients are well without cyanosis. Echocardiography showed no shunt across the patch and all have systemic saturation >95%. We conclude that UVP is a promising technique in patients with large VSD and severe PAH.
Collapse
Affiliation(s)
- Sachin Talwar
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Talwar S, Choudhary SK, Nair VV, Chauhan S, Kothari SS, Juneja R, Saxena A, Airan B. Arterial switch operation with unidirectional valved patch closure of ventricular septal defect in patients with transposition of great arteries and severe pulmonary hypertension. World J Pediatr Congenit Heart Surg 2012; 3:21-5. [PMID: 23804680 DOI: 10.1177/2150135111421939] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE For patients with dextro-transposition of great arteries (d-TGAs), ventricular septal defect (VSD), and severe pulmonary arterial hypertension (PAH), the common surgical options are palliative arterial switch operation (ASO) or palliative atrial switch operation leaving the VSD open. We evaluated the role of ASO with VSD closure using a fenestrated unidirectional valved patch (UVP). METHODS Between July 2009 and February 2011, six patients with TGAs, VSD, and severe PAH (mean age 39.8 ± 47.4 months, median 21, range 8-132 months), weighing 10.7 ± 9.2 kg (median 8.6, range 4.3-29 kg), underwent ASO with VSD closure using our simple technique of UVP. Mean pulmonary artery systolic pressure before the operation was 106 ± 12.7 mm Hg (median 107.5, range 95-126 mm Hg) and pulmonary vascular resistance was 9.5 ± 4.22 units (median 9.5, range 6.6-17.1 Wood units). RESULTS There were no deaths. All patients had a postoperative systemic arterial saturation of more than 95%, although there were frequent episodes of systemic desaturation due to right-to-left shunt across the valved VSD patch (as seen on transesophageal and transthoracic echocardiograms). Mean follow-up was 10 ± 7.6 months (median 7.5, range 1-22 months). At most recent follow-up, all patients had systemic arterial saturation of more than 95% and no right-to-left shunt through the VSD patch. In one patient, the follow-up cardiac catheterization showed a fall in pulmonary artery systolic pressure to 49 mm Hg. CONCLUSION Arterial switch operation with UVP VSD closure is feasible with acceptable early results. It avoids complications of palliative atrial switch (arrhythmia and baffle obstruction) and partially or completely open VSD.
Collapse
Affiliation(s)
- Sachin Talwar
- Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Talwar S, Choudhary SK, Saxena A, Kothari SS, Juneja R, Airan B. Unidirectional valved patches for closure of septal defects in patients with severe pulmonary hypertension. Ann Pediatr Cardiol 2011; 1:114-9. [PMID: 20300252 PMCID: PMC2840745 DOI: 10.4103/0974-2069.43876] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pulmonary hypertension due to delay in presentation, diagnosis, referral, and surgery for septal defects is not uncommon in the developing world and translates into high morbidity and mortality following open heart surgery to close these defects. Leaving a small atrial communication may not always be effective. Extracorporeal membrane oxygenation and inhaled nitric oxide therapy in the immediate postoperative phase may not be available or may not be financially feasible in many institutions which are economically challenged. Unidirectional valved patch is emerging as a new and effective solution to this problem and promises to make at least the immediate postoperative results more predictable in this subset of patients.
Collapse
Affiliation(s)
- Sachin Talwar
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | | | | |
Collapse
|
11
|
The unidirectional valve patch provides no benefits to early and long-term survival in patients with ventricular septal defect and severe pulmonary artery hypertension. J Thorac Cardiovasc Surg 2010; 139:950-5. [DOI: 10.1016/j.jtcvs.2009.05.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 04/09/2009] [Accepted: 05/15/2009] [Indexed: 11/17/2022]
|
12
|
Preoperative pulmonary hemodynamics and assessment of operability: is there a pulmonary vascular resistance that precludes cardiac operation? Pediatr Crit Care Med 2010; 11:S57-69. [PMID: 20216166 DOI: 10.1097/pcc.0b013e3181d10cce] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Preoperative pulmonary vascular disease remains an important risk factor for death or right-heart failure in selected children undergoing two-ventricle repair, single-ventricle palliation, or heart transplantation. Preoperative criteria for poor outcome after operation remain unclear. The purpose of this review is to critically assess both the historic and current data and make recommendations where appropriate. An extensive literature search was undertaken in October 2009. Data were analyzed by an expert multidisciplinary team and recommendations were made by consensus. PubMed was searched in October 2009. Data were analyzed and recommendations were made by consensus of a multidisciplinary team. In patients with suspected pulmonary vascular disease anticipating a two-ventricle repair, although preoperative testing via cardiac catheterization with vasodilators is reasonable, the preoperative parameters and the precise values of these parameters that best correlate with early and late outcome remain unclear. Further investigation is warranted in selected populations, such as the growing group of children with congenital heart disease complicated by chronic lung disease of prematurity, and in the developing world where patients may be more likely to present late with advanced pulmonary vascular disease. In patients with a functional single ventricle, there is growing evidence that mean pulmonary artery pressure of >15 mm Hg may be associated with both early and late mortality after the Fontan operation. The relationship of preoperative pulmonary hemodynamics to early and late morbidity remains to be defined. There most likely is a level of preoperative pulmonary vascular disease that puts an individual patient at increased risk for death or severe cyanosis after a bidirectional cavopulmonary anastomosis. It remains unclear, however, how to best assess this risk preoperatively. The limitations in obtaining an accurate assessment of pulmonary vascular disease in the complex single ventricle are discussed. In children awaiting cardiac transplantation with elevated pulmonary vascular disease of >6 U.m and/or transpulmonary gradient of >15 mm Hg, heart transplantation is deemed feasible in most transplant centers if the administration of inotropes or vasodilators can decrease the pulmonary vascular disease to <6 U.m or transpulmonary gradient to <15 mm Hg. In patients with preoperative pulmonary vascular disease, there may be contributing factors to the pulmonary vascular disease, such as the specifics of the cardiac lesion (atrioventricular valve regurgitation, low cardiac output), parenchymal and/or airway issues, and/or individual genetic predisposition. Amelioration of any reversible factors before operation and optimization of their management in the preoperative and postoperative period are recommended.
Collapse
|
13
|
Chowdhury UK, Mittal CM, Mishra AK, Reddy SM, Sheil A, Subramaniam GK. An alternative technique for septation of the aortopulmonary window using a fenestrated, unidirectional valved fabric patch. J Thorac Cardiovasc Surg 2009; 138:1433-5. [PMID: 19660264 DOI: 10.1016/j.jtcvs.2008.09.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2008] [Revised: 09/09/2008] [Accepted: 09/17/2008] [Indexed: 10/21/2022]
|
14
|
Afrasiabi A, Samadi M, Montazergaem H. Valved patch for ventricular septal defect with pulmonary arterial hypertension. Asian Cardiovasc Thorac Ann 2008; 14:501-4. [PMID: 17130327 DOI: 10.1177/021849230601400612] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
From March 1998 to December 2004, 16 acyanotic patients aged 2 to 22 years (mean, 7 +/- 5.7 years) with a large ventricular septal defect and elevated pulmonary vascular resistance (9.6 +/- 3.8 Wood units) underwent surgery. A Gore-Tex patch with a 5-8 mm longitudinal slit in the center was used. A piece of pericardium was sewn around the slit on one side of the patch, except for the upper quarter. In all patients, the defect was closed with a trimmed patch and the pericardial aspect was placed on the left ventricular side to allow right-to-left shunting. Echocardiography on the day of operation revealed a right-to-left shunt in 6 cases. Two patients (12.5%) died in the early postoperative period due to frequent episodes of pulmonary hypertensive crisis and persistent severe pulmonary hypertension. In 3 years of follow-up, pulmonary vascular resistance gradually decreased in all but one patient in whom it increased with a right-to-left shunt and cyanosis. Insertion of a valved patch seems to be a promising technique to decrease morbidity and mortality in severe pulmonary arterial hypertension.
Collapse
Affiliation(s)
- Abbas Afrasiabi
- Cardiovascular Research Center, Madani Heart Hospital, University of Medical Sciences, Tabriz, Iran.
| | | | | |
Collapse
|
15
|
A simple technique of unidirectional valved patch for closure of septal defects. J Thorac Cardiovasc Surg 2007; 134:1357-8. [DOI: 10.1016/j.jtcvs.2007.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Accepted: 08/07/2007] [Indexed: 11/24/2022]
|
16
|
Zhang B, Wu S, Liang J, Zhang G, Jiang G, Zhou M, Li X. Unidirectional Monovalve Homologous Aortic Patch for Repair of Ventricular Septal Defect With Pulmonary Hypertension. Ann Thorac Surg 2007; 83:2176-81. [PMID: 17532418 DOI: 10.1016/j.athoracsur.2007.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2006] [Revised: 01/28/2007] [Accepted: 02/02/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND Severe pulmonary hypertension is a common complication of congenital cardiac defects with large left to right shunt, and the closure of a large ventricular septal defect (VSD) with elevated pulmonary vascular resistance (PVR) is associated with significant morbidity and mortality. A unidirectional monovalve homologous aortic patch was designed to close the large VSD with severe pulmonary hypertension in an effort to decrease the morbidity and mortality. METHODS Twenty-seven patients (mean age, 15.0 +/- 5.6 years) with large VSD with severe pulmonary hypertension (pulmonary vascular resistance, 15.2 +/- 3.8 Wood units) were repaired with a unidirectional monovalve homologous aortic patch. According to body surface area and the preoperative arterial oxygen saturation, the monovalve homologous aortic patches were fenestrated on the aortic wall with a diameter of 4 to 8 mm. RESULTS Two patients died of pulmonary hypertensive crisis and cardiac arrest postoperatively. All of the survival patients were followed up (5 months to 10 years) and the cardiopulmonary function was well improved with no late death. Obvious opening and closing of the monovalve was detected by early postoperative echocardiography in seven patients. A small amount of right to left shunt was detected in three patients three months after operation, and in two of them the shunt still existed three years after operation. CONCLUSIONS Closure of a large VSD in patients with severe pulmonary hypertension could be performed with low morbidity and mortality when a unidirectional monovalve homologous aortic patch was used and the long-term result was satisfactory.
Collapse
Affiliation(s)
- Bo Zhang
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | | | | | | | | | | | | |
Collapse
|
17
|
Lai YQ, Zhou QW, Wei H, Zhang C, Zhang ZG. Intrapulmonary channel for one-stage correction of aortic arch obstruction. Asian Cardiovasc Thorac Ann 2006; 14:402-6. [PMID: 17005888 DOI: 10.1177/021849230601400511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are several methods of surgical repair of aortic coarctation or interruption; the optimal technique is still controversial. The purpose of this study was to assess a new surgical method: intrapulmonary channel for one-stage repair of aortic coarctation or interruption associated with intracardiac anomalies. Between 1993 and 1995, 4 patients with aortic coarctation or interruption and intracardiac anomalies received one-stage surgical correction. Their ages ranged from 5 to 26 years (mean, 16 years). The aortic arch lesions were preductal coarctation in 2, and type B interruption in 2. Coexisting anomalies consisted of patent ductus arteriosus in 4, ventricular septal defect in 3, and aortopulmonary window in 1. An intrapulmonary channel was constructed in all patients, and co-existing anomalies were corrected simultaneously. There was no hospital death or late mortality. A cerebral complication occurred in one patient because of air embolism. Mean follow-up was 9.5 years (range, 8.5-11.5 years). There was no evidence of recoarctation or late aneurysm formation. For selected patients with aortic coarctation or interruption and intracardiac anomalies, an intrapulmonary channel might be an option for one-stage correction.
Collapse
Affiliation(s)
- Yong-Qiang Lai
- Division of Cardiac Surgery, Beijing Anzhen Hospital, Capital University of Medical Sciences, 36 Wuluju, Chaoyang District, Beijing 100 029, China.
| | | | | | | | | |
Collapse
|
18
|
Takabayashi S, Shimpo H, Yokoyama K, Kajimoto M. One-way valved patch repair in an adult with a hypoplastic right ventricle. J Thorac Cardiovasc Surg 2006; 132:693-4. [PMID: 16935134 DOI: 10.1016/j.jtcvs.2006.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2006] [Accepted: 05/03/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Shin Takabayashi
- Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, Mie, Japan.
| | | | | | | |
Collapse
|
19
|
Novick WM, Gurbuz AT, Watson DC, Lazorishinets VV, Perepeka AN, Malcic I, Marinovic B, Alpert BS, DiSessa TG. Double patch closure of ventricular septal defect with increased pulmonary vascular resistance. Ann Thorac Surg 1998; 66:1533-8. [PMID: 9875747 DOI: 10.1016/s0003-4975(98)00956-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Closure of a large ventricular septal defect (VSD) in children with elevated pulmonary vascular resistance is associated with significant morbidity and mortality. Pulmonary hypertensive episodes continue to be a major cause of postoperative morbidity and mortality. We designed a fenestrated flap valve double VSD patch in an effort to decrease the morbidity and mortality associated with the closure of a large VSD with elevated pulmonary vascular resistance. METHODS Eighteen children (mean age, 5.7 years) with a large VSD and elevated pulmonary vascular resistance (mean, 11.4 Wood units) underwent double patch VSD closure using moderately hypothermic cardiopulmonary bypass and cardioplegic arrest. The routine VSD patch was fenestrated (4 to 6 mm) and on the left ventricular side of the patch, a second, smaller patch was attached to the fenestration along its superior margin before closure of the VSD. RESULTS All children survived operation and were weaned from inotropic and ventilator support within 48 hours postoperatively. Postoperative pulmonary artery pressures were significantly lower than preoperative values. One child died 9 months postoperatively. CONCLUSIONS Closure of a large VSD in children with elevated pulmonary vascular resistance can be performed with low morbidity and mortality when a flap valve double VSD patch is used.
Collapse
Affiliation(s)
- W M Novick
- Le Bonheur Children's Medical Center, University of Tennessee, Memphis, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Luciani GB, Pessotto R, Mazzucco A. Extracardiac shunt for nitric oxide-resistant pulmonary hypertension. J Card Surg 1998; 13:471-4. [PMID: 10543462 DOI: 10.1111/j.1540-8191.1998.tb01085.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
An interatrial extracardiac shunt was used to manage severe postoperative pulmonary hypertension, refractory to inhaled nitric oxide, in an infant undergoing repair of ventricular septal defect. The rationale, technique, and potential applications of this method are discussed.
Collapse
Affiliation(s)
- G B Luciani
- Division of Cardiac Surgery, University of Verona, Italy.
| | | | | |
Collapse
|
21
|
|