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Piccinelli E, Butera G. Surgical repair of peripheral pulmonary artery stenosis: Is there still a place for transcatheter interventions? J Thorac Cardiovasc Surg 2024; 167:e98. [PMID: 37966415 DOI: 10.1016/j.jtcvs.2023.10.032] [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: 10/10/2023] [Accepted: 10/14/2023] [Indexed: 11/16/2023]
Affiliation(s)
- Enrico Piccinelli
- Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART: Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy; Polito BIO Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Gianfranco Butera
- Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART: Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy
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Crean AM. Essentials of Imaging the Repaired Tetralogy of Fallot Patient. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:368-379. [PMID: 38161678 PMCID: PMC10755840 DOI: 10.1016/j.cjcpc.2023.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 08/30/2023] [Indexed: 01/03/2024]
Abstract
Tetralogy of Fallot is one of the commoner forms of congenital heart disease (CHD) with an incidence estimated at around 1 in 3000 live births. Its prevalence is roughly 5%-10% of all forms of CHD. Although it is a cyanotic disorder at presentation, early surgical repair has led to survival to adulthood in the overwhelming majority of cases. However-as with most repaired CHD-such patients are fixed, not cured, and will inevitably come to the attention of the imaging specialist. This article attempts to describe and summarize the main forms of repaired tetralogy that may be encountered in tertiary hospital imaging practice. The anatomy of different forms of tetralogy is reviewed, and relevant pathophysiology is discussed. Reference is made to 22q11 syndrome, which is often missed or not considered by even specialist congenital physicians, and the alerting features of this condition are reviewed. The benefits and challenges of computed tomography and magnetic resonance imaging in the congenital population are covered, and there is discussion regarding the various approaches to imaging available using these techniques.
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Affiliation(s)
- Andrew M. Crean
- Department of Cardiology, University of Manchester, Manchester, United Kingdom
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Zheng WC, Buratto E, Caldaroni F, Ishigami S, Konstantinov IE, d'Udekem Y. T-Remodeling of the Pulmonary Artery Bifurcation for Pulmonary Artery Origin Stenosis. World J Pediatr Congenit Heart Surg 2023; 14:716-722. [PMID: 37933694 DOI: 10.1177/21501351231181109] [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: 11/08/2023]
Abstract
BACKGROUND Various surgical techniques are utilized for reconstructing hypoplastic pulmonary arteries (PAs) in patients with conotruncal anomalies and at times, may be susceptible to restenosis and reoperation. We reviewed our experience with a simple technique of T-shaped remodeling of the PA bifurcation. METHODS Between 2005 and 2019, 31 patients underwent T-remodeling of central PAs by a single cardiac surgeon. The PA bifurcation was opened cranially, and the opening was augmented with an oval-shaped patch effectively transforming the V-shaped bifurcation into a T-shaped bifurcation. Both origins of the PAs were enlarged, even in the instance of single PA origin stenosis. RESULTS Median age at time of T-remodeling was 17 months (range: 7 weeks to 14 years). The following cardiac morphologies were observed: tetralogy of Fallot (n = 12, 39%), pulmonary atresia with ventricular septal defect (VSD) and major aortopulmonary collateral arteries (n = 8, 26%), truncus arteriosus (n = 6, 19%), pulmonary atresia with VSD (n = 3, 9.7%), and transposition of the great arteries (n = 2, 6.5%). Thirteen patients (42%) had previous central shunt, and eight patients (26%) had previous modified Blalock-Taussig shunt. There were no operative mortalities. Immediately after T-remodeling, echocardiographic estimates of right ventricle to PA gradient decreased from 42 [interquartile range 28-58] mm Hg to 20 [12-36] mm Hg (P = .03). Freedom from reoperation on the PA bifurcation for the entire cohort was 100% at one year, 88% (95% CI 68%-96%) at five years and 82% (57%-93%) at ten years. CONCLUSIONS T-remodeling for PA origin stenosis is a safe procedure with excellent freedom from reoperation that is easily reproducible and applicable to patients with all cardiac morphologies.
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Affiliation(s)
- Wayne C Zheng
- Heart Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Department of Cardiology, Alfred Health, Melbourne, Australia
| | - Edward Buratto
- Heart Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Federica Caldaroni
- Heart Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Shuta Ishigami
- Heart Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Igor E Konstantinov
- Heart Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Yves d'Udekem
- Heart Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Division of Cardiovascular Surgery, Children's National Hospital, Washington, DC, USA
- Children's National Heart Institute, Washington, DC, USA
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Greiten LE. Commentary: Surgical correction of peripheral pulmonary artery stenosis appears to be a safe and durable option. J Thorac Cardiovasc Surg 2023; 165:1503-1504. [PMID: 36064465 DOI: 10.1016/j.jtcvs.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/08/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Lawrence E Greiten
- Division of Pediatric Cardiothoracic Surgery, Arkansas Children's Hospital, Little Rock, Ark; Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Ark.
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Ma M, Martin E, Algaze C, Collins RT, McElhinney D, Mainwaring R, Hanley F. Williams Syndrome: Supravalvar Aortic, Aortic Arch, Coronary and Pulmonary Arteries: Is Comprehensive Repair Advisable and Achievable? Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2023; 26:2-8. [PMID: 36842795 DOI: 10.1053/j.pcsu.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
Williams syndrome, and various elastin protein mediated arteriopathies, presents a clinical challenge to pediatric cardiovascular specialists. In the severest phenotypes, multilevel obstruction to the systemic and pulmonic arterial systems result in biventricular dysfunction which can be imminently life-threatening. As a longstanding, quaternary referral center for complex pulmonary arteriopathies and pediatric connective tissue disease, Stanford Medicine Children's Health has developed a sizeable experience managing these patients. This manuscript is a summary of our current strategies, with a focus on our surgical techniques, peri-procedural considerations on timing and staging of various interventions, and long-term results.
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Affiliation(s)
- Michael Ma
- Department of Cardiothoracic Surgery, Division of Pediatric Cardiac Surgery, Stanford University School of Medicine, Stanford, California..
| | - Elisabeth Martin
- Department of Cardiothoracic Surgery, Division of Pediatric Cardiac Surgery, Stanford University School of Medicine, Stanford, California
| | - Claudia Algaze
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Stanford, California
| | - Ronnie Thomas Collins
- Department of Pediatrics, Division of Pediatric Cardiology. University of Kentucky College of Medicine, Lexington, Kentucky
| | - Doff McElhinney
- Department of Cardiothoracic Surgery, Division of Pediatric Cardiac Surgery, Stanford University School of Medicine, Stanford, California
| | - Richard Mainwaring
- Department of Cardiothoracic Surgery, Division of Pediatric Cardiac Surgery, Stanford University School of Medicine, Stanford, California
| | - Frank Hanley
- Department of Cardiothoracic Surgery, Division of Pediatric Cardiac Surgery, Stanford University School of Medicine, Stanford, California
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Mainwaring RD, Felmly LM, Collins RT, Hanley FL. Impact of liver dysfunction on outcomes in children with Alagille syndrome undergoing congenital heart surgery. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY : OFFICIAL JOURNAL OF THE EUROPEAN ASSOCIATION FOR CARDIO-THORACIC SURGERY 2022; 63:6865033. [PMID: 36458925 DOI: 10.1093/ejcts/ezac553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 10/24/2022] [Accepted: 12/01/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES Children with Alagille syndrome often have complex forms of congenital heart defects with the majority having peripheral pulmonary artery stenosis (PPAS) and pulmonary valve atresia (PA) or pulmonary valve stenosis. Children with Alagille syndrome also have variable amounts of liver dysfunction. The purpose of this study was to evaluate the impact of liver dysfunction on outcomes in children with Alagille syndrome undergoing congenital heart surgery. METHODS This was a retrospective review of 69 patients with Alagille syndrome who underwent congenital heart surgery at our institution. The underlying diagnoses included PPAS (n = 29), tetralogy of Fallot with PPAS (n = 14), tetralogy with PA (n = 3), PA with ventricular septal defect and major aortopulmonary collateral arteries (n = 21) and one each with D-transposition and supravalvar aortic stenosis. RESULTS The median age at surgery was 16 months (range 0-228 months). Procedures performed included PPAS repair (n = 43), tetralogy with PA repair (n = 3), unifocalization procedures (n = 21) and other (n = 2). Forty-two (61%) patients had mild or no liver dysfunction, while 26 (38%) had moderate or severe liver dysfunction. The median cardiopulmonary bypass time was 345 min (341 with liver dysfunction, 345 without liver dysfunction). There were a total of 8 operative (12%) deaths and 3 late (4%) deaths. Six operative and 2 late deaths occurred in patients with liver dysfunction (combined 30.7%) versus 2 operative and 1 late death (combined 7.1%) for patients without liver dysfunction (P < 0.05). CONCLUSIONS These results suggest that liver dysfunction has a profound impact on survival in children with Alagille syndrome undergoing congenital heart surgery.
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Affiliation(s)
- Richard D Mainwaring
- Division of Pediatric Cardiac Surgery, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
| | - L Mac Felmly
- Division of Pediatric Cardiac Surgery, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
| | - R Thomas Collins
- Division of Pediatric Cardiology, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
| | - Frank L Hanley
- Division of Pediatric Cardiac Surgery, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
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