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Alsoufi B. Invited Commentary: One Home Run Is Much Better Than Two Doubles. World J Pediatr Congenit Heart Surg 2024; 15:277-278. [PMID: 38753880 DOI: 10.1177/21501351241232073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Affiliation(s)
- 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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Kandachar PS, Varughese NA, Kaur C, AlFarqani AM, Al Lawati A. Mogul in a Baby. Sultan Qaboos Univ Med J 2023; 23:71-73. [PMID: 38161758 PMCID: PMC10754303 DOI: 10.18295/squmj.12.2023.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/16/2023] [Accepted: 07/12/2023] [Indexed: 01/03/2024] Open
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Mini N, Schneider MBE, Asfour B, Mikus M, Zartner PA. Duct Stenting vs. Modified Blalock-Taussig Shunt: New Insights Learned From High-Risk Patients With Duct-Dependent Pulmonary Circulation. Front Cardiovasc Med 2022; 9:933959. [PMID: 35811693 PMCID: PMC9261874 DOI: 10.3389/fcvm.2022.933959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 05/23/2022] [Indexed: 11/28/2022] Open
Abstract
Background As no data were available on the comparison of outcomes between modified Blalock-Taussig shunts (MBTs) vs. duct-stenting (DS) in patients with pulmonary atresia (PA) and an increased ductal tortuosity and in patients with pulmonary atresia and intact septum (PA-IVS) with right ventricle-dependent coronary circulation (RVDCC), we aimed to perform a single-center retrospective evaluation. Methods Between 2010 and 2019, 127 patients with duct-dependent pulmonary circulation (DDPC) underwent either MBTs (without additional repairs) (n = 56) or DS (n = 71). The primary endpoint was defined as arriving at the next planned surgery (Glenn or biventricular repair) avoiding one of the following: (1) unplanned surgery or unplanned perforation of the pulmonary valve (PVP) with a stent, (2) procedure-related permanent complications, and (3) death. Two subgroups were considered: (1) patients who had a ductal curvature index (DCI) >0.45 (n = 32) and (2) patients with PA-IVS and RVDCC (n = 13). Ductal curvature index (DCI) was measured in all the patients to assess the tortuosity of the ducts. Patients with DCI >0.45 were considered as being in a high-risk group for the duct-stenting; a previous study showed that the patients with a DCI < 0.45 had a better outcome when compared with those with a DCI> 0.45. Results The primary outcome was achieved equally in the two groups (77.5% in DS, 75% in MBTs). Hospital deaths, need for ECMO, and the occurrence of major complications was more frequent in the group with MBTs with an Odds Ratio (OR) of 5, 0.8, and 4, respectively, and a 95% Confidence Interval (CI) 1.1–22.6, 0.7–0.9, and 1.6–10.3, respectively, and a P-value < 0.05. For the two subgroups, the primary outcome was achieved in 64% of patients with a DCI >0.45 who received MBTs compared to 20% in those with DS (OR 3.5, 95% CI 1.2–10, P 0.005). While 74.1% of the patients with PA-IVS and RVDCC after DS had achieved the primary outcome, all patients with MBTs had an impaired outcome (OR 3.5, 95%CI 1–11.2, P 0.004). Conclusion MBTs showed a better outcome in patients with tortuous ducts compared to DS. DS seems to be superior in patients with DDPC with DCI <0.45 and patients with PA-IVS with RVDCC.
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Affiliation(s)
- Nathalie Mini
- Department of Cardiology, German Pediatric Heart Center, University Hospital of Bonn, Bonn, Germany
- *Correspondence: Nathalie Mini
| | - Martin B. E. Schneider
- Department of Cardiology, German Pediatric Heart Center, University Hospital of Bonn, Bonn, Germany
| | - Boulos Asfour
- Department of Pediatric Cardiac Surgery, German Pediatric Heart Center, University Hospital of Bonn, Bonn, Germany
| | - Marian Mikus
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Peter A. Zartner
- Department of Cardiology, German Pediatric Heart Center, University Hospital of Bonn, Bonn, Germany
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Possible Association of Pulmonary Atresia with In-Utero Coxsackievirus B Exposure. Pediatr Cardiol 2022; 43:960-968. [PMID: 35022808 PMCID: PMC8754073 DOI: 10.1007/s00246-021-02805-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/09/2021] [Indexed: 11/07/2022]
Abstract
Gestational viral infection has been associated with congenital heart disease (CHD). Few studies, however, have studied the potential role of gestational Coxsackievirus B (CVB) exposure in the pathogenesis of CHD. We prospectively enrolled women with pregnancies affected by CHD to explore possible associations with in utero CVB exposure. Serum samples were obtained from 122 women referred for fetal echocardiography between 2006 and 2018. We quantified CVB IgG and IgM levels, with titers ≥ 15.0 U/mL considered positive and measured neutralizing antibodies for three CVB serotypes: CVB1, CVB3, and CVB4. Using data from the national enterovirus surveillance system, we compared the annual exposure rates for each serotype in our cohort to infections reported across the United States. 98 pregnancies with no genetic defects were included. Overall, 29.6% (29/98) had positive IgG and 4.1% (4/98) of women had positive CVB IgM titers. To explore first-trimester CVB exposure, we focused exclusively on the 26 women with positive IgG and negative IgM titers. 61.5% (16/26) had neutralizing antibodies against a single serotype and 38.5% (10/26) against multiple CVB serotypes. CVB4 neutralizing antibodies were the most common (65.4%, 17/26), followed by CVB3 (53.9%, 14/26) and CVB1 (30.8%, 8/26). Among these, 30.8% of babies presented pulmonary valve anomalies: 19.2% (5/26) pulmonary atresia, and 11.5% (3/26) pulmonary stenosis. 23.1% (6/26) of babies had coronary sinusoids. CVB exposure in our cohort mirrored that of reported infections in the United States. Our results suggest a possible association between gestational CVB exposure and specific CHD, particularly pulmonary valve anomalies and coronary sinusoids.
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Spigel ZA, Qureshi AM, Adachi I. Stratification of the Right Ventricle Dependent Coronary Circulation: Relevance to Treatment Strategy. J Thorac Cardiovasc Surg 2022; 164:765-769. [DOI: 10.1016/j.jtcvs.2022.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 01/08/2022] [Accepted: 01/18/2022] [Indexed: 11/30/2022]
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Impact of decompression of the right ventricle on the sinusoidal communications in pulmonary atresia and intact ventricular septum. J Thorac Cardiovasc Surg 2021; 163:2210-2215. [PMID: 34620505 DOI: 10.1016/j.jtcvs.2021.08.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 08/04/2021] [Accepted: 08/23/2021] [Indexed: 11/24/2022]
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Davidson N, Doig F, Dimpalapang E, Stirling J, Gentles T, Wilson N, Artrip J, Finucane K. Safe Decompression of the Right Ventricle for PAIVS in Neonates With Coronary Fistulae: Including the Selective Use of Fistula Ligation to Avoid Coronary Steal. World J Pediatr Congenit Heart Surg 2021; 12:185-194. [PMID: 33684004 DOI: 10.1177/2150135120974395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There are a number of surgical and interventional treatment options for infants with pulmonary atresia with intact ventricular septum (PAIVS). In our practice, we characterize coronary fistulae and interruptions with angiography in the newborn and have developed a strategy to safely decompress the right ventricle in association with ligation of fistulae if necessary. METHODS All infants operated for PAIVS at age < 60 days from 1999 to 2018 were retrospectively studied. Pre- and postoperative variables were collected, angiograms were reviewed, and a territory score was created to grade the severity of coronary abnormalities. This study focused on the subgroup of patients who had early surgical decompression of the right ventricle. RESULTS A total of 77 patients were included, with a mean follow-up of 8.6 years. Of these, 55 (71%) had coronary fistulae, including 28 (36%) with coronary artery interruption. Right ventricular decompression (RVD) was performed in 47 (60.5%) patients. There was no 30-day mortality in those who underwent RVD, whereas 6 (20%) without RVD died within 30 days (P = .003). Ten-year survival was 97.8% and 73.3% for RVD and non-RVD, respectively. In order to prevent coronary steal, 17 patients underwent coronary fistula ligation as their RV was decompressed with 100% early and late survival. CONCLUSION Early and late survival in infants with PAIVS is better if the RV can be decompressed. Coronary fistula ligation with RVD has been introduced without an adverse outcome in selected patients with large fistulae.
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Affiliation(s)
- Noveen Davidson
- Paediatric and Congenital Cardiac Service, 36716Starship Children's Hospital, Auckland, New Zealand
| | - Fiona Doig
- Paediatric and Congenital Cardiac Service, 36716Starship Children's Hospital, Auckland, New Zealand
| | - Eliazar Dimpalapang
- Department of Cardiology, 58991Auckland City Hospital, Auckland, New Zealand
| | - John Stirling
- Paediatric and Congenital Cardiac Service, 36716Starship Children's Hospital, Auckland, New Zealand
| | - Thomas Gentles
- Paediatric and Congenital Cardiac Service, 36716Starship Children's Hospital, Auckland, New Zealand
| | - Nigel Wilson
- Paediatric and Congenital Cardiac Service, 36716Starship Children's Hospital, Auckland, New Zealand
| | - John Artrip
- Paediatric and Congenital Cardiac Service, 36716Starship Children's Hospital, Auckland, New Zealand
| | - Kirsten Finucane
- Paediatric and Congenital Cardiac Service, 36716Starship Children's Hospital, Auckland, New Zealand
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Manhem S, Hanséus K, Berggren H, Ekman-Joelsson BM. Survival With Respect to Morphology in Pulmonary Atresia and Intact Ventricular Septum in Sweden. World J Pediatr Congenit Heart Surg 2021; 12:27-34. [PMID: 33407024 DOI: 10.1177/2150135120958641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients born with pulmonary atresia and intact ventricular septum represent a challenge to pediatric cardiologists. Our objective was to study changes in survival with respect to morphology in all children born with pulmonary atresia and intact ventricular septum in Sweden during 36 years. METHODS A retrospective, descriptive study based on medical reports and echocardiographic examinations consisting of those born between 1980 and 1998 (early group) and those born between 1999 and 2016 (late group). RESULTS The cohort consists of 171 patients (early group, n = 86 and late group, n = 85) yielding an incidence of 4.35 and 4.46 per 100,000 live births, respectively. One-year survival in the early group was 76% compared to 92% in the late group (P = .0004). For patients with membranous atresia, one-year survival increased from 78% to 98%, and for muscular pulmonary atresia, from 68% to 85%. In patients with muscular pulmonary atresia and ventriculocoronary arterial communications, there was no significant increase in survival. Risk factors for death were being born in the early time period hazard ratio (HR), 6; 95% CI (2.33-14.28) P = .0002, low birth weight HR, 1.26; 95% CI (1.14-1.4) P < .0001 and having muscular pulmonary atresia HR, 3.74; 95% CI (1.71-8.19) P = .0010. CONCLUSION The incidence of pulmonary atresia and intact ventricular septum remained unchanged during the study period. Survival has improved, especially for patients with membranous pulmonary atresia, while being born with muscular pulmonary atresia is still a risk factor for death. To further improve survival, greater focus on patients with muscular pulmonary atresia and ventriculocoronary arterial communications is required.
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Affiliation(s)
- Stina Manhem
- Department of Pediatrics, Institution for Clinical Sciences. Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katarina Hanséus
- Department of Pediatric Cardiology, 59564Skåne University Hospital, Lund, Sweden
| | - Håkan Berggren
- Department of Pediatrics, Institution for Clinical Sciences. Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Britt-Marie Ekman-Joelsson
- Department of Pediatrics, Institution for Clinical Sciences. Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Iyer KS. Invited Commentary: Survival in Pulmonary Atresia With Intact Ventricular Septum: The Coronaries Hold the Key! World J Pediatr Congenit Heart Surg 2021; 12:195-196. [PMID: 33684005 DOI: 10.1177/2150135120979969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Krishna Subramony Iyer
- Pediatric & Congenital Heart Surgery, 78808Fortis Escorts Heart Institute, New Delhi, India
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Maddali MM, Arora NR, Kandachar PS, Thomas E. Systolic Color Doppler Flow Into The Aorta Through The Left Main Coronary Artery: What Is The Diagnosis? J Cardiothorac Vasc Anesth 2020; 35:1244-1247. [PMID: 33109487 DOI: 10.1053/j.jvca.2020.09.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 09/26/2020] [Accepted: 09/28/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Madan Mohan Maddali
- Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Oman.
| | - Nishant Ram Arora
- Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Oman
| | | | - Eapen Thomas
- Department of Pediatric Cardiology, National Heart Center, Royal Hospital, Muscat, Oman
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Spigel ZA, Qureshi AM, Morris SA, Mery CM, Sexson-Tejtel SK, Zea-Vera R, Binsalamah ZM, Imamura M, Heinle JS, Adachi I. Right Ventricle-Dependent Coronary Circulation: Location of Obstruction Is Associated With Survival. Ann Thorac Surg 2020; 109:1480-1487. [DOI: 10.1016/j.athoracsur.2019.08.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 12/20/2022]
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Hubrechts J, Cools B, Brown SC, Eyskens B, Heying R, Boshoff D, Gewillig M. Percutaneous obliteration of the right ventricle to avoid coronary damage by sinusoids in patients with pulmonary atresia intact ventricular septum during staged single ventricle palliation. Catheter Cardiovasc Interv 2019; 94:722-726. [PMID: 31433549 DOI: 10.1002/ccd.28457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 08/08/2019] [Accepted: 08/12/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND AIMS Suprasystemic pressure waves can damage the coronary arteries resulting in myocardial ischemia and excess early mortality. We aimed to reduce the coronary pressure wave through the sinusoids by abolishing RV volume with percutaneous devices. METHODS AND RESULTS Four patients with PA-IVS and coronary sinusoids from the hypertensive rudimentary RV were evaluated at a median age 26.6 months (range: 2.7-51.7). Right ventricle coronary dependent flow to the left ventricular myocardium was excluded. All four patients had dual perfusion with competitive flow from the RV through the sinusoids to the coronary arteries. Devices used were: Amplatzer vascular plug II of 10-16 mm; 27 coils (diameter 5-15 mm) in the oldest patient. Right ventricular angiography after cavity obliteration showed no more significant coronary perfusion through the sinusoids. There were no complications or deaths. Only minor and transient changes in the levels of troponin were observed. Coronary angiography at pre-Fontan evaluation showed no progress of coronary abnormalities in two patients. CONCLUSION In selected patients with functionally single left ventricle, obliteration of the hypertensive RV cavity by percutaneous devices is safe and abolishes the systolic pressure wave in coronary sinusoids. When performed early, this may halt coronary damage and avoid excess mortality.
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Affiliation(s)
- Jelena Hubrechts
- Department of Pediatric and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Bjorn Cools
- Department of Pediatric and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Stephen C Brown
- Department of Pediatric and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium.,Department of Pediatric and Congenital Cardiology, University of the Free State, Bloemfontein, Free State, South Africa
| | - Benedicte Eyskens
- Department of Pediatric and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Ruth Heying
- Department of Pediatric and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Derize Boshoff
- Department of Pediatric and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Marc Gewillig
- Department of Pediatric and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
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Loomba RS, Pelech AN. Aortic perfusion score for pulmonary atresia with intact ventricular septum: An antegrade coronary perfusion scoring system that is predictive of need for transplant and mortality. CONGENIT HEART DIS 2017; 13:92-97. [PMID: 28653340 DOI: 10.1111/chd.12510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 05/20/2017] [Accepted: 05/26/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pulmonary atresia with intact ventricular septum is a unique congenital malformation of the heart in which patients may undergo single-, two- or 1½- ventricle repair. Size of the tricuspid valve annulus, morphology of the right ventricle and presence of ventriculocoronary connections can all impact the selection of appropriate palliative strategy. We developed the aortic perfusion score, a novel scoring system based on anterograde coronary perfusion with the aim of being able to identify patients at risk for death or transplant. METHODS A retrospective study was conducted. Patients were included if an initial catheterization was done prior to any intervention. Each patient was assigned an aortic perfusion score based on the amount of antegrade perfusion to the four main coronary arteries. Various characteristics, including aortic perfusion score, were compared between those who required transplant or died during follow-up vs those who did not. Receiver operator curve analysis was done to determine a cutoff point predictive of a composite endpoint of death or transplant. RESULTS A total of 64 patients were included in the analysis with 10 reaching the composite outcome. An aortic perfusion score of 227.5 predicted the endpoint with a sensitivity of 90% and a specificity of 83%. For each 1-point increase in the APS, the odds of death or transplant decreased by 1.7%. CONCLUSION The aortic perfusion score can be used to predict a composite endpoint of death or transplant and may be helpful in selecting patients that should be listed for transplant.
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Affiliation(s)
- Rohit S Loomba
- Division of Cardiology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA.,Division of Cardiology, UC-Davis Children's Hospital, Sacramento, California, USA
| | - Andrew N Pelech
- Division of Cardiology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA.,Division of Cardiology, UC-Davis Children's Hospital, Sacramento, California, USA
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Awori MN, Mehta NP, Mitema FO, Kebba N. Optimal Z-Score Use in Surgical Decision-Making in Pulmonary Atresia With Intact Ventricular Septum. World J Pediatr Congenit Heart Surg 2017; 8:385-388. [DOI: 10.1177/2150135117701407] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: In the surgical treatment of pulmonary atresia with intact ventricular septum, the size of the tricuspid valve annulus (as measured by z-scores) has emerged as a significant factor in deciding which repair to perform. Various tricuspid valve annulus z-scores are reported as “cutoffs” for successful biventricular repair. We aimed to determine whether the use of different z-score data sets contributed to the gross variation in “cutoffs” for successful biventricular repair reported in the literature. Methods: A single search was made of PubMed using the “advanced” setting with the following search terms: pulmonary, atresia, intact, septum, z, and score. The filters “title” and “title/abstract” were used for the first four and last two terms, respectively; the instruction “AND” combined all terms. Articles that identified which z-score data set was used in patients with biventricular repairs were included. Results: From 13 articles, 1,392 patients were studied, 410 (29.5%) of which achieved biventricular repair. Three z-score data sets were quoted; mean tricuspid valve annulus z-scores in biventricular repair patients ranged between −0.53 and −5.1. After correcting for discrepancies between z-score data sets, no study reported a mean tricuspid valve annulus z-score <−2.8 in biventricular repair patients and 83.3% reported mean tricuspid valve annuli z-scores >−1.7. Conclusion: The use of varied tricuspid valve annuli z-score data sets may have contributed to gross variations in reported “cutoffs” for successful biventricular repair. This could lead to inappropriate surgical pathway allocation.
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Affiliation(s)
- Mark Nelson Awori
- Department of Surgery, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Nikita P. Mehta
- Department of Surgery, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Frederick O. Mitema
- Department of Surgery, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Naomi Kebba
- Department of Surgery, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
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Li FF, Du XL, Chen S. Biventricular repair versus uni-ventricular repair for pulmonary atresia with intact ventrical septum: A systematic review. ACTA ACUST UNITED AC 2015; 35:656-661. [PMID: 26489617 DOI: 10.1007/s11596-015-1485-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/14/2015] [Indexed: 10/22/2022]
Abstract
The management of pulmonary atresia with intact ventricular septum (PA/IVS) remains controversial. The goal of separating systematic and pulmonary circulation can be achieved by biventricular or uni-ventricular (Fontan or one and a half ventricle repair) strategies. Although outcomes have been improved, these surgical procedures are still associated with high mortality and morbidity. An optimal strategy for definitive repair has yet to be defined. We searched databases for genetically randomized controlled trials (RCTs) comparing biventricular with uni-ventricular repair for patient with PA/IVS. Data extraction and quality assessment were performed following the guidelines of the Cochrane Collaboration. Primary outcome measures were overall survival, and secondary criteria included exercise function, arrhythmia-free survival and treatment-related mortality. A total number of 669 primary citations were screened for relevant studies. Detailed analysis revealed that no RCTs were found to adequately address the research question and no systematic meta-analysis would have been carried out. Nevertheless, several retrospective analyses and case series addressed the question of finding right balance between biventricular and uni-ventricular repair for patient with PA/IVS. In this review, we will discuss the currently available data.
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Affiliation(s)
- Fei-Fei Li
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xin-Ling Du
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Shu Chen
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Hascoet S, Combelles S, Acar P. Cardiac Computed Tomography of Multiple Coronary Arteries to Right Ventricle Fistulas in a Newborn With Pulmonary Atresia and Intact Ventricular Septum. Can J Cardiol 2014; 30:247.e7-9. [DOI: 10.1016/j.cjca.2013.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 10/21/2013] [Accepted: 10/24/2013] [Indexed: 11/24/2022] Open
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Two-ventricle repairs in the unbalanced atrioventricular canal defect spectrum with midterm follow-up. J Thorac Cardiovasc Surg 2013; 146:854-860.e3. [DOI: 10.1016/j.jtcvs.2013.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 04/12/2013] [Accepted: 05/02/2013] [Indexed: 11/17/2022]
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SCHNEIDER M, WIEBE W, HRAŠKA V, ZARTNER P. Coronary Interventions in Congenital Heart Diseases: From Preterm to Young Adult Patients. J Interv Cardiol 2013; 26:287-94. [DOI: 10.1111/j.1540-8183.2013.12015.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- M. SCHNEIDER
- Department of Cardiology; German Pediatric Heart Center; Sankt Augustin; Germany
| | - W. WIEBE
- Department of Cardiology; German Pediatric Heart Center; Sankt Augustin; Germany
| | - V. HRAŠKA
- Department of Cardiothoracic Surgery; German Pediatric Heart Center; Sankt Augustin; Germany
| | - P. ZARTNER
- Department of Cardiology; German Pediatric Heart Center; Sankt Augustin; Germany
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Foker JE, Berry J, Setty SP, Harvey BA, Rivard AL, Gittenberger-de Groot AC, Pyles LA. Growth and function of hypoplastic right ventricles and tricuspid valves in infants with pulmonary atresia and intact ventricular septum. PROGRESS IN PEDIATRIC CARDIOLOGY 2010. [DOI: 10.1016/j.ppedcard.2010.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Gittenberger-de Groot AC, Jongbloed MR, Wisse LJ, Poelmann RE. Pulmonary atresia with intact ventricular septum: Second heart field derived myocardial and epicardial developmental clues. PROGRESS IN PEDIATRIC CARDIOLOGY 2010. [DOI: 10.1016/j.ppedcard.2010.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Moller JH. Operative and interventional procedures in 1039 neonates with pulmonary valvular atresia and intact ventricular septum. PROGRESS IN PEDIATRIC CARDIOLOGY 2010. [DOI: 10.1016/j.ppedcard.2010.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Tanoue Y, Kado H, Ushijima T, Tominaga R. Consequences of a hypertensive right ventricle on left ventricular performance of patients with pulmonary atresia and intact ventricular septum after right heart bypass surgery. PROGRESS IN PEDIATRIC CARDIOLOGY 2010. [DOI: 10.1016/j.ppedcard.2010.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pyles LA, Berry JM, Steinberger J, Foker JE. Initial, intra-operative, and post-operative evaluation of children with pulmonary atresia with intact ventricular septum with emphasis on the coronary connections to the right ventricle. PROGRESS IN PEDIATRIC CARDIOLOGY 2010. [DOI: 10.1016/j.ppedcard.2010.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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The long-term consequences of the coronary artery lesions in pulmonary atresia with intact ventricular septum. PROGRESS IN PEDIATRIC CARDIOLOGY 2010. [DOI: 10.1016/j.ppedcard.2010.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Regression of a coronary arterial fistula in an infant with pulmonary atresia and an intact ventricular septum. Pediatr Cardiol 2010; 31:144-6. [PMID: 19859767 DOI: 10.1007/s00246-009-9559-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2009] [Accepted: 09/30/2009] [Indexed: 10/20/2022]
Abstract
This report describes a premature newborn with pulmonary atresia and an intact ventricular septum who presented with a significant fistula between the right ventricle and the left anterior descending coronary artery (LAD). The right ventricle was not decompressed to prevent myocardial damage. After 2 months, the fistula had closed spontaneously. The pulmonary valve was opened, and biventricular circulation was achieved.
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Surgical strategy for pulmonary atresia with intact ventricular septum: initial management and definitive surgery. Gen Thorac Cardiovasc Surg 2009; 57:338-46. [DOI: 10.1007/s11748-008-0415-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2008] [Indexed: 10/20/2022]
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