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Iliopoulos I, Mastropietro CW, Flores S, Cheung E, Amula V, Radman M, Kwiatkowski D, Puente BN, Buckley JR, Allen KY, Loomba R, Karki KB, Chiwane S, Cashen K, Piggott K, Kapileshwarkar Y, Gowda KMN, Badheka A, Raman R, Zang H, Costello JM. Pulmonary Atresia with Intact Ventricular Septum: Midterm Outcomes from a Multicenter Cohort. Pediatr Cardiol 2024; 45:847-857. [PMID: 35751685 DOI: 10.1007/s00246-022-02954-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/08/2022] [Indexed: 11/28/2022]
Abstract
Contemporary multicenter data regarding midterm outcomes for neonates with pulmonary atresia with intact ventricular septum are lacking. We sought to describe outcomes in a contemporary multicenter cohort, determine factors associated with end-states, and evaluate the effect of right ventricular coronary dependency and coronary atresia on transplant-free survival. Neonates treated during 2009-2019 in 19 United States centers were reviewed. Competing risks analysis was performed to determine cumulative risk of each end-state, and multivariable regression analyses were performed to identify factors associated with each end-state and transplant-free survival. We reviewed 295 patients. Median tricuspid valve Z-score was - 3.06 (25%, 75%: - 4.00, - 1.52). Final end-state was biventricular repair for 45 patients (15.2%), one-and-a half ventricle for 16 (5.4%), Fontan for 75 (25.4%), cardiac transplantation for 29 (9.8%), and death for 54 (18.3%). Seventy-six patients (25.7%) remained in mixed circulation. Cumulative risk estimate of death was 10.9%, 16.1%, 16.9%, and 18.8% at 1, 6 months, 1 year, and 5 years, respectively. Tricuspid valve Z-score was inversely, and coronary atresia positively associated with death or transplantation [odds ratio (OR) = 0.46, (95% confidence interval (CI) = 0.29-0.75, p < 0.001) and OR = 3.75 (95% CI 1.46-9.61, p = 0.011), respectively]. Right ventricular coronary dependency and left coronary atresia had a significant effect on transplant-free survival (log-rank p < 0.001). In a contemporary multicenter cohort of patients with PAIVS, consisting predominantly of patients with moderate-to-severe right ventricular hypoplasia, we observed favorable survival outcomes. Right ventricular coronary dependency and left, but not right, coronary atresia significantly worsens transplant-free survival.
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Affiliation(s)
- Ilias Iliopoulos
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Cardiac Intensive Care, The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2003, Cincinnati, OH, 45229, USA.
| | - Christopher W Mastropietro
- Division of Critical Care, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA
| | - Saul Flores
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Eva Cheung
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York, New York, NY, USA
| | - Venugopal Amula
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Monique Radman
- Division of Critical Care, Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, WA, USA
| | - David Kwiatkowski
- Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Lucille Packard Children's Hospital, Palo Alto, CA, USA
| | - Bao Nguyen Puente
- Division of Cardiac Critical Care, Children's National Health System, Washington, DC, USA
| | - Jason R Buckley
- Division of Cardiology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
| | - Kiona Y Allen
- Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rohit Loomba
- Department of Pediatrics, Chicago Medical School, Advocate Children's Hospital, Chicago, IL, USA
| | - Karan B Karki
- Division of Cardiology, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Saurabh Chiwane
- Division of Pediatric Critical Care, Department of Pediatrics, Saint Louis University, Cardinal Glennon Children's Hospital, Saint Louis, MO, USA
| | - Katherine Cashen
- Department of Pediatrics, Central Michigan University, Children's Hospital of Michigan, Detroit, MI, USA
| | - Kurt Piggott
- Division of Critical Care, LSU Health Sciences, Children's Hospital, New Orleans, LA, USA
| | | | | | - Aditya Badheka
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Rahul Raman
- Department of Pediatrics, Mercy Medical Center, Des Moines, IA, USA
| | - Huaiyu Zang
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - John M Costello
- Division of Cardiology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
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Jayaprasad N, Madhavan S. Double-chambered right ventricle in a patient with pulmonary atresia and ventricular septal defect. BMJ Case Rep 2024; 17:e257480. [PMID: 38359952 PMCID: PMC10875559 DOI: 10.1136/bcr-2023-257480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Double-chambered right ventricle is a rare form of right ventricular outflow tract obstruction caused by anomalous hypertrophy of muscle bundles in right ventricle. Cases most often occur in children and rarely in adults. Most cases (80-90%) are associated with ventricular septal defect. We describe a case of pulmonary atresia and ventricular septal defect with double-chambered right ventricle. The interesting clinical findings, ECG, echocardiography and angiocardiography features are described here.
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Affiliation(s)
| | - Suresh Madhavan
- Cardiology, Goverment Medical College, Kottayam, Kerala, India
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Najm H, Chai P. Discussion to: Revascularization of coronary circulation in pulmonary atresia with intact ventricular septum and right ventricular-dependent coronary circulation. J Thorac Cardiovasc Surg 2023; 166:e580-e581. [PMID: 37598321 DOI: 10.1016/j.jtcvs.2023.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Indexed: 08/21/2023]
Affiliation(s)
- Hani Najm
- Pediatric and Congenital Heart Surgery, Cleveland Clinic, Cleveland, Ohio.
| | - Paul Chai
- Cardiothoracic Surgery, Children's Healthcare of Atlanta, Atlanta, Ga
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4
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Sengupta A, Lee JM, Gauvreau K, Colan SD, Del Nido PJ, Mayer JE, Nathan M. Natural history of aortic root dilatation and pathologic aortic regurgitation in tetralogy of Fallot and its morphological variants. J Thorac Cardiovasc Surg 2023; 166:1718-1728.e4. [PMID: 37164053 DOI: 10.1016/j.jtcvs.2023.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/28/2023] [Accepted: 04/12/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE We sought to characterize the natural history of aortic root dilatation and aortic regurgitation in tetralogy of Fallot (TOF). METHODS A single-center review of patients who underwent TOF repair from January 1960 to December 2022 was performed. Morphology was categorized as TOF-pulmonary stenosis or TOF-variant (including TOF-pulmonary atresia and TOF-pulmonary atresia-major aortopulmonary collateral arteries). Echocardiographically determined diameters and derived z scores were measured at the annulus, sinus of Valsalva, and sinotubular junction immediately before TOF repair and throughout follow-up. Linear mixed-effects models assessed trends in dimensions over time. RESULTS Of 2205 patients who underwent primary repair of TOF at a median age of 4.9 months (interquartile range, 2.3-20.5 months) and survived to discharge, 1608 (72.9%) patients had TOF-pulmonary stenosis and 597 (27.1%) patients had TOF-variant. At a median postoperative follow-up of 14.4 years (interquartile range, 3.3-27.6 years; range, 0.1-62.6 years), 313 (14.2%) patients had mild or greater aortic regurgitation and 34 (1.5%) patients required an aortic valve or root intervention. The overall mean rates of annular, sinus of Valsalva, and sinotubular junction growth were 0.5 ± 0.2, 0.6 ± 0.3, and 0.7 ± 0.5 mm/year, respectively. Root z scores remained stable with time. At baseline, patients with TOF-variant had larger diameters and z scores at the annulus, sinus of Valsalva, and sinotubular junction, compared with patients with TOF-pulmonary stenosis (all P values < .05). Over time, patients with TOF-variant demonstrated relatively greater annular (P = .020), sinus of Valsalva (P < .001), and sinotubular junction (P < .001) dilatation. Patients with ≥75th percentile root growth rates had a higher incidence of mild or greater aortic regurgitation (P < .001), moderate or greater aortic regurgitation (P < .001), and aortic valve repair or replacement (P = .045). CONCLUSIONS Patients with TOF-variant are at comparatively greater risk of pathologic root dilatation over time, warranting closer longitudinal follow-up.
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Affiliation(s)
- Aditya Sengupta
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass
| | - Ji M Lee
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Biostatistics, Harvard School of Public Health, Boston, Mass
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Pedro J Del Nido
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass; Department of Surgery, Harvard Medical School, Boston, Mass
| | - John E Mayer
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass; Department of Surgery, Harvard Medical School, Boston, Mass
| | - Meena Nathan
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass; Department of Surgery, Harvard Medical School, Boston, Mass.
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Najm HK, Costello JP, Karamlou T, Amdani S, Suntharos P, Marino B. Revascularization of coronary circulation in pulmonary atresia with intact ventricular septum and right ventricular-dependent coronary circulation. J Thorac Cardiovasc Surg 2023; 166:e154-e158. [PMID: 37156366 DOI: 10.1016/j.jtcvs.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/06/2023] [Accepted: 04/08/2023] [Indexed: 05/10/2023]
Affiliation(s)
- Hani K Najm
- Department of Pediatric and Congenital Heart Surgery, Heart, Vascular, and Thoracic Institute, Cleveland, Ohio.
| | - John P Costello
- Department of Pediatric and Congenital Heart Surgery, Heart, Vascular, and Thoracic Institute, Cleveland, Ohio
| | - Tara Karamlou
- Department of Pediatric and Congenital Heart Surgery, Heart, Vascular, and Thoracic Institute, Cleveland, Ohio
| | - Shahnawaz Amdani
- Department of Pediatric Cardiology, Pediatric Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Patcharapong Suntharos
- Department of Pediatric Cardiology, Pediatric Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Bradley Marino
- Department of Pediatric Cardiology, Pediatric Institute, Cleveland Clinic Foundation, Cleveland, Ohio
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Meadows JJ, Bauser-Heaton H, Petit CJ, Goldstein BH, Qureshi AM, McCracken CE, Kelleman MS, Nicholson GT, Law MA, Zampi JD, Shahanavaz S, Chai PJ, Romano JC, Batlivala SP, Maskatia SA, Asztalos IB, Eilers L, Kamsheh AM, Healan SJ, Smith JD, Ligon RA, Dailey-Schwartz A, Pettus JA, Pajk AL, Glatz AC, Mascio CE. Comparison of treatment strategies for neonates with tetralogy of Fallot and pulmonary atresia. J Thorac Cardiovasc Surg 2023; 166:916-925.e6. [PMID: 36828672 DOI: 10.1016/j.jtcvs.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Neonates with tetralogy of Fallot and pulmonary atresia (TOF/PA) but no major aorta-pulmonary collaterals are dependent on the arterial duct for pulmonary blood flow and require early intervention, either by primary (PR) or staged repair (SR) with initial palliation (IP) followed by complete repair (CR). The optimal approach has not been established. METHODS Neonates with TOF/PA who underwent PR or SR were retrospectively reviewed from the Congenital Cardiac Research Collaborative. Outcomes were compared between PR and SR (IP + CR) strategies. Propensity scoring was used to adjust for baseline differences. The primary outcome was mortality. Secondary outcomes included complications, length of stay, cardiopulmonary bypass and anesthesia times, reintervention (RI), and pulmonary artery (PA) growth. RESULTS Of 282 neonates, 106 underwent PR and 176 underwent SR (IP: 144 surgical, 32 transcatheter). Patients who underwent SR were more likely to have DiGeorge syndrome and greater rates of mechanical ventilation before the initial intervention. Mortality was not significantly different. Duration of mechanical ventilation, inotrope use, and complication rates were similar. Cumulative length of stay, cardiopulmonary bypass, and anesthesia times favored PR (P ≤ .001). Early RI was more common in patients who underwent SR (rate ratio, 1.42; P = .003) but was similar after CR (P = .837). Conduit size at the time of CR was larger with SR. Right PA growth was greater with PR. CONCLUSIONS In neonates with TOF/PA, SR is more common in greater-risk patients. Accounting for this, SR and PR strategies have similar mortality. Perioperative morbidities, RI, and right PA growth generally favor PR, whereas SR allows for larger initial conduit implantation.
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Affiliation(s)
- Jeffery J Meadows
- Department of Pediatrics, University of California, San Francisco, San Francisco, Calif; Benioff Children's Hospital, San Francisco, Calif.
| | - Holly Bauser-Heaton
- Children's Heart Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga; Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Christopher J Petit
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga; Division of Cardiology, Morgan Stanley Children's Hospital of New York, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Bryan H Goldstein
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati School of Medicine, Cincinnati, Ohio; Department of Pediatrics, Heart Institute, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Athar M Qureshi
- Lillie Frank Abercrombie Section on Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Courtney E McCracken
- Children's Heart Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Michael S Kelleman
- Children's Heart Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - George T Nicholson
- Division of Cardiology, Monroe Carrell Jr. Children's Hospital, Vanderbilt University School of Medicine, Nashville, Tenn
| | - Mark A Law
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Ala
| | - Jeffrey D Zampi
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Mich
| | - Shabana Shahanavaz
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Paul J Chai
- Children's Heart Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Jennifer C Romano
- Section of Pediatric Cardiothoracic Surgery, Department of Cardiac Surgery, CS Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, Mich
| | - Sarosh P Batlivala
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Shiraz A Maskatia
- Moore Children's Heart Center, Lucille Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, Calif
| | - Ivor B Asztalos
- Cardiac Center, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Lindsay Eilers
- Lillie Frank Abercrombie Section on Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Alicia M Kamsheh
- Cardiac Center, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Steven J Healan
- Division of Cardiology, Monroe Carrell Jr. Children's Hospital, Vanderbilt University School of Medicine, Nashville, Tenn
| | - Justin D Smith
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Mich
| | - R Allen Ligon
- Children's Heart Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Andrew Dailey-Schwartz
- Lillie Frank Abercrombie Section on Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Joelle A Pettus
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Amy L Pajk
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Andrew C Glatz
- Cardiac Center, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; Washington University Heart Center at St Louis Children's Hospital, St. Louis, Mo
| | - Christopher E Mascio
- Cardiac Center, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; Department of Cardiovascular and Thoracic Surgery, West Virginia University School of Medicine, Morgantown, WVa
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Sengul FS, Tulunoglu A, Ayyildiz P, Guzeltas A. A rare case of anomalous origin of the left pulmonary artery from the ascending aorta with ventricular septal defect and pulmonary atresia. Kardiol Pol 2023; 81:1022-1023. [PMID: 37537919 DOI: 10.33963/kp.a2023.0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 07/26/2023] [Indexed: 08/05/2023]
Affiliation(s)
- Fatma Sevinc Sengul
- Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istambul, Turkey.
| | - Aras Tulunoglu
- Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istambul, Turkey
| | - Pelin Ayyildiz
- Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istambul, Turkey
| | - Alper Guzeltas
- Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istambul, Turkey
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Babaoğlu K, Doğan Y, Erdem S, Özbarlas N, Başar E, Uzun O. Prenatal Diagnosis, Associations and Outcome for Fetuses with Congenital Absence of the Pulmonary Valve Syndrome. Anatol J Cardiol 2022; 26:702-709. [PMID: 35943311 PMCID: PMC9524209 DOI: 10.5152/anatoljcardiol.2022.1461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: The aim of this study is to review the spectrum of the prenatally detected absent pulmonary valve syndrome and its outcome after diagnosis. Methods: Clinical data and echocardiographic findings of 37 cases with a fetal diagnosis of absent pulmonary valve syndrome between 2008 and 2020 were analyzed in this retrospective multicenter study. Results: Median gestational age at diagnosis was 25 weeks. Three subtypes of absent pulmonary valve syndrome were observed: (1) with tetralogy of Fallot (n = 30; 81.0%); (2) absent pulmonary valve syndrome with intact ventricular septum (n = 5; 13.5%); (3) with complete atrioventricular septal defect (n = 2; 5.4%). In contrast to 7/25 fetuses (28%) with tetralogy of Fallot-absent pulmonary valve syndrome who had a patent ductus arteriosus, all 5 fetuses with absent pulmonary valve syndrome-intact ventricular septum had a patent ductus arteriosus (P < .001). No significant difference was found between the z-scores of pulmonary artery branches in fetuses with or without patent ductus arteriosus (P > .05). The analysis did not reveal any correlation between gestational week and z-scores of pulmonary artery, pulmonary artery branches (right pulmonary artery, left pulmonary artery), and ratio of aorta/pulmonary artery ratio. The echocardiographic measurements of survivors did not differ significantly from non-survivors (P > .05). Extracardiac anomalies were observed in 8/37 fetuses (21.6%). The incidence of extracardiac anomaly was significantly higher in cases of tetralogy of Fallot-absent pulmonary valve syndrome (P < .05). Overall, 9 fetuses (24%) had genetic anomalies. All 6 fetuses (20%) with 22q11.2 microdeletion were within the tetralogy of Fallot-absent pulmonary valve syndrome group. Overall survival after initial diagnosis in the total cases was 36.6% (11/30), with 9 of 30 (30%) tetralogy of Fallot-absent pulmonary valve syndrome cases and 2 of 5 (40%) absent pulmonary valve syndrome-intact ventricular septum cases. Conclusions: In this largest series of absent pulmonary valve syndrome, extracardiac, and chromosomal anomalies were found to be a common occurrence. The risk of 22q11.2 microdeletion was higher in tetralogy of Fallot cases at 40%. The sizes of the pulmonary artery and its branches and the aorta had no correlation of high mortality antenatally or after birth, which were 63.4% and 47.7%, respectively.
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Affiliation(s)
- Kadir Babaoğlu
- Department of Pediatric Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
- Corresponding author:Kadir Babaoğlu ✉
| | - Yasemin Doğan
- Department of Perinatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Sevcan Erdem
- Department of Pediatric Cardiology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Nazan Özbarlas
- Department of Pediatric Cardiology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Eviç Başar
- Department of Pediatric Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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Groner LK, Green DB, Singh HS, Truong QA. Major aortopulmonary collateral arteries in a case of unrepaired tricuspid and pulmonary atresia with single ventricle physiology. J Cardiovasc Comput Tomogr 2020; 14:e177-e179. [PMID: 32414677 DOI: 10.1016/j.jcct.2020.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/15/2020] [Accepted: 04/25/2020] [Indexed: 11/19/2022]
Abstract
Tricuspid and pulmonary atresia with single ventricle physiology and major aortopulmonary collateral arteries (MAPCAs) is a complex cyanotic congenital heart disease with heterogeneous pulmonary artery morphology and arborization. The complex anatomy and physiology, coupled with a dearth of existing literature, pose imitable challenges to treatment. Although the exact surgical algorithm is still unclear, the goal is a well-developed, low-resistance pulmonary vascular bed. A precise understanding of the blood supply to each lung is a requisite for successful surgery, and a multimodality and multidisciplinary approach is compulsory. Herein, we describe a case of tricuspid and pulmonary atresia with single ventricle, MAPCAs and aortopulmonary collateral arteries.
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Affiliation(s)
- Lauren K Groner
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA.
| | - Daniel B Green
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Harsimran S Singh
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Quynh A Truong
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
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10
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Takei T, Kaneko Y, Achiwa I, Kondo R, Misaki Y, Ono H. [Spontaneous Closure of Atrial Septal Defect Caused Severe Heart Failure in a Child with Pulmonary Atresia and Intact Ventricular Septum Having an Extracardiac Total Cavopulmonary Connection;Report of a Case]. Kyobu Geka 2019; 72:560-563. [PMID: 31296807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Unobstructed atrial communication is a prerequisite for favorable pulmonary circulation in patients with single-ventricle physiology and atrial-communication-dependent pulmonary venous drainage. It might also be a prerequisite for favorable coronary circulation in patients with single-ventricle physiology and atrial-communication-dependent coronary venous drainage. Obstruction of atrial communication, on which coronary venous drainage depends, has not yet been documented. We report a patient with pulmonary atresia and an intact ventricular septum having an extracardiac total cavopulmonary connection. Spontaneous closure of the atrial septal defect( ASD), measuring 10 mm before the total cavopulmonary connection, led to a leftward ventricular septal shift and left ventricular wall thickening, causing severe left ventricular diastolic dysfunction which resolved after surgical ASD creation. Detection of spontaneous ASD closure by ultrasound was challenging because the to-and-fro blood flow in the dilated coronary sinus mimicked a patent ASD. Prophylactic ASD enlargement accompanying the cavopulmonary connection procedure is advised in such patients.
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Affiliation(s)
- Tetsuri Takei
- Division of Cardiovascular Surgery, National Medical Center for Children and Mothers, Tokyo, Japan
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11
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Arnaz A, Pişkin Ş, Oğuz GN, Yalçınbaş Y, Pekkan K, Sarıoğlu T. Effect of modified Blalock-Taussig shunt anastomosis angle and pulmonary artery diameter on pulmonary flow. Anatol J Cardiol 2018; 20:2-8. [PMID: 29952372 PMCID: PMC6237788 DOI: 10.14744/anatoljcardiol.2018.54810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This study aimed to identify the best graft-to-pulmonary artery (PA) anastomosis angle measuring pulmonary blood flow, wall shear stress (WSS), and shunt flow. METHODS A tetralogy of Fallot with pulmonary atresia computer model was used to study three different modified Blalock-Taussig shunt (mBTS) anastomosis angle configurations with three different PA diameter configurations. Velocity and WSS were analyzed, and the flow rates at the right PA (RPA) and left PA (LPA) were calculated. RESULTS A 4-mm and 8-mm diameter of RPA and LPA, respectively with vertical shunt angle produces the highest total flow. In the RPA larger diameter than the LPA configutations, the left-leaning shunt produces the lowest total PA flow whereas in the LPA larger diameter than the RPA configuratios, the right-leaning shunt produces the lowest total PA flow. Therefore, the shunt anastomosis should not be leaned through the narrow side of PA to reach best flow. As the flow inside the shunt increased, WSS also increased due to enhanced velocity gradients. CONCLUSION The anastomosis angle between the conduit and PA affects the flow to PA. Vertical anastomosis configurations increase the total PA flow; thus, these configurations are preferable than the leaned configurations.
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Affiliation(s)
- Ahmet Arnaz
- Department of Cardiovascular Surgery, Faculty of Medicine, Acıbadem Mehmet Ali Aydınlar University; İstanbul-Turkey.
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12
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Barron DJ, Botha P. Approaches to Pulmonary Atresia With Major Aortopulmonary Collateral Arteries. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2018; 21:64-74. [PMID: 29425527 DOI: 10.1053/j.pcsu.2017.11.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 11/02/2017] [Indexed: 06/08/2023]
Abstract
Pulmonary atresia with major aortopulmonary collateral arteries (MAPCAs) is one of the most challenging surgical conditions to manage-not only because of the technical complexity of the surgery but also in terms of defining the anatomy of the pulmonary vasculature, the timing of surgery, and decision making on staged vs complete repair. The importance of early definition of pulmonary blood supply is paramount, establishing which areas of the lung are supplied by MAPCAs alone and which have dual supply with the native system (noting that 20% of patients have absent intrapericardial native vessels). Early unifocalization (3-6 months) is ideal, with closure of the ventricular septal defect (VSD) performed if 15 or more out of 20 lung segments can be recruited. Leaving the ventricular septal defect open with a limiting right ventricle-pulmonary artery conduit can be a useful interim or even definitive circulation in patients with borderline vasculature. Rehabilitation of small native vessels with central shunts can be very effective, but best outcomes are achieved by a combination of unifocalization of MAPCAs together with the native vessels (if present). A variety of reconstructive techniques are necessary to be able to effect these complex repairs with careful choice of materials. Ideally, surgery can be completed through sternotomy alone, but separate thoracotomies may be necessary to control and access some MAPCAs.
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Affiliation(s)
- David J Barron
- Department Cardiac Surgery, Birmingham Children's Hospital, UK.
| | - Phil Botha
- Department Cardiac Surgery, Birmingham Children's Hospital, UK
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13
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Najm HK, Jha NK, Godman M, Al Mutairi M, Rezk AI, Momenah T. Pulmonary Atresia, VSD in Association with Coronary-Pulmonary Artery Fistula. Asian Cardiovasc Thorac Ann 2016; 15:335-8. [PMID: 17664210 DOI: 10.1177/021849230701500415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Congenital coronary-pulmonary artery fistula is rare in patients with pulmonary atresia and ventricular septal defect. The nomenclature, physiological, clinical, and surgical implications of these fistulas are yet to be defined. We report a one-year-old child with pulmonary atresia, ventricular septal defect, and a right coronary-pulmonary artery fistula who also had a diminutive, disconnected left pulmonary artery in addition to aortopulmonary collaterals. The patient underwent corrective surgery. However, the fate of diminutive pulmonary arteries is unknown. The literature was reviewed to explore the clinical or surgical implications of such fistulas for improved understanding and management in the future.
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Affiliation(s)
- Hani K Najm
- Department of Cardiac Surgery, King Fahad Hospital, Riyadh, Saudi Arabia
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14
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Lee ML, Chiu IS. Platypnea-Orthodeoxia Syndrome Two Decades after Definitive Surgical Repair of Pulmonary Atresia with Intact Ventricular Septum. Yonsei Med J 2016; 57:799-802. [PMID: 26996585 PMCID: PMC4800375 DOI: 10.3349/ymj.2016.57.3.799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 05/29/2015] [Accepted: 06/16/2015] [Indexed: 11/27/2022] Open
Abstract
A 20-year-old female had undergone definitive surgical repair for pulmonary atresia with intact ventricular septum soon after birth. She was referred to our institution with the chief complaint of clubbing fingers. A thorough examination revealed platypnea-orthodeoxia syndrome due to an interatrial right-to-left shunt through a secundum atrial septal defect. Percutaneous closure with an Amplatzer Septal Occluder resulted in resolution of the syndrome.
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Affiliation(s)
- Meng-Luen Lee
- Department of Pediatrics, Division of Pediatric Cardiology, Changhua Christian Children's Hospital, Changhua, Taiwan.
| | - Ing-Sh Chiu
- Department of Surgery, Division of Cardiovascular Surgery, Changhua Christian Children's Hospital, Changhua, Taiwan
- Department of Surgery, Division of Cardiovascular Surgery, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
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15
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Dayan JG, Peyvandi S, Moon-Grady AJ. Pulmonary Atresia With an Intact Ventricular Septum in the Setting of D-Transposition of the Great Arteries With a Hypoplastic Left Ventricle: Fetal Diagnosis. J Ultrasound Med 2015; 34:2313-2315. [PMID: 26507698 DOI: 10.7863/ultra.15.01074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Jonathan G Dayan
- Division of Pediatric Cardiology, University of California, San Francisco, California USA
| | - Shabnam Peyvandi
- Division of Pediatric Cardiology, University of California, San Francisco, California USA
| | - Anita J Moon-Grady
- Division of Pediatric Cardiology, University of California, San Francisco, California USA
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16
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Abstract
This paper describes the orthodontic treatment of two cases, which were awarded the 2005 Maurice Berman Prize.
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Affiliation(s)
- T M Hodge
- Royal Surrey County Hospital, Guildford, UK.
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17
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Perme T, Mali S, Vidmar I, Gvardijančič D, Blumauer R, Mishaly D, Grabnar I, Nemec G, Grosek S. Prolonged prostaglandin E1 therapy in a neonate with pulmonary atresia and ventricular septal defect and the development of antral foveolar hyperplasia and hypertrophic pyloric stenosis. Ups J Med Sci 2013; 118:138-42. [PMID: 23521358 PMCID: PMC3633330 DOI: 10.3109/03009734.2013.778374] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Prostaglandin E1 (alprostadil) is widely used for maintaining the patency of ductus arteriosus in ductus-dependent congenital heart defects in neonates to improve oxygenation. Among more common side effects are fever, rash, apnoea, diarrhoea, jitteriness, and flushing. More severe side effects are brown fat necrosis, cortical hyperostosis, and gastric outlet obstruction, most commonly the result of antral foveolar hyperplasia or hypertrophic pyloric stenosis. We report on an infant with a ductus-dependent congenital heart defect who developed symptoms and sonographic evidence of focal foveolar hyperplasia and hypertrophic pyloric stenosis after prolonged treatment with prostaglandin E1. Gastrointestinal symptoms persisted after corrective cardiac surgery, and pyloromyotomy was required. Study of the case and of available literature showed an association between the total dose of prostaglandin E1 administered and duration of treatment and the development of gastric outlet obstruction. We conclude that if patients are treated with a prostaglandin E1 infusion, careful monitoring for symptoms and signs of gastric outlet obstruction is required.
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Affiliation(s)
- Tina Perme
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Senja Mali
- Department of Radiology and Interventional Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Ivan Vidmar
- Department of Pediatric Surgery and Intensive Therapy, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Diana Gvardijančič
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Robert Blumauer
- Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - David Mishaly
- The Edmond and Lilly Safra Children's Hospital, SHEBA Medical Center, Tel Aviv, Israel
| | - Iztok Grabnar
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Gregor Nemec
- Department of Pediatrics, General Hospital “dr Franca Derganca”, Šempeter pri Gorici, Slovenia
| | - Stefan Grosek
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
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18
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Hahn E, Vincent JA, Kadenhe-Chiweshe A, Ratner V, Krishnamurthy G. Emergent transcatheter relief of bronchus compression by an ectatic ductus arteriosus in a premature neonate: a case report. J Neonatal Perinatal Med 2013; 6:349-353. [PMID: 24441093 DOI: 10.3233/npm-1373013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A premature infant with tetralogy of Fallot with pulmonary atresia and prenatal compression of the left main bronchus by a large and ectatic patent ductus arteriosus is presented. Survival to surgery was accomplished by transcatheter placement of a coronary stent into the left mainstem bronchus.
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Affiliation(s)
- E Hahn
- Division of Pediatric Cardiology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - J A Vincent
- Division of Pediatric Cardiology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - A Kadenhe-Chiweshe
- Division of Pediatric Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - V Ratner
- Division of Neonatology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - G Krishnamurthy
- Division of Neonatology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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19
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Morozov AA. [Surgical treatment of pulmonic atresia with defect of interventricular septum and collateral lung circulation]. Vestn Khir Im I I Grek 2013; 172:115-119. [PMID: 24640762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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20
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Lee ML, Chiu IS. Stent implantation for stenotic Blalock-Taussig shunts in a 5.75-year-old boy with pulmonary atresia. Int J Cardiol 2012; 162:e8-11. [PMID: 22608894 DOI: 10.1016/j.ijcard.2012.04.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Accepted: 04/28/2012] [Indexed: 11/17/2022]
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21
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Silversides CK, Lionel AC, Costain G, Merico D, Migita O, Liu B, Yuen T, Rickaby J, Thiruvahindrapuram B, Marshall CR, Scherer SW, Bassett AS. Rare copy number variations in adults with tetralogy of Fallot implicate novel risk gene pathways. PLoS Genet 2012; 8:e1002843. [PMID: 22912587 PMCID: PMC3415418 DOI: 10.1371/journal.pgen.1002843] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 05/29/2012] [Indexed: 12/03/2022] Open
Abstract
Structural genetic changes, especially copy number variants (CNVs), represent a major source of genetic variation contributing to human disease. Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease, but to date little is known about the role of CNVs in the etiology of TOF. Using high-resolution genome-wide microarrays and stringent calling methods, we investigated rare CNVs in a prospectively recruited cohort of 433 unrelated adults with TOF and/or pulmonary atresia at a single centre. We excluded those with recognized syndromes, including 22q11.2 deletion syndrome. We identified candidate genes for TOF based on converging evidence between rare CNVs that overlapped the same gene in unrelated individuals and from pathway analyses comparing rare CNVs in TOF cases to those in epidemiologic controls. Even after excluding the 53 (10.7%) subjects with 22q11.2 deletions, we found that adults with TOF had a greater burden of large rare genic CNVs compared to controls (8.82% vs. 4.33%, p = 0.0117). Six loci showed evidence for recurrence in TOF or related congenital heart disease, including typical 1q21.1 duplications in four (1.18%) of 340 Caucasian probands. The rare CNVs implicated novel candidate genes of interest for TOF, including PLXNA2, a gene involved in semaphorin signaling. Independent pathway analyses highlighted developmental processes as potential contributors to the pathogenesis of TOF. These results indicate that individually rare CNVs are collectively significant contributors to the genetic burden of TOF. Further, the data provide new evidence for dosage sensitive genes in PLXNA2-semaphorin signaling and related developmental processes in human cardiovascular development, consistent with previous animal models. Congenital heart disease affects nearly 1% of all live births. Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease. This condition is associated with hemizygous deletions of chromosome 22q11.2 and chromosomal trisomies, but little else is known about the genetic heterogeneity of this complex disease. We used high-resolution microarrays and stringent methods to study structural (copy number) variants in a systematically phenotyped cohort of unrelated adults with TOF. We found that individually rare genic copy number variants (CNVs) were collectively significant contributors to the genetic burden in TOF. Among CNVs that implicated candidate genes of interest were loss CNVs overlapping the PLXNA2 gene that codes for plexin A2. This is the first study to show a role for this semaphorin receptor in human congenital heart disease, consistent with a Plxna2 mouse knockout phenotype. Pathway analyses comparing rare exonic loss CNVs in the TOF sample to controls implicated other novel gene sets suggest new pathogenetic mechanisms.
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Affiliation(s)
- Candice K. Silversides
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Division of Cardiology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Anath C. Lionel
- The Centre for Applied Genomics and Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Molecular Genetics and the McLaughlin Centre, University of Toronto, Ontario, Canada
| | - Gregory Costain
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Daniele Merico
- The Centre for Applied Genomics and Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ohsuke Migita
- The Centre for Applied Genomics and Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ben Liu
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Tracy Yuen
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jessica Rickaby
- The Centre for Applied Genomics and Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bhooma Thiruvahindrapuram
- The Centre for Applied Genomics and Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christian R. Marshall
- The Centre for Applied Genomics and Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Molecular Genetics and the McLaughlin Centre, University of Toronto, Ontario, Canada
| | - Stephen W. Scherer
- The Centre for Applied Genomics and Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Molecular Genetics and the McLaughlin Centre, University of Toronto, Ontario, Canada
| | - Anne S. Bassett
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Ontario, Canada
- * E-mail:
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22
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Nakano T. [Surgical strategy for pulmonary atresia with ventricular septal defect associated with severely hypoplastic or absent central pulmonary artery]. Kyobu Geka 2012; 65:676-681. [PMID: 22868427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In patients of pulmonary atresia with ventricular septal defect associated with profound hypoplasia or complete absence of central pulmonary artery, surgical strategy depends on the morphology of native pulmonary artery and major aortopulmonary collateral arteries (MAPCAs). Type of surgery and timing of operation are determined by detailed analysis of angiography and 3-dimensional computed tomography (3D-CT) scan. When native central pulmonary artery exists, palliative procedure like systemicpulmonary shunt or palliative right ventricular outflow tract is recommended in order to promote growth of native pulmonary artery, followed by Rastelli-type definitive repair with/without uniforcalization of MAPCAs. In case of central pulmonary artery absence, staged reconstruction of bilateral pulmonary vascular bed by repeated uniforcalization or 1 stage uniforcalization and Rastelli operation is indicated. However, even after definitive repair, careful attention and scheduled cardiac catheterization with aggressive catheter intervention are required to maintain adequate pulmonary circulation.
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Affiliation(s)
- T Nakano
- Department of Cardiovascular Surgery, Fukuoka Children's Hospital and Medical Center for Infectious Diseases, Fukuoka, Japan
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23
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Galbraith EM, Weiss SH, Fisher MR, Book WM. Twin pregnancy in a woman with pulmonary atresia, ventricular septal defect, and aortopulmonary collaterals complicated by Eisenmenger physiology. Int J Cardiol 2011; 152:e14-5. [PMID: 20961640 DOI: 10.1016/j.ijcard.2010.09.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Accepted: 09/26/2010] [Indexed: 11/18/2022]
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24
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Muñoz-Castellanos L, Ramírez-Marroquín S, Kuri-Nivon M. [Tetralogy of Fallot with pulmonary atresia. Morphopathology and surgical anatomy]. Arch Cardiol Mex 2010; 80:141-153. [PMID: 21147579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
The morphopathology of tetralogy of Fallot with pulmonary atresia is detailed as a spectrum of variations which is the foundation to highlight the surgical anatomy of this cardiopathy and it is the embryological basis which determines its structure. Thirty five hearts were studied with the methodology of the segmental sequential system. The atrial situs, the connections between the cardiac chambers and between the right ventricle and the arterial pulmonary vasculature were determined. The atrial situs was solitus, the concordant atrioventricular connection was the most frequent (33), the ventriculoarterial connections were concordant (17), double outlet right ventricle (9) and single outlet (9). All hearts had atresia of the pulmonary valve; the pulmonary trunk was hypoplastic (20), atretic proximally (6) and completely absent (9), confluent and hypoplastic pulmonary branches (25), absence of confluence (5), complete absence of pulmonary branches and arterial ducts (5) and presence of aortopulmonary collaterals (10). The hearts show a morphopathologic spectrum of severity which documents the tendency in disappearing the connection between the right ventricle and the intrapulmonary arterial circulation. The determination of the arterial supply to the lungs is highlighted to unifocalize the blood flow toward the lungs. The usefulness of Barbero Marcial's surgical classification is emphasized. The embryologic knowledge is basic in understanding the vascular connections between right ventricle and the derivatives of embryonic sixths aortic arches, the intrapulmonary arterial vessels and the aortopulmonary collaterals."
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25
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Zhu ZQ, Liu JF, Zheng JH, Zhang HB, Xu ZW. [Staged surgical treatment of pulmonary atresia with ventricular septal defect]. Zhonghua Yi Xue Za Zhi 2010; 90:898-901. [PMID: 20646509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To determine the choice of palliative procedures, timing and techniques of second-stage operations. METHODS Between April 2004 to July 2008, 50 consecutive patients with pulmonary atresia with ventricular septal defect (PA/VSD) underwent two-stage operation. Palliative procedures included modified Blalock-Taussig shunt (n = 5), central shunt (n = 2), pericardial patch enlargement (n = 10), pericardial tube (n = 4) and Gore-Tex conduit (n = 29). The interval period was 7 - 49 months (20.0 +/- 10.0 months). In the second stage, a surgical shunt was interrupted in 7 cases. Ventricular septal defect was closed in all patients, but fenestrated ventricular septal defect patch was used in 6 cases. Right ventricular outlet tract (RVOT) was widened with pericardial patch in 42 cases and conduit exchange in 8 cases. Aortopulmonary collateral arteries (MAPCASs) unifocalization (n = 1), ligation or transcatheter occlusion with embolization coils (n = 4) and maintaining open or untreated (n = 4). RESULTS Death occurred in 2 and the mortality rate was 4%. Postoperative complications included residual shunt (n = 3), residual obstruction (n = 3), complete AV block (n = 1), athetosis (n = 1) and acute renal failure (n = 3). Neither death nor complication was reported during a follow-up period of 3 months to 4 years. CONCLUSION A palliative procedure should be individualized to the patient's morphology of central pulmonary artery and clinical status of a patient. Right ventricular outlet tract reconstruction, pulmonary arterioplasty, fenestration of VSD patch in baby with suprasystemic right ventricular pressure and appropriate interventions with MAPCASs are key to decrease the mortality and morbidity of staged operations for PA/VSD.
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Affiliation(s)
- Zhong-qun Zhu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Medical College of Shanghai Jiaotong University, Shanghai 200127, China
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26
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Bianca S, Bartoloni G, Boemi G, Barrano B, Cataliotti A, Barone C, Indaco L, Campione C, Ettore G. Fetal Eagle-Barrett syndrome and pulmonary atresia with intact ventricular septum. Congenit Anom (Kyoto) 2010; 50:75-6. [PMID: 20201973 DOI: 10.1111/j.1741-4520.2009.00264.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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27
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Unlü M, Ozeke O. Pulmonary atresia with double ventricular septal defect. Turk Kardiyol Dern Ars 2009; 37:593. [PMID: 20200467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Affiliation(s)
- Murat Unlü
- Department of Cardiology, Diyarbakir Military Hospital, Diyarbakir, Turkey
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28
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Amin P, Levi DS, Likes M, Laks H. Pulmonary atresia with intact ventricular septum causing severe left ventricular outflow tract obstruction. Pediatr Cardiol 2009; 30:851-4. [PMID: 19365655 PMCID: PMC2715465 DOI: 10.1007/s00246-009-9438-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Accepted: 03/16/2009] [Indexed: 11/26/2022]
Abstract
We describe an infant with pulmonary atresia with intact ventricular septum (PAIVS) and severe left ventricular outflow tract (LVOT) obstruction secondary to a suprasystemic right ventricle causing leftward displacement of the interventricular septum. Imaging demonstrated an aneurysmal dilation at the base of the proximal main pulmonary artery (MPA) with no forward flow from the right ventricle. During transannular patch and central shunt placement, the communication between the pulmonary artery and the right ventricle was enlarged to ensure adequate decompression. We report this successful palliation and resulting complete elimination of the LVOT obstruction in a very unique presentation of PAIVS in a newborn.
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Affiliation(s)
- Payal Amin
- Division of Pediatric Cardiology, Mattel Children’s Hospital at UCLA, Los Angeles, CA 90095-1743 USA
| | - Daniel S. Levi
- Division of Pediatric Cardiology, Mattel Children’s Hospital at UCLA, Los Angeles, CA 90095-1743 USA
| | - Maggie Likes
- Division of Pediatric Cardiology, Mattel Children’s Hospital at UCLA, Los Angeles, CA 90095-1743 USA
| | - Hillel Laks
- Division of Cardiothoracic Surgery, Mattel Children’s Hospital at UCLA, Los Angeles, CA 90095-1743 USA
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29
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Awasthi N, Marwah A, Sharma R. Congenital mitral stenosis with ventricular septal defect and pulmonary atresia: a rare association. Indian Heart J 2009; 61:113-114. [PMID: 19729704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Affiliation(s)
- Neeraj Awasthi
- Escorts Heart Institute and Research Centre, Okhla Road, New Delhi, India
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30
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Hraska V, Photiadis J, Schindler E, Sinzobahamvya N, Fink C, Haun C, Schneider M, Blaschczok HC, Asfour B. A novel approach to the repair of tetralogy of Fallot with absent pulmonary valve and the reduction of airway compression by the pulmonary artery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2009; 12:59-62. [PMID: 19349015 DOI: 10.1053/j.pcsu.2009.01.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Controversy persists regarding the management of patients suffering from tetralogy of Fallot with absent pulmonary valve syndrome. Airway obstruction caused by the dilated pulmonary arteries is the determining factor in the mortality of symptomatic newborns and infants. A number of surgical techniques for the reduction of bronchial obstruction have been proposed, producing variable results. All strategies have focused on plication and reduction of the anterior or posterior wall of the normally positioned pulmonary arteries, with or without pulmonary valve replacement. An alternative approach is to bring the pulmonary arteries anterior to the aorta and away from the trachea and bronchial tree. This technique has the potential to reduce or eliminate bronchial compression by the central pulmonary arteries. Failure of the treatment could be expected in symptomatic patients, where the pathology of the airways extends beyond the proximal pulmonary arteries.
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Affiliation(s)
- Viktor Hraska
- German Pediatric Heart Center, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany.
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Malhotra SP, Hanley FL. Surgical management of pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals: a protocol-based approach. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2009; 12:145-151. [PMID: 19349030 DOI: 10.1053/j.pcsu.2009.01.017] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Historically, outcomes of pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals have been quite poor. Over the past 15 years, our group has strived to apply a consistent surgical strategy for this lesion based on two guiding principles: early unifocalization of all important collaterals; and the early establishment of a low-pressure pulmonary arterial bed, preferably using simultaneous intracardiac repair. We describe a management protocol that has been developed to handle the highly variable nature of pulmonary blood flow observed with this lesion.
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Affiliation(s)
- Sunil P Malhotra
- Departments of Surgery and Pediatrics, Congenital Heart Center, University of Florida, Gainesville, FL, USA
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Zeybek C, Yalçin Y, Polat TB, Celebi A. [Coexistence of partial anomalous pulmonary venous drainage and pulmonary atresia with ventricular septal defect: a report of two cases]. Turk Kardiyol Dern Ars 2008; 36:415-419. [PMID: 19155649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Coexistence of partial anomalous pulmonary venous drainage (PVD) and pulmonary atresia with ventricular septal defect (PA-VSD) is very rare with the exception of heterotaxy syndromes. We presented two cases of PA-VSD in which partial anomalous PVD was detected during pulmonary artery angiography. One was a six-month-old girl who underwent cardiac catheterization to evaluate the chance of unifocalization. There were true pulmonary arteries and three major aortopulmonary collaterals. It was noted that the right upper pulmonary vein was in direct continuity with the right atrium. The second case was a 12-year-old girl who was previously diagnosed as having PA-VSD and absence of true pulmonary arteries, for which she had undergone two subsequent aortopulmonary shunt operations four years before. During cardiac catheterization, confluent but hypoplastic true pulmonary arteries and multiple minor aortopulmonary collaterals were detected. The right and left upper pulmonary veins were draining to the right atrium. It should be known that, albeit very rare, partial anomalous PVD may be present in PA-VSD cases, requiring careful evaluation of pulmonary venous drainage during echocardiographic and angiographic studies.
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Affiliation(s)
- Cenap Zeybek
- Department of Pediatric Cardiology, Dr. Siyami Ersek Cardiovascular Surgery Center, Istanbul, Turkey.
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33
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Iacobelli R, Pasquini L, Toscano A, Raimondi F, Michielon G, Tozzi AE, Sanders SP. Role of tricuspid regurgitation in fetal echocardiographic diagnosis of pulmonary atresia with intact ventricular septum. Ultrasound Obstet Gynecol 2008; 32:31-35. [PMID: 18570204 DOI: 10.1002/uog.5356] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Pulmonary atresia with intact ventricular septum (PAIVS) is a rare cardiac malformation with a broad spectrum of anatomical manifestations, varying from types suitable for biventricular repair to those with diminutive right ventricle and primitive ventriculocoronary connections (VCC), more suitable for single-ventricle palliation or heart transplantation. We sought to test whether tricuspid regurgitation is an easily detectable prenatal criterion with which to identify PAIVS patients at lower risk of needing postnatal single-ventricle palliation. METHOD We identified retrospectively patients with both fetal diagnosis and postnatal confirmation of PAIVS who were seen at Bambino Gesù Hospital between January 2000 and December 2006. Tricuspid valve/mitral valve (TV/MV) ratio, presence and severity of tricuspid regurgitation and direct visualization of VCC were evaluated by echocardiography both pre- and postnatally. RESULTS We identified 22 patients with a prenatal diagnosis of PAIVS. Four pregnancies were terminated and one fetus was lost to follow-up, leaving 17 patients for the analysis. Based on postnatal cardiac catheterization and/or echocardiography we divided our population in two groups: Group 1 included 10 patients with VCC; Group 2 included seven patients without VCC. At fetal echocardiography, tricuspid regurgitation was absent in all ten Group 1 patients and present in all seven Group 2 patients. VCC were seen directly in 6/10 Group 1 patients and in no Group 2 patients. A cut-off value of 0.56 for the TV/MV ratio was highly predictive of VCC during fetal life, with a sensitivity of 100% and a specificity of 90%. CONCLUSIONS The absence of tricuspid regurgitation in fetuses affected by PAIVS is a strong prenatal echocardiographic predictor of VCC, as is a TV/MV ratio < 0.56. Fetuses presenting with tricuspid regurgitation and relatively large right ventricle are at lower risk of needing single-ventricle palliation postnatally. This inforation could be helpful for appropriate prenatal counseling and postnatal decision-making.
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Affiliation(s)
- R Iacobelli
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Hospital, Rome, Italy
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Panzer J, Taeymans Y, De Wolf D. Three-dimensional rotational angiography of a patient with pulmonary atresia intact septum and coronary fistulas. Pediatr Cardiol 2008; 29:686-7. [PMID: 17805917 DOI: 10.1007/s00246-007-9071-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Accepted: 08/14/2007] [Indexed: 10/22/2022]
Abstract
Three-dimensional rotational angiography (3D-RA) was used to image the coronary arteries of a 2(1/2)-year-old boy with pulmonary atresia intact septum and coronary fistulas. As seen in the accompanying video clips and stills, this imaging method is advantageous in depicting the coronary anatomy. Furthermore, less contrast is used for patients undergoing diagnostic coronary angiography with 3D-RA compared with biplane angiography.
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Affiliation(s)
- J Panzer
- Universitair Ziekenhuis Gent, Afdeling Kindercardiologie, 185 De Pintelaan, 9000 Gent, Belgium.
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Kovacikova L, Skrak P, Zahorec M, Masura J. Shock--manifestation of pulmonary atresia with aorto-pulmonary collaterals and single ventricle physiology in a 2-day neonate. BRATISL MED J 2008; 109:202-203. [PMID: 18630802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND The combination of pulmonary valve atresia and ventricular septal defect accounts for about 2% of cases of congenital heart disease. Most of the cases have intracardiac anatomy of Tetralogy Fallot and present with cyanosis in neonatal age. OBJECTIVES To report a case of a newborn with rare combination of pulmonary atresia, ventricular septal defect and single ventricle physiology presenting with shock very early following birth. METHODS AND RESULTS We describe a newborn infant who developed shock with severe metabolic acidosis and respiratory distress several hours following birth. Cardiac ultrasound showed pulmonary atresia and ventricular septal defect with single ventricle physiology. Cardiac cathetrisation revealed major aorto-pulmonary collaterals with an excessive pulmonary blood flow. Resuscitative measures resulted in hemodynamic stability. However, due to unfavorable prognosis, a decision not to undertake surgical palliation was made. Withdrawal of intensive care led to rapid demise of the patient. CONCLUSIONS We report a case of a newborn with pulmonary atresia, ventricular septal defect and single ventricle physiology in whom an excessive flow through major aorto-pulmonary collaterals led to shock and death very early following birth (Fig. 1, Ref. 5). Full Text (Free, PDF) www.bmj.sk.
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Affiliation(s)
- L Kovacikova
- Intensive Care Unit, Pediatric Cardiac Center, Bratislava, Slovakia.
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36
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Celebi A, Yalçin Y, Zeybek C, Erdem A, Polat TB, Akdeniz C. Transcatheter closure of large fistula between right coronary artery and pulmonary artery using Amplatzer vascular plug in a patient with pulmonary atresia and ventricular septal defect. Anadolu Kardiyol Derg 2007; 7:E4-E5. [PMID: 18065324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Ahmet Celebi
- Clinic of Pediatric Cardiology, Dr. Siyami Ersek Thorax and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
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37
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Bökenkamp R, Hazekamp MG, Schalij MJ, Clur SAB, Ottenkamp J, Blom NA. [Percutaneous implantation of a pulmonary valve in 3 children with surgically corrected cardiac anomalies]. Ned Tijdschr Geneeskd 2007; 151:2580-2585. [PMID: 18074730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
An 11-year-old girl, a 15-year-old boy and a 12-year-old girl all underwent percutaneous implantation of a Melody pulmonary valve prosthesis to replace a stenotic and insufficient homograft in the pulmonary artery. Preoperatively, 2 of the children suffered from fatigue and dyspnoea on exertion The homografts had been implanted between the ages of 1-2, to establish surgical continuity between the right ventricle and the pulmonary artery. The anomalies were tetralogy of Fallot, pulmonary atresia with intact ventricular septum and pulmonary atresia with a ventricular septum defect. Percutaneous pulmonary valve replacement was successful in all 3 patients. After implantation, right ventricular pressure decreased to 30% of systemic pressure and regurgitation was not observed. All patients were discharged in a good condition on the day after the implantation. Percutaneous pulmonary valve replacement is a promising technique with good short-term results. In selected patients this percutaneous technique can substitute or postpone the surgical replacement ofa stenotic or insufficient homograft.
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Affiliation(s)
- R Bökenkamp
- Centrum voor Aangeboren Hartafwijkingen Amsterdam-Leiden, p/a Leids Universitair Medisch Centrum, Postbus 9600, 2300 RC Leiden.
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Calder AL, Peebles CR, Occleshaw CJ. The prevalence of coronary arterial abnormalities in pulmonary atresia with intact ventricular septum and their influence on surgical results. Cardiol Young 2007; 17:387-96. [PMID: 17572929 DOI: 10.1017/s1047951107000893] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The relatively high mortality in patients with pulmonary atresia and intact ventricular septum may be related to the presence of significant coronary arterial anomalies. This retrospective review of cineangiocardiograms was undertaken to further elucidate the types and variety of such coronary arterial abnormalities, and to assess their effect on postoperative survival. MATERIAL AND RESULTS Details regarding coronary arterial anatomy and abnormalities were assessed in 116 patients. We noted the site and severity of lesions, and the presence of fistulous communications from the right ventricle to the coronary arteries, assessing the proportion of left ventricular myocardium affected by coronary arterial interruptions or significant stenoses, in other words, the amount dependent on coronary circulation from the right ventricle. We also measured diameters of the tricuspid and mitral valves. Fistulas were found in 87 patients (75%), interruptions of major coronary arteries in 40 patients (34%), lack of connections between the coronary arteries and the aorta in 18 patients (16%), and single origin of a coronary artery, with the right coronary artery arising from the left, in 6 patients (5%). We found increased mortality in 47 patients (40%) who had a right ventricular-dependent coronary arterial circulation. The presence of fistulas in itself was not associated with higher mortality, but the presence of coronary arterial interruptions (p = 0.05), and a higher myocardial score (p = 0.0009), were. CONCLUSION We encountered a higher prevalence of both coronary arterial abnormalities and right ventricular-dependent circulation than previously reported. Awareness of the severity of the coronary arterial abnormalities should assist in planning treatment.
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Affiliation(s)
- A Louise Calder
- Department of Paediatric Cardiology, Green Lane Hospital, Auckland, New Zealand.
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40
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Boussaada R, Békir S, Ben Romdhane N, Mechmèche R. [Chemotherapy against polycythemia due to a cyanotic congenital heart disease in adults. One case report]. Tunis Med 2007; 85:437-40. [PMID: 17657936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Hydroxyurea has largely been utilized in the management of primary polycythemia. It is certainly efficient in the short and medium terms side effects are marked by a leukemogenic risk. AIM In this study we report the case in which hydroxyrea was for the first time used in the reatment of secondary polycythemia due to cyanotic congenital heart disease. CASE Our patient was a 22-years-old man suffering from pulmonary atresia with ventricular septal defect, and for whom ther was no available surgical option. Because of severe symptomatic and demanding polycythemia requiring frequent phlebotomies, we decided to use hydroxyurea at the dose of Igr a day. Eight months later, ther was obvious clinical improvement with stable hematocrit levels below 60% and with only 3 phlebotomies in 8 months. CONCLUSION Hydroxyurea seems to be an eddicient there alternative therapy for seconday polycythemia caused by incurable cyantic congenital heart disease.
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Affiliation(s)
- R Boussaada
- Service des explorations fonctionnelles cardiologiques, Hôpital la Rabta Tunis
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41
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Tissot C, da Cruz E, Beghetti M, Aggoun Y. Successful use of a new Amplatzer® Vascular plug for percutaneous closure of a large aortopulmonary collateral artery in a pulmonary atresia with ventricular septal defect prior to complete repair. Int J Cardiol 2007; 116:e39-41. [PMID: 17052781 DOI: 10.1016/j.ijcard.2006.07.142] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Accepted: 07/22/2006] [Indexed: 11/30/2022]
Abstract
We report the case of a 14 year-old girl with a pulmonary atresia with VSD and multiple aortopulmonary collaterals who underwent a successful complementary occlusion of a large collateral vessel using an Amplatzer vascular plug after a previously failed attempt of occlusion with a coil. The percutaneous procedure, performed from the femoral artery before the complete surgical repair, provided an immediate closure of the vessel. This new device is safe and effective for the occlusion of aortopulmonary collaterals, specifically if of large dimensions.
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42
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Stapleton GE, Eble BK, Dickerson HA, Andropoulos DB, Chang AC. Mesenteric oxygen desaturation in an infant with congenital heart disease and necrotizing enterocolitis. Tex Heart Inst J 2007; 34:442-444. [PMID: 18172526 PMCID: PMC2170498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Congenital heart disease is a risk factor for the development of necrotizing enterocolitis, although the exact mechanism of development remains unclear. Herein, we report the case of an infant with pulmonary atresia, an intact ventricular septum, and multiple aortopulmonary collateral vessels. At 4 weeks of age, the infant developed necrotizing enterocolitis in association with significant mesenteric oxygen desaturation, as measured by means of near-infrared spectroscopy. With bowel rest and antibiotic therapy, the patient's mesenteric oxygen saturation and clinical status improved. This case highlights the importance of impaired mesenteric oxygen delivery consequential to congenital heart disease as a possible risk factor for necrotizing enterocolitis, and the use of near-infrared spectroscopy to measure tissue perfusion noninvasively in high-risk patients. To our knowledge, this is the 1st report of mesenteric oxyhemoglobin desaturation in association with necrotizing enterocolitis in a patient who also had congenital heart disease.
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Affiliation(s)
- Gary E Stapleton
- Divisions of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas 77030, USA.
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Abstract
Near-infrared spectroscopy is a noninvasive optical technique used to monitor brain tissue oxygenation. Measurement of cerebral oxygenation is a more sensitive monitor of oxygen delivery to the brain than other available monitors. Prolonged cerebral desaturation is correlated with poor neurological outcomes. We report a case where the cerebral oximeter alerted us to diminished blood flow in a preexisting Blalock-Taussig (subclavian artery to pulmonary artery) shunt.
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Affiliation(s)
- Michael Rossi
- Division of Cardiac Anesthesia, Congenital Heart Institute of Miami Children's Hospital and Arnold Palmer Hospital for Women and Children, Miami, FL 33155, USA
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Lopes KRM, Mennes F, Delazoide AL, Iserin F, Azancot A. Prenatal diagnosis of absent pulmonary valve with membranous tricuspid atresia and intact ventricular septum: report of one case and review of the literature. Prenat Diagn 2007; 27:973-5. [PMID: 17600853 DOI: 10.1002/pd.1799] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- K R M Lopes
- Department of Perinatal Cardiology, Hôpital Robert Debré, Paris, France
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Shinkawa T, Yamagishi M, Shuntoh K, Miyazaki T, Hisaoka T, Yaku H. Pulmonary Arterial Reconstruction for Pulmonary Coarctation in Early Infancy. Ann Thorac Surg 2007; 83:188-92. [PMID: 17184658 DOI: 10.1016/j.athoracsur.2006.08.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2006] [Revised: 08/15/2006] [Accepted: 08/16/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND Pulmonary atresia with pulmonary coarctation may complicate diminished and unbalanced pulmonary development. The aim of this study is to assess the outcome of pulmonary arterial reconstruction with cardiopulmonary bypass in early infancy for sufficient and balanced pulmonary development. METHODS We performed a retrospective review of 15 patients with pulmonary coarctation younger than 4 months of age who underwent pulmonary arterial reconstruction between 2001 and 2005. The mean age and weight were 42.2 days and 3.62 kg, respectively. The patient population included 5 biventricular repair candidates and 10 Fontan candidates. To evaluate the pulmonary arterial development, the preoperative and postoperative pulmonary arterial index and minimum diameter of the pulmonary artery were compared. RESULTS No early or in-hospital deaths occurred, and there was no nonconfluent pulmonary artery development or segmental mal-development after a mean follow-up period of 14.9 months. Immediate pulmonary flow regulation was required in 2 patients because of excessive pulmonary flow. The mean pulmonary arterial index increased significantly from 103 mm2/m2 to 343 mm2/m2, and the mean minimum diameter of the pulmonary artery increased significantly from 2.02 mm to 4.45 mm. Four biventricular repair candidates completed definitive repair, and 2 required surgical reintervention in the pulmonary artery. Six Fontan candidates completed the Glenn procedure, and 1 completed the Fontan procedure. Three required surgical reintervention in the pulmonary artery. Two late deaths occurred after the Glenn procedure because of ventricular dysfunction and respiratory infection. CONCLUSIONS Pulmonary arterial reconstruction in early infancy provides sufficient and balanced pulmonary arterial development for pulmonary atresia with pulmonary coarctation.
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Affiliation(s)
- Takeshi Shinkawa
- Department of Pediatric Cardiovascular Surgery, Children's Research Hospital, Kyoto, Japan
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Walsh MA, Lee KJ, Chaturvedi R, Van Arsdell GS, Benson LN. Radiofrequency perforation of the right ventricular outflow tract as a palliative strategy for pulmonary atresia with ventricular septal defect. Catheter Cardiovasc Interv 2007; 69:1015-20. [PMID: 17377999 DOI: 10.1002/ccd.21119] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Radiofrequency perforation (RF) of the right ventricular outflow tract (RVOT), while an effective management strategy in children with an intact ventricular septum, has not been fully detailed in those presenting with a ventricular septal defect. OBJECTIVE To determine whether transcatheter perforation of the atretic pulmonary valve is an acceptable management strategy prior to surgical repair. RESULTS Valve perforation was attempted in eight children seen between May 2000 and March 2006, five being infants between 1 and 9 days of age. In five children, this was the first of two procedures, the second a planned surgical correction. The RF was successful in six children with one child requiring additional stenting of the RVOT. Of these children, three attained a biventricular repair within the next year without additional palliative surgical procedures. Of the remaining three patients, one is awaiting surgical correction, one did not require further surgery, and one had this procedure as the only planned palliation. The two children in whom RF was not possible were referred for surgical augmentation of pulmonary blood flow. CONCLUSION A treatment strategy that includes pulmonary valve perforation as initial palliation to increase pulmonary blood flow may be effective. Additional experience to better define those children who would benefit from this treatment algorithm is required.
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Affiliation(s)
- Mark A Walsh
- Department of Pediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Ontario, Canada
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Kawaraguchi Y, Taniguchi A, Otomo T, Ota C, Uchida N. Anesthetic management of bidirectional cavopulmonary shunt in a patient with pulmonary atresia with intact ventricular septum associated with sinusoidal communications. J Anesth 2006; 20:220-2. [PMID: 16897243 DOI: 10.1007/s00540-006-0395-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2005] [Accepted: 02/09/2006] [Indexed: 10/24/2022]
Abstract
Pulmonary atresia with intact ventricular septum (PAIVS) is sometimes associated with coronary artery anomalies, including right ventricle (RV)-to-coronary artery fistulas (sinusoidal communications), coronary artery stenoses, and coronary artery occlusions. In some cases, the coronary circulation depends entirely or partly on the desaturated systemic venous blood supply from the RV. Under these circumstances, decompression of the RV can result in fatal myocardial ischemia. A 6-month-old boy, diagnosed with PAIVS associated with sinusoidal communications, underwent a bidirectional cavopulmonary shunt procedure under venoarterial cardiopulmonary bypass (CPB). During CPB, to prevent RV decompression, we maintained right atrial pressure above 5 mmHg and used a pump perfusion rate of 30%-40% of the calculated value based on body surface area. Although electrocardiography showed slight ST depression and bradycardia, myocardial contractility after weaning from CPB was adequate to maintain the circulation with the administration of dobutamine and atrial pacing. In patients with PAIVS and RV-dependent coronary circulation, it is important to maintain coronary artery perfusion throughout the period of anesthesia.
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Affiliation(s)
- Yoshitaka Kawaraguchi
- Department of Anesthesia and Critical Care, Miyagi Children's Hospital, 4-3-17 Ochiai, Sendai 989-3126, Japan
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Piacentini G, Placidi S, Marino B. Re: right isomerism, pulmonary atresia, and major aorto-pulmonary collateral arteries. Cardiol Young 2006; 16:608; author reply 609. [PMID: 17116278 DOI: 10.1017/s1047951106211259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Brown JW, Ruzmetov M, Vijay P, Rodefeld MD, Turrentine MW. Surgical Treatment of Absent Pulmonary Valve Syndrome Associated With Bronchial Obstruction. Ann Thorac Surg 2006; 82:2221-6. [PMID: 17126138 DOI: 10.1016/j.athoracsur.2006.07.022] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Revised: 07/10/2006] [Accepted: 07/11/2006] [Indexed: 12/01/2022]
Abstract
BACKGROUND Absent pulmonary valve syndrome (APVS) is a relatively rare anomaly that is usually associated with a ventricular septal defect and a restrictive pulmonary annulus with severe pulmonary regurgitation. The to-and-fro flow across the right ventricular outflow tract produces enormously dilated and pulsatile pulmonary arteries (PAs) that cause severe respiratory distress and tracheomalacia by compression of the trachea and primary bronchi. This retrospective study summarizes our 20-year experience of surgical treatment in patients with APVS. METHODS Between 1984 and 2005, 20 patients underwent repair of APVS using a valved conduit (n = 9), transannular patch (TAP) insertion alone (n = 5), or TAP with monocusp valve (n = 6) with PA reduction arterioplasty. Median age was 7 months (range, 6 days to 9 years). RESULTS There were one perioperative and two late deaths. All deaths were related to airway complications. Survival was 90% at 1 year and 85% at 10 and 15 years. In a multivariate analysis only preoperative ventilator dependency was associated with a worse outcome (p = 0.02). Follow-up was available in 18 operative survivors (mean follow-up, 7.3 +/- 5.2 years). Six patients (33%) underwent reoperation for pulmonary valve incompetence and right ventricular dysfunction. Three patients (17%) had episodic bronchospasm of mild to moderate severity that were responsive to sympathomimetic bronchodilators. CONCLUSIONS Morbidity associated with perioperative respiratory complications and ventilator dependency due to underlying tracheobronchomalacia is an important problem in patients with APVS. These infants may require multiple hospitalizations for recurrent respiratory infections secondary to their tracheobronchomalacia. Complete repair with a valved conduit and reduction pulmonary arterioplasty at the onset of symptoms and a definitive diagnosis is our procedure of choice for infants with APVS. With this approach, the airway can be optimized to give the best patient outcome.
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Affiliation(s)
- John W Brown
- Section of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, Indiana 46202-5123, USA.
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Brown TA, Emad M, Pablo M. Cardiac arrest at induction of anesthesia in a child with undiagnosed right-ventricular dependent coronary circulation: a case report. Paediatr Anaesth 2006; 16:1179-83. [PMID: 17040308 DOI: 10.1111/j.1460-9592.2006.01958.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Pediatric perioperative cardiac arrest occurs in 1.4 per 10,000 anesthetics, with an overall mortality rate of 26%. The etiology of the arrest is identifiable in the majority of these patients. We report the case of a child with a complex congenital heart defect, who sustained a cardiac arrest at induction of anesthesia, secondary to right-ventricular dependent coronary circulation. We discuss the incidence, risks, anesthetic management and outcomes of pediatric cardiac arrest in the perioperative period especially in patients with complex congenital heart disease.
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Affiliation(s)
- Todd A Brown
- Department of Cardiothoracic Anesthesia, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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