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Clouthier KL, Taylor AC, Xuhuai J, Liu Y, Parker S, Van Eyk J, Reddy S. A Noninvasive Circulating Signature of Combined Right Ventricular Pressure and Volume Overload in Tetralogy of Fallot/Pulmonary Atresia/Major Aortopulmonary Collateral Arteries. World J Pediatr Congenit Heart Surg 2024; 15:162-173. [PMID: 38128927 DOI: 10.1177/21501351231213626] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Background: Despite surgical advances, children with tetralogy of Fallot/pulmonary atresia/major aortopulmonary collaterals (TOF/PA/MAPCAs) are subject to chronic right ventricular (RV) pressure and volume overload. Current diagnostic tools do not identify adverse myocardial remodeling and cannot predict progression to RV failure. We sought to identify a noninvasive, circulating signature of the systemic response to right heart stress to follow disease progression. Methods: Longitudinal data were collected from patients with TOF/PA/MAPCAs (N = 5) at the time of (1) early RV pressure overload and (2) late RV pressure and volume overload. Plasma protein and microRNA expression were evaluated using high-throughput data-independent mass spectroscopy and Agilent miR Microarray, respectively. Results: At the time of early RV pressure overload, median patient age was 0.34 years (0.02-9.37), with systemic RV pressures, moderate-severe hypertrophy, and preserved systolic function. Late RV pressure and volume overload occurred at a median age of 4.08 years (1.51-10.83), with moderate RV hypertrophy and dilation, and low normal RV function; 277 proteins were significantly dysregulated (log2FC ≥0.6/≤-0.6, FDR≤0.05), predicting downregulation in lipid transport (apolipoproteins), fibrinolytic system, and extracellular matrix structural proteins (talin 1, profilin 1); and upregulation in the respiratory burst. Increasing RV size and decreasing RV function correlated with decreasing structural protein expression. Similarly, miR expression predicted downregulation of extracellular matrix-receptor interactions and upregulation in collagen synthesis. Conclusion: To our knowledge, we show for the first time a noninvasive protein and miR signature reflecting the systemic response to adverse RV myocardial remodeling in TOF/PA/MAPCAs which could be used to follow disease progression.
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Affiliation(s)
- Katie L Clouthier
- Department of Pediatrics (Cardiology), Stanford University, Palo Alto, CA, USA
| | - Anne C Taylor
- Department of Pediatrics (Cardiology), Stanford University, Palo Alto, CA, USA
| | - Ji Xuhuai
- Human Immune Monitoring Center and Functional Genomics Facility, Stanford University, Palo Alto, CA, USA
| | - Yuhan Liu
- Department of Medicine (Quantitative Science Unit), Stanford University, Palo Alto, CA, USA
| | - Sarah Parker
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jennifer Van Eyk
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sushma Reddy
- Department of Pediatrics (Cardiology), Stanford University, Palo Alto, CA, USA
- Cardiovascular Institute, Stanford University, Los Angeles, CA, USA
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Bhat SS, Bui HT, Farnan A, Vietmeyer K, Armstrong AK, Breuer CK, Dasi LP. Development of Novel Sutureless Balloon Expandable Fetal Heart Valve Device Using Absorbable Polycaprolactone Leaflets. Ann Biomed Eng 2024; 52:386-395. [PMID: 37864043 DOI: 10.1007/s10439-023-03386-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 10/10/2023] [Indexed: 10/22/2023]
Abstract
Congenital heart disease (CHD) accounts for nearly one-third of all congenital defects, and patients often require repeated heart valve replacements throughout their lives, due to failed surgical repairs and lack of durability of bioprosthetic valve implants. This objective of this study is to develop and in vitro test a fetal transcatheter pulmonary valve replacement (FTPVR) using sutureless techniques to attach leaflets, as an option to correct congenital defects such as pulmonary atresia with intact ventricular septum (PA/IVS), in utero. A balloon expandable design was analyzed using computational simulations to identify areas of failure. Five manufactured valves were assembled using the unique sutureless approach and tested in the fetal right heart simulator (FRHS) to evaluate hemodynamic characteristics. Computational simulations showed that the commissural loads on the leaflet material were significantly reduced by changing the attachment techniques. Hemodynamic analysis showed an effective orifice area of 0.08 cm2, a mean transvalvular pressure gradient of 7.52 mmHg, and a regurgitation fraction of 8.42%, calculated over 100 consecutive cardiac cycles. In conclusion, the FTPVR exhibited good hemodynamic characteristics, and studies with biodegradable stent materials are underway.
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Affiliation(s)
- Sanchita S Bhat
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Office 232, 387 Technology Circle NW, Suite 200, Atlanta, GA, 30313-2412, USA
| | - Hieu T Bui
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Office 232, 387 Technology Circle NW, Suite 200, Atlanta, GA, 30313-2412, USA
| | - Anna Farnan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Office 232, 387 Technology Circle NW, Suite 200, Atlanta, GA, 30313-2412, USA
| | - Katherine Vietmeyer
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Office 232, 387 Technology Circle NW, Suite 200, Atlanta, GA, 30313-2412, USA
| | - Aimee K Armstrong
- The Heart Center, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH, 43205, USA
| | - Christopher K Breuer
- Department of General Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH, 43205, USA.
| | - Lakshmi Prasad Dasi
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Office 232, 387 Technology Circle NW, Suite 200, Atlanta, GA, 30313-2412, USA.
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3
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Jin JB, Robinson JD, Camarda JA, Satzer MB, Carr MR, Monge M, Patel A. Tricuspid Atresia with Absent Pulmonary Valve with Nearly Discontinuous Branch Pulmonary Arteries. Pediatr Cardiol 2024; 45:446-451. [PMID: 37955720 DOI: 10.1007/s00246-023-03331-6] [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: 09/24/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023]
Abstract
Absent pulmonary valve with tricuspid atresia or tricuspid stenosis (APV-TA/TS) is an extremely rare congenital heart defect associated with significant morbidity and mortality. Compared to Tetralogy of Fallot with Absent Pulmonary Valve Syndrome, branch pulmonary arteries are not typically significantly dilated. We present the case of a newborn male prenatally diagnosed APV-TA with intact ventricular septum (IVS) and nearly discontinuous branch pulmonary arteries, the surgical strategy employed, and the salient hemodynamic factors considered in the medical decision-making.
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Zou MH, Cao F, Ma L, Xia YS, Yang SC, Chen WD, Li WL, Chen XX. [Outcomes after surgical repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries: a series of 104 cases]. Zhonghua Wai Ke Za Zhi 2023; 61:1093-1098. [PMID: 37932146 DOI: 10.3760/cma.j.cn112139-20230108-00012] [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: 11/08/2023]
Abstract
Objective: To examine the early and midterm surgical outcome of pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries (PA/VSD/MAPCA) using revised surgical strategies. Methods: A retrospective analysis of clinical data, surgical methods, and follow-up results was performed of 104 cases of PA/VSD/MAPCA in Department of Cardiovascular Surgery, Guangzhou Women and Children's Medical Center from January 2017 to September 2022. There were 55 males and 49 females, aged (M(IQR)) 33.9(84.0) months (range: 0.5 to 209.6 months) at the first surgical procedures. The anatomical classification included 89 cases of type B and 15 cases of type C. The number of major aortopulmonary collateral arteries was 4.2 (3.0) (range: 1 to 8). The Kaplan-Meier method was used for survival estimation. Results: In the first stage of surgery, 50 patients underwent a complete primary repair, 12 patients underwent partial repair, 32 patients underwent palliative right ventricular-pulmonary artery connection, and only 10 patients chose the Blalock-Taussig shunt. There were 10 cases of early death. In the second stage, 14 patients underwent complete repair and 4 patients underwent partial repair with no early death. The interval between the two surgeries was 19 (10) months (range: 9 to 48 months). Finally, during the 40 (34) months follow-up period, a total of 64 patients were complete repair and the right/left ventricular pressure ratio after complete repair was 0.63±0.16 (range: 0.36 to 1.00). Survival analysis showed that survival rates at 1 and 5 years after first-stage surgery were both 89.4% (95%CI: 83.5% to 95.3%). At 28 (34) months (range: 1 to 67 months) of follow-up after complete repair, the survival analysis showed that the survival rates at 1 and 5 years were both 95.2% (95%CI: 89.9% to 100%). Conclusions: Using combined approaches tailored to individual patients and optimized unifocalization strategy, the complete repair rate at one stage and the cumulative complete repair rate at 5 years improved significantly with a lower right/left ventricular pressure ratio and satisfactory early and intermediate survival.
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Affiliation(s)
- M H Zou
- Department of Cardiovascular Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - F Cao
- Department of Cardiovascular Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - L Ma
- Department of Cardiovascular Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - Y S Xia
- Department of Cardiovascular Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - S C Yang
- Department of Cardiovascular Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - W D Chen
- Department of Cardiovascular Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - W L Li
- Department of Cardiovascular Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - X X Chen
- Department of Cardiovascular Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China
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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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Xu Q, Hou K, Lv B, Xing Q, Chen R. Application of Foley balloon catheter in palliative surgery for pulmonary atresia with an intact ventricular septem, with additional cases of pulmonary atresia with ventricular septal defect and tetralogy of Fallot. BMC Cardiovasc Disord 2023; 23:547. [PMID: 37940877 PMCID: PMC10634058 DOI: 10.1186/s12872-023-03587-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 10/29/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Pulmonary atresia and tetralogy of Fallot can require palliative surgery in the neonatal period due to severe hypoxia; however, limitations of established techniques include high failure rate and need for cardiopulmonary bypass. Herein, right ventricular outflow tract reconstruction on a beating heart using a Foley balloon catheter is described. METHODS A retrospective review of patients who underwent right ventricular outflow tract reconstruction on a beating heart using a Foley balloon catheter at our institution between September 2018 and March 2022 was completed. During the procedure, a Foley balloon catheter was used to occlude the blood from the right ventricular inflow tract. RESULTS Eight patients with pulmonary atresia and intact ventricular septum underwent an off-pump right ventricular outflow tract reconstruction. One patient with pulmonary atresia and ventricular septal defect, and two patients with tetralogy of Fallot underwent an on-pump right ventricular outflow tract reconstruction on a beating heart. The procedures were successful in all patients. Patent ductus arteriosus ligation without modified Blalock-Taussig shunt placement was performed in three patients with pulmonary atresia with intact ventricular septum and two patients with tetralogy of Fallot, ductus arteriosus was left open in four patients with pulmonary atresia with intact ventricular septum. All patients remained clinically well without serious complications. CONCLUSIONS Right ventricular outflow tract reconstruction on a beating heart using a Foley balloon catheter for pulmonary atresia and tetralogy of Fallot is a feasible alternative to catheter-based interventions or traditional surgical treatment, especially in patients with muscular infundibular stenosis or hypoplastic pulmonary annulus. Further studies with more cases are needed to verify feasibility and superiority of this approach.
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Affiliation(s)
- Qiteng Xu
- Medical College, Qingdao University, Qingdao, China
| | - Kefeng Hou
- Heart Center, Qingdao Women and Children's hospital, 6 Tongfu Road , Qingdao, 266000, China
| | - Bei Lv
- Heart Center, Qingdao Women and Children's hospital, 6 Tongfu Road , Qingdao, 266000, China
| | - Quansheng Xing
- Heart Center, Qingdao Women and Children's hospital, 6 Tongfu Road , Qingdao, 266000, China
| | - Rui Chen
- Heart Center, Qingdao Women and Children's hospital, 6 Tongfu Road , Qingdao, 266000, China.
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Leclair G, Dingankar A, Robertson CMT, Bond GY, Mohammadian P, Dinu I, Averin K, Guerra GG, Atallah J. Neurodevelopmental Outcomes of Infants after Neonatal Surgical Intervention for Tetralogy of Fallot or Pulmonary Atresia. J Pediatr 2023; 262:113640. [PMID: 37517650 DOI: 10.1016/j.jpeds.2023.113640] [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] [Received: 01/08/2023] [Revised: 07/13/2023] [Accepted: 07/25/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To determine the 2-year neurodevelopmental outcomes for survivors of neonatal cardiac surgery for the most common right ventricular outflow tract obstructive lesions: tetralogy of Fallot and pulmonary atresia with a ventricular septal defect. STUDY DESIGN A single-center consecutive cohort of 77 children underwent neonatal surgery for tetralogy of Fallot or pulmonary atresia with a ventricular septal defect at ≤6 weeks of age between 2006 and 2017. The patients underwent a multidisciplinary neurodevelopmental assessment at 18-24 months of age. Survivor outcomes were compared by univariable and multivariable analyses. RESULTS The 2-year mortality was 7.8% (6/77) with a postoperative in-hospital mortality of 3.9% (3/77). Freedom from reintervention by cardiac catheterization or surgical intervention at 2 years was 36%. Functional and neurodevelopmental assessment for 69 of 71 survivors was completed at a mean age of 22.6 ± 4.0 months using the Bayley Scales of Infant and Toddler Development III. The mean neurodevelopmental outcome scores were 83.4 ± 16.5 for cognitive skills, 82.2 ± 18.7 for language skills, and 81.4 ± 18.1 for motor skills. Cognitive, language, and motor delay, defined as a score of <70, was identified in 25%, 25%, and 23% of patients, respectively. Multivariable analyses for factors associated with worse neurodevelopmental outcomes identified chromosomal anomalies (P < .001) and postoperative complications (P < .03). CONCLUSIONS Cyanotic tetralogy of Fallot and pulmonary atresia with ventricular septal defect requiring neonatal repair showed similar 2-year neurodevelopmental outcomes below normative values and a high prevalence of cognitive, language and motor delays.
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Affiliation(s)
- Guillaume Leclair
- Departments of Pediatrics, University of Alberta, Edmonton, AB, Canada.
| | - Adil Dingankar
- Departments of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Charlene M T Robertson
- Departments of Pediatrics, University of Alberta, Edmonton, AB, Canada; Complex Pediatric Therapies Follow-up Program, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Gwen Y Bond
- Complex Pediatric Therapies Follow-up Program, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Parsa Mohammadian
- Institute of Biostatistics and Registry Research, Brandenburg Medical School, Neuruppin, Germany
| | - Irina Dinu
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Konstantin Averin
- Departments of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | | | - Joseph Atallah
- Departments of Pediatrics, University of Alberta, Edmonton, AB, Canada
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Uygur L, Demirci O, Yücel IK. Pulmonary atresia and ventricular septal defect: How accurate is the fetal echocardiography, and do the major aortopulmonary collateral arteries matter? Echocardiography 2023; 40:1259-1268. [PMID: 37878331 DOI: 10.1111/echo.15706] [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] [Received: 06/17/2023] [Revised: 08/29/2023] [Accepted: 10/15/2023] [Indexed: 10/26/2023] Open
Abstract
OBJECTIVE To assess the accuracy of prenatal echocardiography in defining pulmonary vasculature in pulmonary atresia with VSD (PAVSD). The second aim is to compare the perinatal and postnatal outcomes of different pulmonary blood supply types. STUDY DESIGN The cases prenatally diagnosed with PAVSD between 2017 and 2022 in a single tertiary fetal medicine center were identified on the electronic database. Fetal echocardiography reports and images were reviewed retrospectively. Postnatal outcomes were acquired from the hospital records of relevant pediatric cardiology and cardiovascular surgery clinics. Fetal echocardiography results were compared with postnatal results. Perinatal and postnatal outcomes were compared between the different pulmonary vascular supply types. RESULTS Among the 24 PAVSD cases, six were diagnosed with major aortopulmonary collateral arteries (MAPCA) dependent, eleven were diagnosed with ductus arteriosus (DA) dependent pulmonary supply, and seven were diagnosed with double pulmonary supply (MAPCA + DA) on prenatal echocardiography. Seventeen cases were live-born and have undergone postnatal investigations. Fetal echocardiography was 88.2% accurate about the type of pulmonary supply. The accuracy of fetal echocardiography regarding pulmonary vascular anatomy was 82.3%. Postoperative survival was 69.2%. Mortality before surgery and postoperative survival did not differ between pulmonary supply groups. Survival was impaired by the extracardiac anomalies. The need for early interventions was significantly higher in the DA group. CONCLUSION Pulmonary vascularization in PAVSD can be defined precisely on fetal echocardiography. The source of pulmonary blood supply does not impact postnatal short-term outcomes significantly but it impacts the management. The associated anomalies highly contribute to postnatal mortality.
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Affiliation(s)
- Lütfiye Uygur
- Department of Perinatology, Zeynep Kamil Gynecologic and Pediatric Training Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Oya Demirci
- Department of Perinatology, Zeynep Kamil Gynecologic and Pediatric Training Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Ilker Kemal Yücel
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Health Sciences University, Istanbul, Turkey
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Mainwaring RD, Felmly LM, Hanley FL. A Deep Dive Into Retroesophageal Major Aortopulmonary Collateral Arteries. World J Pediatr Congenit Heart Surg 2023; 14:729-735. [PMID: 37499043 DOI: 10.1177/21501351231183970] [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: 07/29/2023]
Abstract
Background: The anatomy of major aortopulmonary collateral arteries (MAPCAs) can be highly variable with regard to number, anatomic origin, course, and relationship to the native pulmonary arteries. Some MAPCAs travel behind the esophagus (retroesophageal) and bronchus before entering the lung parenchyma. The purpose of this paper was to review the anatomy, physiology, and surgical characteristics of retroesophageal MAPCAs. Methods: This manuscript summarizes the data from a series of three papers that have focused on the subject of retroesophageal MAPCAs from our institution over the past ten years. Results: Two-thirds of patients evaluated had a retroesophageal MAPCA identified at surgery. Retroesophageal major aortopulmonary collateral arteries (REMs) were more common with a left arch (77%) compared with a right arch (53%). Of all REMs evaluated, 83% were single supply, 13% were dual supply with an inadequate connection, and 4% were dual supply with an adequate connection. Based on these findings, 96% of retroesophageal MAPCAs were unifocalized. Follow-up catheterization was performed at a median of 17 months after surgery; 75% of unifocalized MAPCAs were widely patent, 20% were patent but stenotic, and 5% were occluded. Conclusions: The data demonstrate that retroesophageal MAPCAs are relatively common and almost always require unifocalization. At mid-term follow-up, 95% of unifocalized MAPCAs were found to be patent.
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Affiliation(s)
- Richard D Mainwaring
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Stanford, CA, USA
| | - L Mac Felmly
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Stanford, CA, USA
| | - Frank L Hanley
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Stanford, CA, USA
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Zheng WC, Buratto E, Caldaroni F, Ishigami S, Konstantinov IE, d'Udekem Y. T-Remodeling of the Pulmonary Artery Bifurcation for Pulmonary Artery Origin Stenosis. World J Pediatr Congenit Heart Surg 2023; 14:716-722. [PMID: 37933694 DOI: 10.1177/21501351231181109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
BACKGROUND Various surgical techniques are utilized for reconstructing hypoplastic pulmonary arteries (PAs) in patients with conotruncal anomalies and at times, may be susceptible to restenosis and reoperation. We reviewed our experience with a simple technique of T-shaped remodeling of the PA bifurcation. METHODS Between 2005 and 2019, 31 patients underwent T-remodeling of central PAs by a single cardiac surgeon. The PA bifurcation was opened cranially, and the opening was augmented with an oval-shaped patch effectively transforming the V-shaped bifurcation into a T-shaped bifurcation. Both origins of the PAs were enlarged, even in the instance of single PA origin stenosis. RESULTS Median age at time of T-remodeling was 17 months (range: 7 weeks to 14 years). The following cardiac morphologies were observed: tetralogy of Fallot (n = 12, 39%), pulmonary atresia with ventricular septal defect (VSD) and major aortopulmonary collateral arteries (n = 8, 26%), truncus arteriosus (n = 6, 19%), pulmonary atresia with VSD (n = 3, 9.7%), and transposition of the great arteries (n = 2, 6.5%). Thirteen patients (42%) had previous central shunt, and eight patients (26%) had previous modified Blalock-Taussig shunt. There were no operative mortalities. Immediately after T-remodeling, echocardiographic estimates of right ventricle to PA gradient decreased from 42 [interquartile range 28-58] mm Hg to 20 [12-36] mm Hg (P = .03). Freedom from reoperation on the PA bifurcation for the entire cohort was 100% at one year, 88% (95% CI 68%-96%) at five years and 82% (57%-93%) at ten years. CONCLUSIONS T-remodeling for PA origin stenosis is a safe procedure with excellent freedom from reoperation that is easily reproducible and applicable to patients with all cardiac morphologies.
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Affiliation(s)
- Wayne C Zheng
- Heart Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Department of Cardiology, Alfred Health, Melbourne, Australia
| | - Edward Buratto
- Heart Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Federica Caldaroni
- Heart Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Shuta Ishigami
- Heart Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Igor E Konstantinov
- Heart Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Yves d'Udekem
- Heart Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Division of Cardiovascular Surgery, Children's National Hospital, Washington, DC, USA
- Children's National Heart Institute, Washington, DC, USA
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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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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12
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McElhinney DB, Asija R, Zhang Y, Jaggi A, Shek J, Peng LF, Boltz MG, Ma M, Martin E, Hanley FL. 20-Year Experience With Repair of Pulmonary Atresia or Stenosis and Major Aortopulmonary Collateral Arteries. J Am Coll Cardiol 2023; 82:1206-1222. [PMID: 37704311 DOI: 10.1016/j.jacc.2023.06.041] [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: 02/24/2023] [Revised: 05/31/2023] [Accepted: 06/27/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND We have followed a consistent, albeit evolving, strategy for the management of patients with pulmonary atresia or severe stenosis and major aortopulmonary collateral arteries (MAPCAs) that aims to achieve complete repair with low right ventricular pressure by completely incorporating blood supply and relieving stenoses to all lung segments. OBJECTIVES The purpose of this study was to characterize our 20-year institutional experience managing patients with MAPCAs. METHODS We reviewed all patients who underwent surgery for MAPCAs and biventricular heart disease from November 2001 through December 2021. RESULTS During the study period, 780 unique patients underwent surgery. The number of new patients undergoing surgery annually was relatively steady during the first 15 years, then increased substantially thereafter. Surgery before referral had been performed in almost 40% of patients, more often in our recent experience than earlier. Complete repair was achieved in 704 patients (90%), 521 (67%) during the first surgery at our center, with a median right ventricular to aortic pressure ratio of 0.34 (25th, 75th percentiles: 0.28, 0.40). The cumulative incidence of mortality was 15% (95% CI: 12%-19%) at 10 years, with no difference according to era of surgery (P = 0.53). On multivariable Cox regression, Alagille syndrome (HR: 2.8; 95% CI: 1.4-5.7; P = 0.004), preoperative respiratory support (HR: 2.0; 95% CI: 1.2-3.3; P = 0.008), and palliative first surgery at our center (HR: 3.5; 95% CI: 2.3-5.4; P < 0.001) were associated with higher risk of death. CONCLUSIONS In a growing pulmonary artery reconstruction program, with increasing volumes and an expanding population of patients who underwent prior surgery, outcomes of patients with pulmonary atresia or stenosis and MAPCAs have continued to improve.
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Affiliation(s)
- Doff B McElhinney
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Stanford, California, USA; Department of Pediatrics, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Stanford, California, USA.
| | - Ritu Asija
- Department of Pediatrics, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Stanford, California, USA
| | - Yulin Zhang
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Stanford, California, USA
| | - Ayush Jaggi
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Stanford, California, USA
| | - Jennifer Shek
- Department of Pediatrics, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Stanford, California, USA
| | - Lynn F Peng
- Department of Pediatrics, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Stanford, California, USA
| | - M Gail Boltz
- Department of Anesthesia, Perioperative, and Pain Medicine, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Stanford, California, USA
| | - Michael Ma
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Stanford, California, USA
| | - Elisabeth Martin
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Stanford, California, USA
| | - Frank L Hanley
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Stanford, California, USA
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13
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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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14
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Kisamori E, Kotani Y, Suzuki H, Kobayashi J, Kawabata T, Kuroko Y, Kasahara S. When to intervene the pulmonary artery: Importance of anatomical assessment in the diagnosis of pulmonary artery coarctation. J Thorac Cardiovasc Surg 2023; 166:926-932. [PMID: 36967371 DOI: 10.1016/j.jtcvs.2023.02.021] [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: 10/06/2022] [Revised: 01/09/2023] [Accepted: 02/21/2023] [Indexed: 02/26/2023]
Abstract
OBJECTIVE Pulmonary artery coarctation (PACoA) is a major problem that increases the frequency of intervention. However, there is little evidence regarding the prediction of PACoA development. METHODS A retrospective chart review was performed on 42 patients who underwent modified Blalock-Taussig shunt and preoperative contrast-enhanced computed tomography. An uneven PA branching was defined as an abnormal ductus arteriosus connection to the left PA distal to the PA branching on contrast-enhanced computed tomography. RESULTS Nineteen (45.2%) of 42 patients were diagnosed with PACoA. The median diameters of the ductus on the aorta and PA sides were 4.1 mm and 3.6 mm in the PACoA group and 3.6 mm and 2.9 mm in the non-PACoA group, respectively (P = .07 and .28, respectively). Tortuous ductus was recognized in 7 (36.8%) patients in the PACoA group and 14 (60.8%) patients in the non-PACoA group (P = .12). PACoA was associated with pulmonary atresia (16 patients [84.2%] in the PACoA group and 12 patients [52.1%] in the non-PACoA group) (P = .02). All 19 patients had uneven PA branching in the PACoA group, whereas 5 of 23 (21.7%) patients had uneven PA branching in the non-PACoA group (P < .001). CONCLUSIONS Uneven PA branching rather than the ductus arteriosus size was strongly associated with PACoA development; therefore, morphologic assessment by contrast-enhanced computed tomography should be considered in patients with pulmonary atresia.
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Affiliation(s)
- Eiri Kisamori
- Department of Cardiovascular Surgery, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University and Okayama University Hospital, Okayama, Japan
| | - Yasuhiro Kotani
- Department of Cardiovascular Surgery, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University and Okayama University Hospital, Okayama, Japan.
| | - Hiroyuki Suzuki
- Department of Cardiovascular Surgery, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University and Okayama University Hospital, Okayama, Japan
| | - Junko Kobayashi
- Department of Cardiovascular Surgery, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University and Okayama University Hospital, Okayama, Japan
| | - Takuya Kawabata
- Department of Cardiovascular Surgery, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University and Okayama University Hospital, Okayama, Japan
| | - Yosuke Kuroko
- Department of Cardiovascular Surgery, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University and Okayama University Hospital, Okayama, Japan
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University and Okayama University Hospital, Okayama, Japan
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15
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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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16
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Topcu FS, Simsek B, Ozyuksel A. An unusual case of pulmonary atresia with ventricular septal defect and multiple major aortopulmonary collateral arteries: undiagnosed until adulthood. Cardiol Young 2023; 33:1445-1447. [PMID: 36621769 DOI: 10.1017/s1047951122004127] [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] [Indexed: 01/10/2023]
Abstract
Pulmonary atresia and ventricular septal defect with major aortopulmonary collateral arteries is an extremely complex, heterogeneous, and rare anomaly. This group of patients may not be able to survive until adulthood without any interventions or treatment. Although surgical management of patients diagnosed in newborn, infant, or early childhood is clear, treatment of patients diagnosed in adulthood still remains a significant problem. The pre-operative clinical status, imaging methods, and operative findings might be helpful for planning the most appropriate management. Herein, we report a unique case of pulmonary atresia and ventricular septal defect with major aortopulmonary collateral arteries who remained asymptomatic until the age of 18 years.
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Affiliation(s)
- Feyza Sönmez Topcu
- Department of Radiology, Aydin University, Medical Park Florya Hospital, Istanbul, Turkey
| | - Baran Simsek
- Department of Cardiovascular Surgery, Medicana International Hospital, Istanbul, Turkey
| | - Arda Ozyuksel
- Department of Cardiovascular Surgery, Medicana International Hospital, Istanbul, Turkey
- Department of Cardiovascular Surgery, Biruni University, Istanbul, Turkey
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17
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Kakarla S, Sasikumar D, Dharan BS. Heart failure in a newborn with tetralogy of Fallot: uncommon association of a common anomaly. Cardiol Young 2023; 33:1201-1202. [PMID: 36408640 DOI: 10.1017/s104795112200364x] [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] [Indexed: 11/22/2022]
Abstract
Heart failure in tetralogy of Fallot in the newborn period is rare and is usually due to either large aortopulmonary collaterals or absent pulmonary valve syndrome with severe pulmonary regurgitation. Pink tetralogy of Fallot and tetralogy of Fallot with disconnected pulmonary arteries from the aorta may present beyond the newborn period with heart failure when Pulmonary vascular resistance (PVR) falls. We describe the diagnostic and therapeutic pathway in a rare case of heart failure in newborn with tetralogy of Fallot.
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Affiliation(s)
- Saikiran Kakarla
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Deepa Sasikumar
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Baiju S Dharan
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
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18
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Yamda H, Muneuchi J, Sugitani Y, Ezaki H, Koga H, Tanaka A, Watanabe M. Transcatheter atrial septal defect closure late after completion of biventricular circulation in patients with pulmonary atresia intact ventricular septum or critical pulmonary stenosis. Catheter Cardiovasc Interv 2023; 101:847-852. [PMID: 36906810 DOI: 10.1002/ccd.30623] [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: 09/19/2022] [Revised: 12/15/2022] [Accepted: 02/27/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVE This study aimed to explore anatomical and hemodynamic features of atrial septal defect, which was treated by transcatheter device closure late after completion of biventricular circulation in patients with pulmonary atresia and intact ventricular septum (PAIVS) or critical pulmonary stenosis (CPS). METHODS We studied echocardiographic and cardiac catheterization data, including defect size, retroaortic rim length, single or multiple defects, the presence of malalignment atrial septum, tricuspid and pulmonary valve diameters, and cardiac chamber sizes, in patients with PAIVS/CPS who underwent transcatheter closure of atrial septal defect (TCASD), and compared to control subjects. RESULTS A total of 173 patients with atrial septal defect, including 8 patients with PAIVS/CPS, underwent TCASD. Age and weight at TCASD were 17.3 ± 18.3 years and 36.6 ± 13.9 kg, respectively. There was no significant difference in defect size (13.7 ± 4.0 vs. 15.6 ± 5.2 mm, p = 0.317) and the retro-aortic rim length (3.7 ± 4.3 vs. 3.6 ± 0.3.1 mm, p = 0.948) between the groups; however, multiple defects (50% vs. 5%, p < 0.001) and malalignment atrial septum (62% vs. 14%. p < 0.001) were significantly frequent in patients with PAIVS/CPS compared to control subjects. The ratio of pulmonary to systemic blood flow in patients with PAIVS/CPS was significantly lower than that in the control patients (1.2 ± 0.4 vs. 2.0 ± 0.7, p < 0.001); however, four out of eight patients with atrial septal defect associated with PAIVS/CPS had right-to-left shunt through a defect, who were evaluated by the balloon occlusion test before TCASD. The indexed right atrial and ventricular areas, the right ventricular systolic pressure, and mean pulmonary arterial pressure did not differ between the groups. After TCASD, the right ventricular end-diastolic area remained unchanged in patients with PAIVS/CPS, whereas it significantly decreased in control subjects. CONCLUSIONS Atrial septal defect associated with PAIVS/CPS had more complex anatomy, which would be a risk for device closure. Hemodynamics should be individually evaluated to determine the indication for TCASD because PAIVS/CPS encompassed anatomical heterogeneity of the entire right heart.
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Affiliation(s)
- Hiromu Yamda
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, Kitakyushu, Japan
| | - Jun Muneuchi
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, Kitakyushu, Japan
| | - Yuichiro Sugitani
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, Kitakyushu, Japan
| | - Hiroki Ezaki
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, Kitakyushu, Japan
| | - Hirotaka Koga
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, Kitakyushu, Japan
| | - Atsushi Tanaka
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, Kitakyushu, Japan
| | - Mamie Watanabe
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, Kitakyushu, Japan
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19
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Wise-Faberowski L, Long J, Ma M, Nadel HR, Shek J, Feinstein JA, Martin E, Hanley FL, McElhinney DB. Serial Lung Perfusion Scintigraphy After Unifocalization and Repair of Tetralogy of Fallot With Major Aortopulmonary Collaterals. World J Pediatr Congenit Heart Surg 2023; 14:261-272. [PMID: 36972512 DOI: 10.1177/21501351231162959] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Background In patients with tetralogy of Fallot and major aortopulmonary collaterals (MAPCAs), pulmonary blood supply is highly variable. Our approach to this condition emphasizes complete unifocalization of the pulmonary circulation, incorporating all lung segments and addressing stenoses out to the segmental level. Post-repair, we recommend serial lung perfusion scintigraphy (LPS) to assess short-term changes in pulmonary blood flow distribution. Methods We reviewed post-discharge and follow-up LPS performed through three years post-repair and analyzed serial changes in perfusion, risk factors for change, and the relationship between LPS parameters and pulmonary artery reintervention. Results Of 543 patients who had postoperative LPS results in our system, 317 (58%) had only a predischarge LPS available for review, while 226 had 1 (20%) or more (22%) follow-up scans within three years. Overall, pulmonary flow distribution prior to discharge was balanced, and there was minimal change over time; however, there was considerable patient-to-patient variation in both metrics. On multivariable mixed modeling, time after repair ( P = .025), initial anatomy consisting of a ductus arteriosus to one lung ( P < .001), and age at repair ( P = .014) were associated with changes on serial LPS. Patients who had follow-up LPS were more likely to undergo pulmonary artery reintervention, but within that cohort, LPS parameters were not associated with reintervention risk. Conclusion Serial LPS during the first year after MAPCAs repair is a noninvasive method of screening for significant post-repair pulmonary artery stenosis that occurs in a small but important minority of patients. In patients who received follow-up LPS beyond the perioperative period, there was minimal change over time in the population overall, but large changes in some patients and considerable variability. There was no statistical association between LPS findings and pulmonary artery reintervention.
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Affiliation(s)
| | - Jin Long
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Michael Ma
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Helen R Nadel
- Department of Radiology, Lucile Packard Children's Hospital Children's Heart Center, Stanford University, Stanford, CA, USA
| | - Jennifer Shek
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | | | - Elisabeth Martin
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Frank L Hanley
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Doff B McElhinney
- Department of Pediatrics, Stanford University, Stanford, CA, USA
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
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20
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Luo G, Zhang B, Wang D, Pan S, Sun Y, Wang S. Fetal pulmonary valvuloplasty for pulmonary atresia with intact ventricular septum: a single-center clinical experience. Chin Med J (Engl) 2023; 136:740-742. [PMID: 37078103 PMCID: PMC10129219 DOI: 10.1097/cm9.0000000000002268] [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: 08/19/2021] [Indexed: 04/21/2023] Open
Affiliation(s)
- Gang Luo
- Heart Center, Women and Children's Hospital, Qingdao University, Qingdao, Shandong 266034, China
| | - Bei Zhang
- Heart Center, Women and Children's Hospital, Qingdao University, Qingdao, Shandong 266034, China
| | - Dunliang Wang
- Department of Anesthesiology, Women and Children's Hospital, Qingdao University, Qingdao, Shandong 266034, China
| | - Silin Pan
- Heart Center, Women and Children's Hospital, Qingdao University, Qingdao, Shandong 266034, China
| | - Yue Sun
- Department of Obstetrics, Women and Children's Hospital, Qingdao University, Qingdao, Shandong 266034, China
| | - Sibao Wang
- Heart Center, Women and Children's Hospital, Qingdao University, Qingdao, Shandong 266034, China
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21
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Strobel RJ, Young AM, Kron IL. Commentary: Should we "keep rollin'" for PA/VSD/MAPCA? J Card Surg 2022; 37:2651-2652. [PMID: 35661266 PMCID: PMC9383053 DOI: 10.1111/jocs.16651] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 11/29/2022]
Abstract
Pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries (PA/VSD/MAPCA) represents an anatomically diverse and technically demanding spectrum of congenital disease. Here, we review a manuscript by Onalan et al. in the Journal of Cardiac Surgery detailing a retrospective, single-center cohort study of patients undergoing unifocalization for PA/VSD/MAPCA via either a pulmonary artery patch augmentation or pericardial roll technique. While they report statistically equivalent outcomes using both techniques, longer follow-up and increased sample size are necessary to determine efficacy and safety.
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Affiliation(s)
- Raymond J. Strobel
- Division of Cardiac Surgery, Department of Surgery,
University of Virginia, Charlottesville, VA
| | - Andrew M. Young
- Division of Cardiac Surgery, Department of Surgery,
University of Virginia, Charlottesville, VA
| | - Irving L. Kron
- Division of Cardiac Surgery, Department of Surgery,
University of Virginia, Charlottesville, VA
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22
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Shivaram P, Van den Eynde J, Barnes BT, Danford DA, Cedars A, Kutty S. Fetal Echocardiographic Predictors of Postnatal Surgical Strategies in Critical Pulmonary Stenosis or Atresia with Intact Ventricular Septum: A Meta-Analysis. Fetal Diagn Ther 2022; 49:225-234. [PMID: 35793649 DOI: 10.1159/000525718] [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] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/20/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Critical pulmonary stenosis or atresia with intact ventricular septum (PSAIVS) may be managed either by biventricular repair or univentricular palliation. This systematic review and meta-analysis aims to synthesize the evidence for the role of fetal echocardiography in predicting the postnatal treatment pathway. METHODS PubMed/MEDLINE, CINHAL, Cochrane Library, Academic Search Complete, Web of Science, and Trip Pro were searched for observational studies published before July 2021. Random-effects meta-analysis was performed to identify factors associated with biventricular repair. RESULTS Eleven individual studies published between 2006 and 2021, including a total of 285 participants (159 biventricular repair; 126 univentricular palliation), met our eligibility criteria. The pooled estimated prevalence of biventricular repair among patients with PSAIVS was 55.6% (95% confidence interval 48.5-62.5%). Those who underwent biventricular repair had greater right to left ventricle (RV/LV) and tricuspid to mitral valve (TV/MV) dimension ratios, greater TV z score, and longer TV inflow duration / cardiac cycle length by fetal echocardiography. They were also more likely to have significant tricuspid regurgitation, and less likely to have ventriculo-coronary connections (VCC). CONCLUSIONS Commonly obtained fetal echocardiographic measurements have strong associations with treatment pathway choice for patients with PSAIVS. Greater RV growth appears to favor biventricular repair, whereas patients with VCC almost invariably undergo univentricular palliation. Future studies should aim to establish how these fetal echocardiographic parameters might predict outcomes for the two treatment pathways.
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Affiliation(s)
- Pushpa Shivaram
- Division of Pediatric Cardiology, Department of Pediatrics, University of Augusta, Augusta, Georgia, USA
| | - Jef Van den Eynde
- The Helen B. Taussig Heart Center, The Johns Hopkins University and School of Medicine, Baltimore, Maryland, USA
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Benjamin T Barnes
- The Helen B. Taussig Heart Center, The Johns Hopkins University and School of Medicine, Baltimore, Maryland, USA
| | - David A Danford
- The Helen B. Taussig Heart Center, The Johns Hopkins University and School of Medicine, Baltimore, Maryland, USA
| | - Ari Cedars
- The Helen B. Taussig Heart Center, The Johns Hopkins University and School of Medicine, Baltimore, Maryland, USA
| | - Shelby Kutty
- The Helen B. Taussig Heart Center, The Johns Hopkins University and School of Medicine, Baltimore, Maryland, USA
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23
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Overman DM. Commentary: Is it safe? The marathon man meets pulmonary atresia with intact ventricular septum. J Thorac Cardiovasc Surg 2022; 163:2216-2217. [PMID: 34749939 DOI: 10.1016/j.jtcvs.2021.10.021] [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: 10/14/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 11/18/2022]
Affiliation(s)
- David M Overman
- Division of Cardiovascular Surgery, Children's Minnesota, Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, and Division of Cardiac Surgery, The Children's Heart Clinic, Minneapolis, Minn.
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24
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Kaplan B, Evans WN, Restrepo H, Rothman A. Atresia of the Midportion of the Coronary Sinus: A Case Report. World J Pediatr Congenit Heart Surg 2022; 13:802-804. [PMID: 35585704 DOI: 10.1177/21501351221099940] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 12-year-old with a history of critical pulmonary stenosis and moderate right ventricular hypoplasia underwent neonatal pulmonary valve dilation, an aortopulmonary shunt, and an infant cavopulmonary anastomosis with aortopulmonary shunt takedown. During a diagnostic cardiac catheterization at 12 years of age, angiography showed interruption in the midportion of the coronary sinus, which required no intervention.
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Affiliation(s)
- Bryan Kaplan
- Department of Biological Engineering, 1466Johns Hopkins University, Baltimore, MD, USA
| | - William N Evans
- 20567Congenital Heart Center Nevada, Las Vegas, NV, USA
- Division of Pediatric Cardiology, Department of Pediatrics, 212548Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Humberto Restrepo
- 20567Congenital Heart Center Nevada, Las Vegas, NV, USA
- Division of Pediatric Cardiology, Department of Pediatrics, 212548Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Abraham Rothman
- 20567Congenital Heart Center Nevada, Las Vegas, NV, USA
- Division of Pediatric Cardiology, Department of Pediatrics, 212548Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
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25
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McClean M, Ngwezi D, Colen T, Mah K, Al-Aklabi M, Hornberger L. Echocardiographic Predictors of Ductal Tissue-Related Branch Pulmonary Artery Stenosis in Pulmonary Atresia. Pediatr Cardiol 2022; 43:878-886. [PMID: 35022807 DOI: 10.1007/s00246-021-02799-4] [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: 06/18/2021] [Accepted: 11/24/2021] [Indexed: 11/25/2022]
Abstract
Branch pulmonary artery (PA) stenosis due to ductus arteriosus (DA) tissue (DA-PS) contributes to the morbidity associated with pulmonary atresia (PAtr). We sought to identify preoperative echocardiographic features predictive of DA-PS. Patients consecutively encountered with PAtr and a DA-dependent pulmonary circulation at birth who underwent intervention in our program over a 5-year period were identified and records reviewed. Preoperative echocardiograms were reviewed to identify features that predicted postoperative DA-PS. Seventy patients with PAtr met inclusion criteria and 36 (51%) had DA-PS. At preoperative echocardiography, the proximal diameter of the PA ipsilateral to the DA was smaller in those with versus without DA-PS (Z-score - 4.8 ± 1.7 vs - 1.1 ± 1.7, respectively p < 0.001). PA origins could not be imaged on the same axial plane in 21/36 (58%) with versus 2/34 (6%) without DA-PS. Patients with DA-PS had an obtuse posterior angle of the PA bifurcation compared to those without (128 ± 17° and 87 ± 21°, p < 0.001), and a posterior angle of > 100° best predicted DA-PS with a sensitivity of 97% and specificity of 76%. An abnormal PA relationship and/or an obtuse posterior bifurcation angle had a sensitivity, specificity, positive and negative predictive value for DA-PS of 78%, 94%, 90% and 86%, respectively. Finally, DA insertion was into the ipsilateral PA in 26/36 (72%) of cases with DA-PS. A smaller proximal ipsilateral PA diameter, inability to image the PAs in the same plane, a posterior PA bifurcation angle of > 100°, and insertion of the DA in the ipsilateral PA demonstrated by echo are useful in identifying patients at risk for DA-PS.
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Affiliation(s)
- Marisha McClean
- Division of Cardiology, Department of Pediatrics, Women's & Children's Health Research Institute, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
- Division of Cardiology, Department of Pediatrics, Children's Hospital LHSC, Western University, London, ON, Canada
| | - Deliwe Ngwezi
- Division of Cardiology, Department of Pediatrics, Women's & Children's Health Research Institute, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Timothy Colen
- Division of Cardiology, Department of Pediatrics, Women's & Children's Health Research Institute, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Kandice Mah
- Division of Cardiology, Department of Pediatrics, Women's & Children's Health Research Institute, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
- Division of Cardiology, BC Children's Hospital, Vancouver, BC, Canada
| | - Mohammed Al-Aklabi
- Division of Cardiac Surgery, Department of Surgery, Stollery Children's Hospital and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Lisa Hornberger
- Division of Cardiology, Department of Pediatrics, Women's & Children's Health Research Institute, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada.
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Wu M, Fan C, Liu J, Iroegbu CD, Chen W, Huang P, Tang M, Wu X, Wang C, Xiang K, Zhou W, Yang J. Individualized right ventricular outflow tract reconstruction using autologous pulmonary tissue in situ for the treatment of pulmonary atresia with ventricular septum defect. Rev Cardiovasc Med 2022; 23:85. [PMID: 35345252 DOI: 10.31083/j.rcm2303085] [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: 11/09/2021] [Revised: 12/10/2021] [Accepted: 12/20/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ming Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, 410011 Changsha, Hunan, China
- Department of the Cardiovascular Surgery, Hunan Provincial People's Hospital, 410005 Changsha, Hunan, China
| | - Chengming Fan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, 410011 Changsha, Hunan, China
| | - Jian Liu
- Department of Cardiothoracic Surgery, Hunan Children's Hospital, 410007 Changsha, Hunan, China
| | - Chukwuemeka Daniel Iroegbu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, 410011 Changsha, Hunan, China
| | - Wangping Chen
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, 410011 Changsha, Hunan, China
| | - Peng Huang
- Department of Cardiothoracic Surgery, Hunan Children's Hospital, 410007 Changsha, Hunan, China
| | - Mi Tang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, 410011 Changsha, Hunan, China
| | - Xun Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, 410011 Changsha, Hunan, China
| | - Chunle Wang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, 410011 Changsha, Hunan, China
| | - Kun Xiang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, 410011 Changsha, Hunan, China
| | - Wenwu Zhou
- Department of the Cardiovascular Surgery, Hunan Provincial People's Hospital, 410005 Changsha, Hunan, China
| | - Jinfu Yang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, 410011 Changsha, Hunan, China
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van de Woestijne PC, Bakhuis W, Sadeghi AH, Peek JJ, Taverne YJ, Bogers AJ. 3D Virtual Reality Imaging of Major Aortopulmonary Collateral Arteries: A Novel Diagnostic Modality. World J Pediatr Congenit Heart Surg 2021; 12:765-772. [PMID: 34812684 PMCID: PMC8637380 DOI: 10.1177/21501351211045064] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/19/2021] [Accepted: 08/19/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Major aortopulmonary collateral arteries (MAPCAs), as seen in patients with pulmonary atresia, are arteries that supply blood from the aorta to the lungs and often require surgical intervention. To achieve complete repair in the least number of interventions, optimal imaging of the pulmonary arterial anatomy and MAPCAs is critical. 3D virtual reality (3D-VR) is a promising and upcoming new technology that could potentially ameliorate current imaging shortcomings. METHODS A retrospective, proof-of-concept study was performed of all operated patients with pulmonary atresia and MAPCAs at our center between 2010 and 2020 with a preoperative computed tomography (CT) scan. CT images were reviewed by two congenital cardiac surgeons in 3D-VR to determine additional value of VR for MAPCA imaging compared to conventional CT and for preoperative planning of MAPCA repair. RESULTS 3D-VR visualizations were reconstructed from CT scans of seven newborns where the enhanced topographic anatomy resulted in improved visualization of MAPCA. In addition, surgical planning was improved since new observations or different preoperative plans were apparent in 4 out of 7 cases. After the initial setup, VR software and hardware was reported to be easy and intuitive to use. CONCLUSIONS This study showed technical feasibility of 3D-VR reconstruction of children with immersive visualization of topographic anatomy in an easy-to-use format leading to an improved surgical planning of MAPCA surgery. Future prospective studies are required to investigate the clinical benefits in larger populations.
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Affiliation(s)
| | - Wouter Bakhuis
- Thoraxcenter, Erasmus University Medical
Center, Rotterdam, the Netherlands
| | - Amir H. Sadeghi
- Thoraxcenter, Erasmus University Medical
Center, Rotterdam, the Netherlands
| | - Jette J. Peek
- Thoraxcenter, Erasmus University Medical
Center, Rotterdam, the Netherlands
| | | | - Ad J.J.C. Bogers
- Thoraxcenter, Erasmus University Medical
Center, Rotterdam, the Netherlands
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28
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Lawley C, Hockey K, Yeo LL, Liava'a M, Roberts P. Increasing Use of Neonatal Catheter Intervention for Pulmonary Atresia With Intact Ventricular Septum: Management Trends From a Single Centre. Heart Lung Circ 2021; 31:549-558. [PMID: 34654648 DOI: 10.1016/j.hlc.2021.08.025] [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] [Received: 01/30/2021] [Revised: 08/02/2021] [Accepted: 08/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND There is increasing use of catheter-based therapy as part of the neonatal treatment algorithm for pulmonary atresia with an intact ventricular septum (PAIVS). The management strategies utilised and outcomes of patients with PAIVS at our centre have not been examined. METHODS A retrospective case series was undertaken including all infants with PAIVS born January 2009 to July 2019 (follow-up to January 2020) managed at The Children's Hospital at Westmead, New South Wales. Demographic features, anatomical substrate, management pathway and subsequent clinical outcomes were examined. RESULTS Fifty-two (52) infants were included (male n=28, 53.8%). The right ventricular morphology was classified as normal, mildly, moderately and severely hypoplastic in 3 (5.8%), 13 (25.0%), 19 (36.5%) and 17 (32.7%) patients respectively. Thirty-seven (37) patients underwent an initial aortopulmonary (AP) shunt (surgical shunt or patent ductus arteriosus [PDA] stent). The remaining 15 patients underwent an initial intervention to decompress the right ventricle. Twenty (20) patients underwent a neonatal catheter-based intervention. An initial catheter-based intervention was more likely in the second half of the period. Sixteen (16) patients had an attempted pulmonary valve perforation, 12 as their initial procedure. Median follow-up was 62 months (range 3-119 months). Final circulation status was known in 37 patients; biventricular n=14 (37.8%), "1.5 ventricles" n=4 (10.8%), single n=19 (51.4%). There were five deaths during the period (9.6%), including two during the initial procedural admission attributed to tamponade requiring extracorporeal membrane oxygenation (ECMO) at the time of percutaneous pulmonary valve perforation. CONCLUSION There has been an overall trend towards including catheter-based strategies in the neonatal period as part of management at our centre. Given the risk of bleeding and ECMO related to this, consideration should be given to the availability of multidisciplinary support when planning the timing of these procedures.
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Affiliation(s)
- Claire Lawley
- The Heart Centre for Children, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, NSW, Australia; The University of Sydney Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - Kaitlyn Hockey
- The Heart Centre for Children, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, NSW, Australia; School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Lee Lian Yeo
- The Heart Centre for Children, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, NSW, Australia
| | - Matthew Liava'a
- The Heart Centre for Children, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, NSW, Australia
| | - Philip Roberts
- The Heart Centre for Children, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, NSW, Australia
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29
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Luo G, Pan SL, Wan H, Chen TT, Xu Q, Sun Y. [Interim follow-up of fetal cardiac intervention in five fetuses with pulmonary atresia with intact ventricular septum]. Zhonghua Er Ke Za Zhi 2021; 59:782-786. [PMID: 34645220 DOI: 10.3760/cma.j.cn112140-20210219-00141] [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: 06/13/2023]
Abstract
Objective: To summarize the interim outcome and right heart development of pulmonary atresia with intact ventricular septum (PA-IVS) in children after fetal cardiac intervention (FCI). Methods: The clinical data of 5 live births underwent FCI from October 2018 to April 2019 in Women and Children's Hospital, Qingdao University were analyzed retrospectively. The development of right ventricle (RV) and tricuspid valve (TV) in uterus after FCI, at birth, the age of 6 months, 1 year and 2 years, and the final outcome were assessed. Results: Five PA-IVS fetuses were included in this study. The first evaluation was performed at 24-26 weeks of gestational age, and the FCI was performed at 26-28 weeks of gestational age. During the follow-up of 6 weeks after FCI, the minimum diameter of tricuspid annulus increased from 0.85 cm to 0.92 cm, and the minimum Z-score of tricuspid annulus decreased from -0.03 to -1.62. The minimum values of TV/mitral valve annular diameter and RV/left ventricular length ratios of all fetuses increased from 0.57, 0.52 to 0.88, 0.82, respectively. The maximum tricuspid regurgitation velocity decreased from 4.60 m/s to 3.64 m/s. No severe hemodynamic change was found in any of the fetuses. All 5 fetuses were born alive. Three cases underwent percutaneous balloon pulmonary valvuloplasty (PBPV) and stent implantation for ductus arteriosus. Two cases received PBPV alone. At follow-up (26 to 32 months), obvious development of TV was observed 6 months to 1 year after birth in 5 cases with the growth rate ranging from 19.64% to 40.00%. Meanwhile, the RV development was relatively slow at 6 months with the growth rate ranging from 9.41% to 21.42%. There were individual differences in RV development at 2 years. The growth and development of all children were equal to healthy children of the same age with the body mass index less than 18.4 kg/m2. At the last follow-up, all children had a transcutaneous oxygen saturation of greater than 0.95, three became biventricular circulation and two had circulation approximation to biventricular circulation with almost closed stent. Conclusions: The findings support the potential of development of right ventricular and tricuspid valve for fetuses with PA-IVS underwent FCI. All fetuses underwent FCI received intervention after birth, and biventricular circulation can be realized finally. The development of right ventricular and tricuspid valve is not proportional. In utero, the right ventricle develops rapidly, and the development of tricuspid valve is more advantageous after birth.
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Affiliation(s)
- G Luo
- Heart Center, Women and Children's Hospital, Qingdao University, Qingdao 266034, China
| | - S L Pan
- Heart Center, Women and Children's Hospital, Qingdao University, Qingdao 266034, China
| | - H Wan
- Department of Ultrasonography, Women and Children's Hospital, Qingdao University, Qingdao 266034, China
| | - T T Chen
- Department of Ultrasonography, Women and Children's Hospital, Qingdao University, Qingdao 266034, China
| | - Q Xu
- Department of Obstetrics, Women and Children's Hospital, Qingdao University, Qingdao 266034, China
| | - Y Sun
- Department of Obstetrics, Women and Children's Hospital, Qingdao University, Qingdao 266034, China
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Kamalı H, Tanıdır İC, Erdem A, Sarıtaş T, Güzeltaş A. The Use of Chronic Total Occlusion (CTO) Wires for Perforation of Atretic Pulmonary Valve; Two Centers Experience. Pediatr Cardiol 2021; 42:1041-1048. [PMID: 33844078 DOI: 10.1007/s00246-021-02578-1] [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: 10/03/2020] [Accepted: 02/25/2021] [Indexed: 11/25/2022]
Abstract
Pulmonary valve atresia with intact ventricular septum (PA-IVS) can be treated either surgically or transcatheterly for eligible patients. Perforation of pulmonary valves using chronic total occlusion (CTO) guidewires has been reported as an alternative to radiofrequency (RF) perforation. We sought to report our experience with CTO guidewires for perforation of atretic pulmonary valves and subsequent balloon dilatation (with or without patent ductus arteriosus stenting) in patients with PA-IVS from two centers. A retrospective study was carried out on PA-IVS patients who underwent intervention between March 2014 and September 2019, in which CTO guidewire was employed for pulmonary valve perforation. A total of 26 patients were identified. The median age and weight of the patients were 5.2 days (range 1-21 days) and 3.1 kg (range 2.2-3.8 kg), respectively. All patients were situs solitus, except one patient with left atrial isomerism. The right ventricle (RV) morphology was bipartite in 22/26 patients and tripartite in 4/26 patients. Before the procedure, the mean saturation was 76% (range 70-86%) while the patients were under prostaglandin infusion. The pulmonary valve perforation attempt was performed with the Asahi Conquest Pro 9 CTO wire (n = 6) or Asahi Pro 12 CTO wire (n = 18) and/or Asahi Miracle CTO wire (n = 2). The procedure was successful in 20/26 (77%) patients using CTO wires. We analyzed the efficiency of CTO wire based on the subtypes: Conquest Pro 9 in 6/6 (100%) patients, Conquest Pro 12 in 12/18 (67%) patients, and Miracle in 2/2 (100%) patients. Before CTO wire usage in 3 patients, radiofrequency (RF) perforation was unsuccessful. Among these 3 patients, pulmonary valve perforation was successful in 2 patients with CTO wire; hence, in the remaining patient, perforation was also unsuccessful with CTO wire. After CTO wire perforation was unsuccessful in 6 patients, RF perforation was attempted in 3 patients (2 successful attempts and 1 unsuccessful attempts), and one patient as referred to surgery. Desaturation was persistent in 19 cases, which necessitated ductus arteriosus stenting. Early procedural complication was observed in 3/26 (11%) patients. Two of these patients had vascular complications due to the sheath, which was treated with heparin infusion and streptokinase, and the remaining patient had sudden bradycardia and cardiac arrest during the procedure and did not respond to cardiac resuscitation. CTO wires should be keep in mind for atretic pulmonary valve perforation as a first choice or when RF perforation is unsuccessful.
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Affiliation(s)
- Hacer Kamalı
- Department of Pediatric Cardiology, Istanbul Health Scıence University, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istasyonmahallesi Turgut Özal Bulvarı Küçükçekmece, 34303, Istanbul, Turkey.
| | - İbrahim Cansaran Tanıdır
- Department of Pediatric Cardiology, Istanbul Health Scıence University, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istasyonmahallesi Turgut Özal Bulvarı Küçükçekmece, 34303, Istanbul, Turkey
| | - Abdullah Erdem
- Department of Pediatric Cardiology, Istanbul Medipol Universıty, Istanbul, Turkey
| | - Türkay Sarıtaş
- Department of Pediatric Cardiology, Istanbul Medipol Universıty, Istanbul, Turkey
| | - Alper Güzeltaş
- Department of Pediatric Cardiology, Istanbul Health Scıence University, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istasyonmahallesi Turgut Özal Bulvarı Küçükçekmece, 34303, Istanbul, Turkey
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31
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LaPar DJ, Moroi MK, Nguyen SN, Bacha EA. Neonatal Cone Valvuloplasty for Pulmonary Atresia/Intact Ventricular Septum and Ebsteinoid Valve. Ann Thorac Surg 2021; 112:e345-e347. [PMID: 33421397 DOI: 10.1016/j.athoracsur.2020.09.086] [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] [Received: 05/08/2020] [Revised: 07/16/2020] [Accepted: 09/27/2020] [Indexed: 11/18/2022]
Abstract
Pulmonary atresia with intact ventricular septum (PA/IVS) is a rare lesion with wide anatomic variability. A rare variant exists, marked by right-sided dilatation, an Ebsteinoid tricuspid valve (TV), and severe tricuspid regurgitation. Neonatal cone valvuloplasty allows for a biventricular circulation and avoids complications of prosthetic valves; however, this technique inevitably requires reintervention to exchange the RV-PA conduit as the patient grows. We present a successful complete repair cone tricuspid valvuloplasty in a 9-day-old (2.8 kg) neonate with trisomy 21, PA/IVS, and an Ebsteinoid TV.
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Affiliation(s)
- Damien J LaPar
- Section of Congenital and Pediatric Cardiothoracic Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Morgan Stanley Children's Hospital, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York; Vascular Surgery, Department of Surgery, Morgan Stanley Children's Hospital, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York.
| | - Morgan K Moroi
- Section of Congenital and Pediatric Cardiothoracic Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Morgan Stanley Children's Hospital, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York; Vascular Surgery, Department of Surgery, Morgan Stanley Children's Hospital, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Stephanie N Nguyen
- Section of Congenital and Pediatric Cardiothoracic Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Morgan Stanley Children's Hospital, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York; Vascular Surgery, Department of Surgery, Morgan Stanley Children's Hospital, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Emile A Bacha
- Section of Congenital and Pediatric Cardiothoracic Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Morgan Stanley Children's Hospital, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York; Vascular Surgery, Department of Surgery, Morgan Stanley Children's Hospital, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York
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32
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Hayashi T, Ono H, Kaneko Y. Association of Preoperative Mixed Venous Oxygen Saturation with Postoperative Segmental Pulmonary Hypertension in Pulmonary Atresia with Ventricular Septal Defect and Major Aortopulmonary Collaterals. Pediatr Cardiol 2020; 41:1689-1696. [PMID: 32710283 DOI: 10.1007/s00246-020-02428-6] [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: 05/18/2020] [Accepted: 07/21/2020] [Indexed: 11/25/2022]
Abstract
In patients with pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries (PA/VSD/MAPCAs), segmental pulmonary hypertension is common; however, its pathophysiology remains to be elucidated. This study aimed to identify preoperative hemodynamic factors associated with segmental pulmonary hypertension after intracardiac repair in patients with PA/VSD/MAPCAs. This study included 12 patients with PA/VSD/MAPCAs who underwent unifocalization and intracardiac repair from 2009 at our institution. Hemodynamic measurements of preoperative and postoperative cardiac catheterization were collected. Patients were considered to have pulmonary hypertension if the mean pulmonary pressure measured postoperatively at any peripheral pulmonary artery was ≥ 20 mmHg. The data were compared between patients with and without postoperative segmental pulmonary hypertension; p value < 0.05 was considered statistically significant. Intracardiac repair was performed at the age of 2.1 years (range 0.5-28.2 years). Unifocalization was performed separately prior to intracardiac repair in two patients and concomitantly in 10 patients. Postoperative cardiac catheterization, performed 1.2 years (range 0.2-8.7 years) after intracardiac repair, revealed that five patients had segmental pulmonary hypertension. Patients with postoperative pulmonary hypertension had significantly lower preoperative mixed venous oxygen saturation than those without pulmonary hypertension (57% [55-63%] vs. 65% [53-75%], p < 0.05). No significant differences were found between the groups in terms of age at intracardiac repair, preoperative arterial oxygen saturation, and preoperative peripheral pulmonary arterial mean pressure. Lower preoperative mixed venous oxygen saturation was associated with segmental pulmonary hypertension after intracardiac repair in patients with PA/VSD/MAPCAs.
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Affiliation(s)
- Taiyu Hayashi
- Division of Cardiology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 1578535, Japan.
| | - Hiroshi Ono
- Division of Cardiology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 1578535, Japan
| | - Yukihiro Kaneko
- Division of Cardiovascular Surgery, National Center for Child Health and Development, Tokyo, Japan
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Gottschalk I, Strizek B, Jehle C, Stressig R, Herberg U, Breuer J, Brockmeier K, Hellmund A, Geipel A, Gembruch U, Berg C. Prenatal Diagnosis and Postnatal Outcome of Fetuses with Pulmonary Atresia and Ventricular Septal Defect. Ultraschall Med 2020; 41:514-525. [PMID: 30616264 DOI: 10.1055/a-0770-2832] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To assess the intrauterine course, associated conditions and postnatal outcome of fetuses with pulmonary atresia with ventricular septal defect (PAVSD). METHODS All cases of PAVSD diagnosed prenatally over a period of 10 years with a minimum follow-up of 6.5 years were retrospectively collected in 3 tertiary referral centers. RESULTS 50 cases of PAVSD were diagnosed prenatally. 44.0 % of fetuses had isolated PAVSD, 4.0 % had associated cardiac anomalies, 10.0 % had extra-cardiac anomalies, 38.0 % had chromosomal anomalies, 4.0 % had non-chromosomal syndromes. Among the 32 liveborn children, 56.3 % had reverse flow in the patent arterial duct, 25.0 % had major aortopulmonary collateral arteries (MAPCAs) with ductal agenesis and 18.7 % had a double supply. 17 pregnancies were terminated (34.0 %), there was 1 intrauterine fetal death (2.0 %), 1 neonatal death (2.0 %), and 6 deaths (12.0 %) in infancy. 25 of 30 (83.3 %) liveborn children with an intention to treat were alive at the latest follow-up. The mean follow-up among survivors was 10.0 years (range 6.5-15.1). 56.0 % of infants underwent staged repair, 44.0 % had one-stage complete repair. After exclusion of infants with additional chromosomal or syndromal anomalies, 88.9 % were healthy, and 11.1 % had mild limitations. The presence of MAPCAs did not differ significantly between survivors and non-survivors (p = 0.360), between one-stage or staged repair (p = 0.656) and healthy and impaired infants (p = 0.319). CONCLUSION The prognosis in cases without chromosomal or syndromal anomalies is good. MAPCAs did not influence prognosis or postoperative health. The incidence of repeat interventions due to recurrent stenoses is significantly higher after staged compared with single-stage repair.
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Affiliation(s)
- Ingo Gottschalk
- Division of Prenatal Medicine, University-Hospital of Cologne, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University-Hospital of Bonn, Germany
| | - Christel Jehle
- Division of Prenatal Medicine, University-Hospital of Cologne, Germany
| | - Rüdiger Stressig
- Praenatal.plus Prenatal Medicine and Genetics, praenatal.plus Cologne, Germany
| | - Ulrike Herberg
- Department of Pediatric Cardiology, University-Hospital of Bonn, Germany
| | - Johannes Breuer
- Department of Pediatric Cardiology, University-Hospital of Bonn, Germany
| | - Konrad Brockmeier
- Department of Pediatric Cardiology, University-Hospital of Cologne, Germany
| | - Astrid Hellmund
- Department of Obstetrics and Prenatal Medicine, University-Hospital of Bonn, Germany
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University-Hospital of Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University-Hospital of Bonn, Germany
| | - Christoph Berg
- Division of Prenatal Medicine, University-Hospital of Cologne, Germany
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Ikai A. [Surgical Strategy for Pulmonary Atresia with Ventricular Septal Defect with Major Aortopulmonary Collateral Artery]. Kyobu Geka 2020; 73:805-811. [PMID: 33130770] [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: 06/11/2023]
Abstract
Although the characteristics and pathophysiology of major aortopulmonary collateral artery (MAPCA) have been better understood, treatment of pulmonary atresia and ventricular septal defect with MAPCA remains challenging. The difficulty in treating this disease is the lack of availability of pulmonary homografts required for pulmonary angioplasty in Japan and the need for manipulation of the posterior mediastinum region, which is not performed in normal cardiac surgery. It is important to build an appropriate surgical strategy by means of preoperative computed tomography( CT) and selective angiography. For treatment, unifocalization or rehabilitation is selected depending on the condition of MAPCA and central pulmonary artery. Because unifocalization is highly invasive, it would be performed at 6 months of age and weigh 5 kg. As a procedure, extensive dissection is performed, and anastomoses between tissue to tissue are basically performed, and reconstruction of the right ventricular outflow tract is performed using a valved conduit that can secure anterograde pulmonary blood flow that is not affected by the condition of the lung. It is effective to confirm postoperative lung perfusion scan and CT, perform a cardiac catheterization test approximately 6 months after surgery, and maintain the pulmonary vessels with catheter intervention if necessary. The ultimate goal of treating this disease is not only to improve cyanosis, but also to maintain pulmonary circulation at lower right ventricular pressure.
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Affiliation(s)
- Akio Ikai
- Department of Cardiovascular Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
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35
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Linnane N, Cox DW, James A. A case of COVID-19 in a patient with a univentricular heart post total cavopulmonary connection (Fontan) surgery. Cardiol Young 2020; 30:1350-1352. [PMID: 32613935 PMCID: PMC7322153 DOI: 10.1017/s1047951120001882] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 12/11/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has caused a global pandemic which has affected patients and healthcare systems around the world. Patients with underlying health conditions seem to be more severely affected. There are limited reports of patients with univentricular circulations and COVID 19; thus, we report a case of COVID-19 in a patient with a univentricular circulation.
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Affiliation(s)
- Niall Linnane
- Department of Cardiology and Cardiac Surgery, Children’s Health Ireland, Crumlin, Dublin, Ireland
| | - Des W. Cox
- Department of Respiratory Medicine, Children’s Health Ireland, Crumlin, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Adam James
- Department of Cardiology and Cardiac Surgery, Children’s Health Ireland, Crumlin, Dublin, Ireland
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36
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Agasthi P, Graziano JN, Pophal SG. Percutaneous Closure of a "Doughnut Leak" Around an Atrial Septal Occluder Device in a Patient With Recurrent Migraines. J Invasive Cardiol 2020; 32:E242-E243. [PMID: 32865512] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A 10-year-old girl with pulmonary atresia status post transannular patch repair and secundum atrial septal defect (ASD) underwent percutaneous ASD closure 5 years earlier. There was improvement in arterial saturation from 86% to 98% with minimal residual right-to-left shunt. Despite subsequent medical therapy, she developed recurrent migraines, which led us to pursue percutaneous closure of the shunt.
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Affiliation(s)
- Pradyumna Agasthi
- Department of Cardiovascular Diseases, Mayo Clinic, 5779 East Mayo Blvd, Phoenix, AZ 85054 USA. pradyumna_agasthi@ hotmail.com
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Kozik D, Dydynski P, Austin E, Alsoufi B. Unusual Case of Common Arterial Trunk With Atresia of the Right Pulmonary Artery and Aortopulmonary Collaterals. World J Pediatr Congenit Heart Surg 2020; 11:534-536. [PMID: 32645783 DOI: 10.1177/2150135120913807] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe a two-year-old African girl with late diagnosis of unusual case of common arterial trunk with two separate pulmonary artery branch origins from the ascending aorta, hypoplastic right pulmonary artery that becomes atretic and reconstitutes at hilum, and three aortopulmonary collaterals providing right lung blood supply. She underwent single-stage intracardiac repair and unifocalization of collaterals.
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Affiliation(s)
- Deborah Kozik
- Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, KY, USA
| | - Philip Dydynski
- Department of Radiology, Norton Children's Hospital, Louisville, KY, USA
| | - Erle Austin
- Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, KY, USA
| | - Bahaaldin Alsoufi
- Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, KY, USA
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38
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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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Zhao LQ, Chen S, Wu YR, Yang JP, Jiao XT, Jin WH, Sun K. [Efficacy of transcatheter pulmonary valve perforation by micro-guidewire and balloon dilation in neonates with pulmonary atresia with intact ventricular septum]. Zhonghua Er Ke Za Zhi 2020; 58:96-100. [PMID: 32102144 DOI: 10.3760/cma.j.issn.0578-1310.2020.02.006] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Objective: To investigate the safety and efficacy of transcatheter perforation of pulmonary valve by micro-guidewire and balloon dilation in the treatment of neonatal pulmonary atresia with intact ventricular septum (PA-IVS). Methods: The retrospective study included 21 neonates (14 males and 7 females) with PA-IVS who underwent transcatheter micro-guidewire pulmonary valve perforation and balloon dilation in Xinhua Hospital from January 2012 to December 2018. All patients underwent the pulmonary valve perforation by micro-guidewire through the Simmons catheter. During the follow-up period at 1, 3, 6, 12 months postoperatively and annually thereafter, the operative efficacy and the development of the right ventricle (RV) were evaluated by echocardiography. Statistical analyses were performed using t test. Results: A total of 21 neonates with PA-IVS were enrolled, and 13 cases were diagnosed prenatally. The median age of surgery was 6 days, the weight was (3.2±0.5) kg. The balloon/valve ratio was 1.19±0.12, and the RV pressure measured by catheter was (121±33) mmHg (1 mmHg=0.133 kPa) . The immediate postoperative RV pressure was (47±13) mmHg. The median follow-up time was 30 months. All the cases enrolled achieved biventricular circulation without death and serious complications. According to the last follow-up data including 16 cases who were followed up for 1 year or longer, the pulmonary artery transvalvular pressure was (29±15) mmHg. The postoperation ratio of right to left ventricular transverse diameter was significantly higher than that before operation (0.86+0.10 vs. 0.73+0.13, t=-2.96, P=0.006). Compared with preoperative data, the postoperation pulmonary valvular diameter Z-score was significantly higher (-1.41±0.89 vs. -2.83±1.06, t=-3.65, P=0.001) and the tricuspid valvular diameter Z-score was significantly higher (-0.52±0.29 vs. -1.34±0.81, t=-3.55, P=0.001). Conclusion: Transcatheter perforation of pulmonary valve by micro-guidewire and balloon dilation is a safe and effective initial therapy for neonatal PA-IVS.
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Affiliation(s)
- L Q Zhao
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - S Chen
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Y R Wu
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - J P Yang
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - X T Jiao
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - W H Jin
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - K Sun
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
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Abstract
BACKGROUND The optimal surgical strategy for pulmonary atresia with ventricular septal defect (PA/VSD) in neonates and young infants is controversial. Staged repair may be associated with a higher risk of inter-stage mortality, while primary repair may lead to frequent post-repair re-interventions. METHODS From 2004 to 2017, 65 patients with PA/VSD who underwent surgical intervention before 90 days of age were identified and enrolled in this retrospective study. The cohort was divided into two groups: group-SR, who underwent initial palliation with staged repair (n = 50), and group-PR who underwent primary repair (n = 15). RESULTS There were three post-palliation in-hospital mortalities, four inter-stage mortalities, and one post-repair in-hospital mortality in group-SR. In group-PR, there was one in-hospital death and one late death. Five-year survival rates were comparable between the two groups (group-SR: 83.6%; group-PR: 86.7%; p = 0.754). During the median follow-up duration of 44.7 months (Inter-quartile range, 19-109 months), 40 post-repair re-interventions (22 in group-SR, 18 in group-PR) were performed in 26 patients (18 in group-SR, 8 in group-PR). On Cox proportional hazards model, primary repair was identified as the only risk factor for decreased time to death/1st post-repair re-intervention (Hazard ratio (HR): 2.3, p = 0.049) and death/2nd post-repair re-intervention (HR 2.91, p = 0.033). CONCLUSIONS A staged repair strategy, compared with primary repair, was associated with comparable overall survival with less frequent re-interventions after repair in young infants with PA/VSD. Lowering the inter-stage mortality after initial palliation by vigilant outpatient care and aggressive home monitoring may be the key to better surgical outcomes in this subset. Surgical outcomes of PA with VSD according to the surgical strategies. Patient 1 (birth weight: 2.7 kg) underwent primary Rastelli-type repair at post-natal day # 50 (body weight: 3.8 kg) using Contegra® 12 mm. The postoperative course was rocky, with long ventilatory support (10 days), ICU stay (14 days), and hospital stay (20 days). Cardiac CT scan at 9 months post-repair showed severe branch pulmonary artery stenosis, which necessitated LPA stenting at 12 months post-repair and RV-PA conduit replacement with extensive pulmonary artery reconstruction at 25 months post-repair. Patient 2 (birth weight: 2.5 kg) underwent RMBT at post-natal day #30 (body weight: 3.4 kg) using 4 mm PTFE vascular graft and staged Rastelli-type repair at post-natal 11 months using a hand-made Gore-Tex valved conduit (14 mm). No post-repair re-intervention has been performed. Cardiac CT scan at 90 months post-repair showed no branch pulmonary artery stenosis.CT computed tomography, ICU intensive care unit, LPA left pulmonary artery, PA pulmonary atresia, PTFE polytetrafluoroethylene, RMBT right modified Blalock-Taussig shunt, RV-PA right ventricle to pulmonary artery, VSD ventricular septal defect.
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Affiliation(s)
- Won Young Lee
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Seung Ri Kang
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Yu Mi Im
- College of Nursing, Dankook University, Cheonan, Republic of Korea
| | - Tae-Jin Yun
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea.
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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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Bauser-Heaton H, Ma M, McElhinney DB, Goodyer WR, Zhang Y, Chan FP, Asija R, Shek J, Wise-Faberowski L, Hanley FL. Outcomes After Aortopulmonary Window for Hypoplastic Pulmonary Arteries and Dual-Supply Collaterals. Ann Thorac Surg 2019; 108:820-827. [PMID: 30980823 DOI: 10.1016/j.athoracsur.2019.03.022] [Citation(s) in RCA: 7] [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] [Received: 01/16/2019] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Our institutional approach to tetralogy of Fallot with major aortopulmonary collateral arteries (MAPCAs) emphasizes early unifocalization and complete repair (CR). In the small subset of patients with dual-supply MAPCAs and confluent but hypoplastic central pulmonary arteries (PAs), our surgical approach is early creation of an aortopulmonary window (APW) to promote PA growth. Factors associated with successful progression to CR and mid-term outcomes have not been assessed. METHODS Clinical data were reviewed. PA diameters were measured offline from angiograms prior to APW and on follow-up catheterization >1 month after APW but prior to any additional surgical interventions. RESULTS From November 2001 to March 2018, 352 patients with tetralogy of Fallot/MAPCAs underwent initial surgery at our center, 40 of whom had a simple APW with or without ligation of MAPCAs as the first procedure (median age, 1.4 months). All PA diameters increased significantly on follow-up angiography. Ultimately, 35 patients underwent CR after APW. Nine of these patients (26%) underwent intermediate palliative operation between 5 and 39 months (median, 8 months) after APW. There were no early deaths. The cumulative incidence of CR was 65% 1 year post-APW and 87% at 3 years. Repaired patients were followed for a median of 4.2 years after repair; the median PA:aortic pressure ratio was 0.39 (range, 0.22 to 0.74). CONCLUSIONS Most patients with tetralogy of Fallot/MAPCAs and hypoplastic but normally arborizing PAs and dual-supply MAPCAs are able to undergo CR with low right ventricular pressure after APW early in life. Long-term outcomes were good, with acceptable PA pressures in most patients.
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Affiliation(s)
- Holly Bauser-Heaton
- Department of Pediatrics, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
| | - Michael Ma
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
| | - Doff B McElhinney
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California.
| | - William R Goodyer
- Department of Pediatrics, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
| | - Yulin Zhang
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
| | - Frandics P Chan
- Department of Radiology, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
| | - Ritu Asija
- Department of Pediatrics, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
| | - Jennifer Shek
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
| | - Lisa Wise-Faberowski
- Department of Anesthesia, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
| | - Frank L Hanley
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
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Kaneko Y, Achiwa I, Kondo R, Takei T. [Total Repair of Pulmonary Atresia, Ventricular Septal Defect, and Major Aorto-pulmonary Collateral Arteries That were Deemed Unrepairable in an Adolescent and Adults]. Kyobu Geka 2019; 72:263-268. [PMID: 31266911] [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
Pulmonary atresia, ventricular septal defect, and major aorto-pulmonary collateral arteries are deemed unrepairable in some patients. Reportedly, 39% to 63% of patients treated by the staged unifocalization pathway, and 25% to 51% of patients treated by the pulmonary artery rehabilitation strategy were deemed unsuitable to undergo total repair. Single-stage complete unifocalization with intracardiac repair can be performed in some older patients with pulmonary atresia, ventricular septal defect, and major aorto-pulmonary collateral arteries that were previously deemed unrepairable. We report four such patients with ages between 12 years and 28 years at surgery. Bosentan hydrate was administered pre-operatively in one female patient for 14 months to ameliorate regional pulmonary hypertension. Seventeen months after repair, she delivered a baby by cesarean section. One patient underwent aortic valve replacement concomitant with repair due to severe aortic regurgitation caused by healed infective endocarditis. All patients were discharged home 9 to 18 days after surgery. After 72 to 100 months of follow-up, three patients are in New York Heart Association (NYHA) class Ⅰ, and the remaining patient are in NYHA class Ⅱ. Single-stage complete unifocalization can allow total repair in adolescents and adults with pulmonary atresia, ventricular septal defect, and major aorto-pulmonary collateral arteries that were previously deemed unrepairable.
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Affiliation(s)
- Yukihiro Kaneko
- Division of Cardiovascular Surgery, National Medical Center for Children and Mothers, Tokyo, Japan
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44
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LaPar DJ, Bacha E. Pulmonary Atresia With Intact Ventricular Septum With Borderline Tricuspid Valve: How Small Is Too Small. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2019; 22:27-31. [PMID: 31027561 DOI: 10.1053/j.pcsu.2019.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 02/04/2019] [Accepted: 02/26/2019] [Indexed: 06/09/2023]
Abstract
PA/IVS is a rare, heterogenous congenital heart defect anatomically defined by complete obstruction to the right ventricular outflow tract with varying degrees of hypoplasia of the right ventricle and tricuspid valve. This lesion can have associated coronary artery anomalies and, in some cases, right ventricular-dependent coronary circulation. Due to the wide spectrum of presenting anatomic and clinical features, the treatment options are often dictated by the degree of development of the tricuspid valve and right ventricle. The purpose of this review is to discuss the spectrum of pulmonary atresia with intact ventricular septum morphologies and to evaluate the surgical decision-making process and approaches to surgical repair with respect to the impact of hypoplastic right-sided cardiac features.
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Affiliation(s)
- Damien J LaPar
- Congenital and Pediatric Cardiac Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University, New York, New York.
| | - Emile Bacha
- Congenital and Pediatric Cardiac Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University, New York, New York
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Tezza M, Witsenburg M, Nieman K, van de Woestijne PC, Budde RPJ. Cardiac CT to assess the risk of coronary compression in patients evaluated for percutaneous pulmonary valve implantation. Eur J Radiol 2018; 110:88-96. [PMID: 30599879 DOI: 10.1016/j.ejrad.2018.11.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 04/04/2018] [Revised: 09/06/2018] [Accepted: 11/19/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Coronary compression (CC) is a life threatening complication that can occur during percutaneous pulmonary valve implantation (PPVI). We describe our experience using cardiac CT prior to PPVI to identify patients at high CC-risk due to a close relationship between the coronary arteries and pulmonary trunk (PT). METHODS A retrospective evaluation of candidates for PPVI who underwent CT prior to the procedure was done. Measurements of PT were performed using double oblique reconstructed images, with special attention to the stenotic tract of the PT. The analysis of coronary arteries included detection of anomalies of origin and course and assessment of their relationship with the PT, measuring the minimum distance between the coronary artery and the intended site of the future percutaneous valve implantation. RESULTS CT analysis was performed for 52 patients. Thirty patients underwent PPVI after CT and 22 didn't. In 6/22 cases the reason not to receive a PPVI was high CC-risk detected at CT. In 6 other patients CT detected an intermediate CC-risk but the test balloon performed during angiography prior to valve placement was safe and the patients successfully underwent the procedure. None of the patients deemed as no CC-risk at CT had CC during PPVI. CONCLUSION CT can detect patients with high and intermediate CC-risk and therefore may identify which patients are unlikely to undergo successful PPVI and those who need a careful analysis with balloon testing. CT can also rule out CC-risk identifying those patients in which balloon inflation testing could be omitted.
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Affiliation(s)
- Michela Tezza
- Department of Radiology, Erasmus Medical Center, 's Gravendijkwal 230, 3015, CE Rotterdam, The Netherlands; Department of Radiology, Fracastoro Hospital ULSS 9, v. Circonvallazione 1, San Bonifacio, 37047, Verona, Italy.
| | - Maarten Witsenburg
- Department of Cardiology, Erasmus Medical Center, 's Gravendijkwal 230, 3015, CE Rotterdam, The Netherlands
| | - Koen Nieman
- Department of Radiology, Erasmus Medical Center, 's Gravendijkwal 230, 3015, CE Rotterdam, The Netherlands; Department of Cardiology, Erasmus Medical Center, 's Gravendijkwal 230, 3015, CE Rotterdam, The Netherlands
| | - Pieter C van de Woestijne
- Department of Cardiothoracic Surgery, Erasmus Medical Center, 's Gravendijkwal 230, 3015, CE Rotterdam, The Netherlands
| | - Ricardo P J Budde
- Department of Radiology, Erasmus Medical Center, 's Gravendijkwal 230, 3015, CE Rotterdam, The Netherlands; Department of Cardiology, Erasmus Medical Center, 's Gravendijkwal 230, 3015, CE Rotterdam, The Netherlands
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Abstract
Charcot-Marie-Tooth disease comprises a vast array of defects in myelin integrity that causes progressive peripheral sensorimotor neuropathy. It is the most prevalent inherited peripheral neuropathy, and it can affect the management of coexisting medical conditions. We report the case of a 25-year-old woman who had undergone successful Fontan surgery during childhood, but her Fontan circulation failed as a result of diaphragmatic paresis caused by Charcot-Marie-Tooth disease type 1A. This diagnosis precluded cardiac transplantation.
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Tulzer A, Arzt W, Gitter R, Prandstetter C, Grohmann E, Mair R, Tulzer G. Immediate effects and outcome of in-utero pulmonary valvuloplasty in fetuses with pulmonary atresia with intact ventricular septum or critical pulmonary stenosis. Ultrasound Obstet Gynecol 2018; 52:230-237. [PMID: 29569770 PMCID: PMC6100104 DOI: 10.1002/uog.19047] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 02/15/2018] [Accepted: 02/23/2018] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To assess the immediate effects of fetal pulmonary valvuloplasty on right ventricular (RV) size and function as well as in-utero RV growth and postnatal outcome. METHODS Patients with pulmonary atresia with intact ventricular septum (PAIVS) or critical pulmonary stenosis (CPS) who underwent fetal pulmonary valvuloplasty at our center between October 2000 and July 2017 were included. Echocardiographic data obtained before and after the procedure were analyzed retrospectively (median interval after intervention, 1 (range, 1-3) days) for ventricular and valvular dimensions and ratios, RV filling time (duration of tricuspid valve (TV) inflow/cardiac cycle length), TV velocity time integral (TV-VTI) × heart rate (HR) and tricuspid regurgitation (TR) velocity. Longitudinal data were collected from only those fetuses followed up in our center. Outcome was assessed using the scoring system as described by Roman et al. for non-biventricular outcome. RESULTS Thirty-five pulmonary valvuloplasties were performed in our institution on 23 fetuses with PAIVS (n = 15) or CPS (n = 8). Median gestational age at intervention was 28 + 4 (range, 23 + 6 to 32 + 1) weeks. No fetal death occurred. Immediately after successful intervention, RV/left ventricular length (RV/LV) ratio (P ≤ 0.0001), TV/mitral valve annular diameter (TV/MV) ratio (P ≤ 0.001), RV filling time (P ≤ 0.00001) and TV-VTI × HR (P ≤ 0.001) increased significantly and TR velocity (P ≤ 0.001) decreased significantly. In fetuses followed longitudinally to delivery (n = 5), RV/LV and TV/MV ratios improved further or remained constant until birth. Fetuses with unsuccessful intervention (n = 2) became univentricular, all others had either a biventricular (n = 15), one-and-a-half ventricular (n = 3) or still undetermined (n = 3) outcome. Five of nine fetuses with a predicted non-biventricular outcome, in which the procedure was successful, became biventricular, while two of nine had an undetermined circulation. CONCLUSION In selected fetuses with PAIVS or CPS, in-utero pulmonary valvuloplasty led immediately to larger RV caused by reduced afterload and increased filling, thus improving the likelihood of biventricular outcome even in fetuses with a predicted non-biventricular circulation. © 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A. Tulzer
- Children's Heart Center Linz, Department of Pediatric CardiologyKepler University HospitalLinzAustria
| | - W. Arzt
- Institute of Prenatal MedicineKepler University HospitalLinzAustria
| | - R. Gitter
- Children's Heart Center Linz, Department of Pediatric CardiologyKepler University HospitalLinzAustria
| | - C. Prandstetter
- Children's Heart Center Linz, Department of Pediatric CardiologyKepler University HospitalLinzAustria
| | - E. Grohmann
- Children's Heart Center Linz, Department of Pediatric CardiologyKepler University HospitalLinzAustria
| | - R. Mair
- Children's Heart Center Linz, Department of Pediatric Cardiac SurgeryKepler University HospitalLinzAustria
| | - G. Tulzer
- Children's Heart Center Linz, Department of Pediatric CardiologyKepler University HospitalLinzAustria
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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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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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Affiliation(s)
- Ronald K Woods
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin and Herma Heart Center and Children's Hospital of Wisconsin, Milwaukee, Wis.
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