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Moodley A, Meyer HM, Salie S, Human P, Zühlke LJ, Brooks A. Common Arterial Trunk Repair at the Red Cross War Memorial Hospital, Cape Town: A 20-Year Review of Surgical Practice and Outcomes. World J Pediatr Congenit Heart Surg 2024:21501351241256582. [PMID: 39043204 DOI: 10.1177/21501351241256582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
BACKGROUND This study describes the 20-year experience of managing common arterial trunk (CAT) in a low-and-middle-income country and compares the early and medium-term outcomes following the transition from conduit to nonconduit repair at the Red Cross War Memorial Children's Hospital. METHODS Single-center retrospective study of consecutive patients aged less than 18 years who underwent repair of CAT from January 1999 to December 2018 at the Red Cross War Memorial Children's Hospital. Patients with interrupted aortic arch or previous pulmonary artery banding were excluded. RESULTS Fifty-four patients had CAT repair during the study period. Thirty-four (63.0%) patients had a conduit repair, and 20 (37.0%) patients had a nonconduit repair. There were two intraoperative deaths. Thirty-day in-hospital mortality was 22.2% (12/54). Overall, in-hospital mortality was 29.6% (16/54). Eight (21.1%) late mortalities were observed. The actuarial survival for the conduit group was 77.5%, 53.4%, and 44.5% at 6, 12, and 27 months, respectively, and the nonconduit group was 58.6% at six months. The overall freedom from reoperation between the conduit group and nonconduit group was 66.2% versus 86.5%, 66.2% versus 76.9%, and 29.8% versus 64.1% at 1, 2, and 8 years, respectively. CONCLUSIONS The outcomes following the transition to nonconduit repair for CAT in a low- and middle-income setting appear to be encouraging. There was no difference in mortality between conduit and nonconduit repairs, and importantly the results suggest a trend toward lower reintervention rates.
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Affiliation(s)
- A Moodley
- Division of Cardio-Thoracic Surgery, University of Cape Town, Cape Town, South Africa
| | - H M Meyer
- Division of Paediatric Anaesthesia, Department of Anesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - S Salie
- Division of Paediatric Critical Care, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
- Paediatric Intensive Care Unit, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - P Human
- Division of Cardio-Thoracic Surgery, University of Cape Town, Cape Town, South Africa
| | - L J Zühlke
- South African Medical Research Council, Francie van Zijl Drive, Cape Town, South Africa
- Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - A Brooks
- Division of Cardio-Thoracic Surgery, University of Cape Town, Cape Town, South Africa
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Goyal A, Knight J, Hasan M, Rao H, Thomas AS, Sarvestani A, St Louis J, Kochilas L, Raghuveer G. Survival After Single-Stage Repair of Truncus Arteriosus and Associated Defects. Ann Thorac Surg 2024; 117:153-160. [PMID: 37414385 DOI: 10.1016/j.athoracsur.2023.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/21/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND The goal of this study was to describe in-hospital and long-term mortality after single-stage repair of truncus arteriosus communis (TAC) and explore factors associated with these outcomes. METHODS This was a cohort study of consecutive patients undergoing single-stage TAC repair between 1982 and 2011 reported to the Pediatric Cardiac Care Consortium registry. In-hospital mortality was obtained for the entire cohort from registry records. Long-term mortality was obtained for patients with available identifiers by matching with the National Death Index through 2020. Kaplan-Meier survival estimates were created for up to 30 years after discharge. Cox regression models estimated hazard ratios for the associations with potential risk factors. RESULTS A total of 647 patients (51% male) underwent single-stage TAC repair at a median age of 18 days; 53% had type I TAC, 13% had interrupted aortic arch, and 10% underwent concomitant truncal valve surgery. Of these, 486 (75%) patients survived to hospital discharge. After discharge, 215 patients had identifiers for tracking long-term outcomes; 30-year survival was 78%. Concomitant truncal valve surgery at the index procedure was associated with increased in-hospital and 30-year mortality. Concomitant interrupted aortic arch repair was not associated with increased in-hospital or 30-year mortality. CONCLUSIONS Concomitant truncal valve surgery but not interrupted aortic arch was associated with higher in-hospital and long-term mortality. Careful consideration of the need and timing for truncal valve intervention may improve TAC outcomes.
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Affiliation(s)
- Anmol Goyal
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
| | - Jessica Knight
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia
| | - Mohammed Hasan
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Hussain Rao
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Amanda S Thomas
- Center for Epidemiology and Clinical Research, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Amber Sarvestani
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - James St Louis
- Department of Surgery, Medical College of Georgia, Augusta, Georgia
| | - Lazaros Kochilas
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Geetha Raghuveer
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
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3
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Swartz MF, Yoshitake S, Cholette JM, Atallah-Yunes N, Wang H, Alfieris GM. A modified approach in the repair of type I and II truncus arteriosus to promote branch pulmonary arterial growth and limit early reoperation. JTCVS Tech 2022; 16:196-211. [PMID: 36510535 PMCID: PMC9735427 DOI: 10.1016/j.xjtc.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 12/16/2022] Open
Abstract
Objective Maintaining adequate branch pulmonary arterial growth is critical in preventing early (<3 years) right ventricular outflow tract reoperation after the repair of truncus arteriosus. We hypothesized that a modified truncus arteriosus repair keeping the branch pulmonary arteries in situ would promote branch pulmonary arterial growth and limit early right ventricular outflow tract reoperation. Methods For infants requiring repair for type I and II truncus arteriosus, the truncal root was septated through a hockey stick incision keeping the branch pulmonary arteries in situ, the ventricular septal defect was closed, and a short aortic homograft was used to reconstruct the right ventricular outflow tract. Echocardiograms measured preoperative and follow-up branch pulmonary artery diameter. Results Between 1998 and 2020, 41 infants were repaired using the modified approach (type I, 28; type II, 13). With a median follow-up of 11.6 (interquartile range, 3.1-15.5) years, there was no significant change between preoperative left pulmonary artery and right pulmonary artery Z-scores and their corresponding follow-up measurement (left pulmonary artery: 0.97, interquartile range, 0.6-1.6 vs left pulmonary artery: 1.4, interquartile range, -0.3 to 1.9) (right pulmonary artery: 0.6, interquartile range, -0.4 to 1.7 vs right pulmonary artery: 0.3 interquartile range, 0.5-0.9). Only 7.3% (n = 2) of follow-up right pulmonary artery Z-scores were less than 2.5 Z-scores below preoperative measurements. Four children (9.8%) required early right ventricular outflow tract reoperation. On multivariable analysis, larger conduit Z-scores were associated with greater time to right ventricular outflow tract reoperation (hazard ratio, 0.55, confidence interval, 0.307-0.984; P = .043). Conclusions Maintaining the branch pulmonary arteries in situ at initial truncus arteriosus repair allows for branch pulmonary arterial growth, limiting early right ventricular outflow tract reoperation.
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Affiliation(s)
- Michael F. Swartz
- Department of Surgery, University of Rochester Medical Center, Rochester, NY,Pediatric Cardiac Consortium of Upstate New York, Syracuse, NY,Address for reprints: Michael F. Swartz, PhD, Strong Memorial Hospital, Box Surg/Cardiac, 601 Elmwood Ave, Rochester, NY 14642.
| | - Shuichi Yoshitake
- Department of Surgery, University of Rochester Medical Center, Rochester, NY,Pediatric Cardiac Consortium of Upstate New York, Syracuse, NY
| | - Jill M. Cholette
- Pediatric Cardiac Consortium of Upstate New York, Syracuse, NY,Department of Pediatrics, University of Rochester Medical Center, Rochester, NY
| | - Nader Atallah-Yunes
- Pediatric Cardiac Consortium of Upstate New York, Syracuse, NY,Department of Pediatrics, University of Rochester Medical Center, Rochester, NY
| | - Hongyue Wang
- Department of Biostatistics, University of Rochester Medical Center, Rochester, NY
| | - George M. Alfieris
- Department of Surgery, University of Rochester Medical Center, Rochester, NY,Pediatric Cardiac Consortium of Upstate New York, Syracuse, NY,Department of Pediatrics, University of Rochester Medical Center, Rochester, NY
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4
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Yacoub MH, Hosny H, Afifi A, Nagy M, Mahgoub A, Simry W, AbouZeina MG, Doss R, El Sawy A, Shehata N, Elafifi A, Abdullah H, Romeih S. Novel concepts and early results of repairing common arterial trunk. Eur J Cardiothorac Surg 2021; 61:562-571. [PMID: 34347066 PMCID: PMC8922708 DOI: 10.1093/ejcts/ezab336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/14/2021] [Accepted: 06/21/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Common Arterial Trunk (CAT) continues to have a very poor prognosis globally. To address that, we have developed a novel technique targeting key concepts for the correction of all components of the anomaly, using autologous arterial tissue. This aims to enhance results, availability worldwide, and importantly to avoid the need for repeated reoperations. METHODS From January 2019 to 4 January 2021, all patients with isolated CAT had repair of the defect using autologous arterial trunk tissue with direct right ventricle (RV) to pulmonary artery (PA) connection. Clinical outcomes, follow-up which included multi-slice computed tomography 3D segmentation and 4D cardiovascular magnetic resonance flow, are presented. RESULTS Twenty patients were included in the study (median age 4.5 months). There were 2 hospital deaths due to systemic infection and pulmonary hypertensive crisis, respectively. Following discharge all patients remained asymptomatic with no signs of heart failure and improved pattern of growth (median follow-up: 8 months). Early postoperative 3D segmentation showed a conical shaped neo-right ventricular outflow chamber connecting the body of the RV to the main PA through a valveless ostium, and normal crossing of PA and neo-aorta. 4D cardiovascular magnetic resonance pattern of flow showed normal rapid laminar flow through the atrioventricular valves followed by a vortex towards the outflow tracts. There was laminar flow through the neo-aorta and neo-PA with velocity not exceeding 2.5 m/s. The PA regurgitant fraction was 25 ± 5% and was limited to early diastole. CONCLUSIONS The initial results of utilizing the key concepts, using autologous arterial tissue for the repair of CAT, are encouraging, both clinically and by multimodality imaging.
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Affiliation(s)
- Magdi H Yacoub
- Cardiac Surgery Department, Aswan Heart Centre, Aswan, Egypt.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Hatem Hosny
- Cardiac Surgery Department, Aswan Heart Centre, Aswan, Egypt
| | - Ahmed Afifi
- Cardiac Surgery Department, Aswan Heart Centre, Aswan, Egypt.,Cardiac Surgery Department, National Heart Institute, Giza, Egypt
| | - Mohamed Nagy
- Biomedical Engineering and Innovation Laboratory, Aswan Heart Centre, Aswan, Egypt
| | - Ahmed Mahgoub
- Cardiac Surgery Department, Aswan Heart Centre, Aswan, Egypt
| | - Walid Simry
- Cardiac Surgery Department, Aswan Heart Centre, Aswan, Egypt.,Cardiac Surgery Department, National Heart Institute, Giza, Egypt
| | | | - Ramy Doss
- Internal Medicine Department, Baylor University Medical Center, Dallas, TX, USA
| | - Amr El Sawy
- Biomedical Engineering and Innovation Laboratory, Aswan Heart Centre, Aswan, Egypt
| | - Nairouz Shehata
- Biomedical Engineering and Innovation Laboratory, Aswan Heart Centre, Aswan, Egypt
| | | | - Hedaia Abdullah
- Pediatric Intensive Care unit, Aswan Heart Centre, Aswan, Egypt
| | - Soha Romeih
- Radiology Department, Aswan Heart Centre, Aswan, Egypt.,Cardiology Department, Tanta University, Tanta, Egypt
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Hazekamp MG, Barron DJ, Dangel J, Homfray T, Jongbloed MRM, Voges I. Consensus document on optimal management of patients with common arterial trunk. Eur J Cardiothorac Surg 2021; 60:7-33. [PMID: 34017991 DOI: 10.1093/ejcts/ezaa423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/18/2020] [Accepted: 09/30/2020] [Indexed: 01/12/2023] Open
Affiliation(s)
- Mark G Hazekamp
- Department of Cardiothoracic Surgery, University Hospital Leiden, Leiden, Netherlands
| | - David J Barron
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Joanna Dangel
- Department of Perinatal Cardiology and Congenital Anomalies, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Tessa Homfray
- Department of Medical Genetics, Royal Brompton and Harefield hospitals NHS Trust, London, UK
| | - Monique R M Jongbloed
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - Inga Voges
- Department for Congenital Cardiology and Pediatric Cardiology, University Medical Center of Schleswig-Holstein, Kiel, Germany
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6
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Ma M. Commentary: The Devil in Z Details. Semin Thorac Cardiovasc Surg 2021; 34:1010. [PMID: 34118392 DOI: 10.1053/j.semtcvs.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 01/10/2023]
Affiliation(s)
- Michael Ma
- Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
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8
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Ma M, Arunamata A, Peng LF, Wise-Faberowski L, Hanley FL, McElhinney DB. Longevity of Large Aortic Allograft Conduits in Tetralogy With Major Aortopulmonary Collaterals. Ann Thorac Surg 2021; 112:1501-1507. [PMID: 33600790 DOI: 10.1016/j.athoracsur.2021.01.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 01/18/2021] [Accepted: 01/26/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Appropriate conduit selection for right ventricle (RV)-to-pulmonary artery (PA) connection has been extensively studied, with older implantation age, pulmonary (vs aortic) homografts, and true sizing associated with increased longevity. Notably, patients with PA arborization abnormalities (ie, major aortopulmonary collateral arteries [MAPCAs]) are reported to require earlier and more frequent conduit interventions. We aim to understand the behavior of large-diameter aortic homografts in patients with MAPCAs, which are programmatically utilized at our institution. METHODS This is a single-center retrospective cohort study including all children less than 12 years of age who underwent RV-PA connection using an aortic homograft greater than or equal to 16 mm diameter between 2002 and 2019, with a primary outcome of freedom from any RV-PA reintervention and a secondary outcome of freedom from surgical reintervention. Patients were grouped by absolute and indexed conduit sizes for further analysis. RESULTS A total of 336 conduits were followed for a median of 3.0 years; transcatheter (n = 30) or surgical (n = 35) reintervention was performed on 64 conduits. Estimated freedom from reintervention and surgical replacement was 84% and 90% at 5 years. Younger age and smaller absolute conduit size were associated with earlier reintervention, but conduit Z-score (median 3.5) was not associated with outcome. CONCLUSIONS The programmatic use of oversized aortic homograft RV-PA conduits in the surgical repair of MAPCAs provides a focused experience that demonstrates similar longevity to reported best alternatives. Secondarily, conduit oversizing may improve durability and enables an increased likelihood of nonoperative reintervention.
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Affiliation(s)
- Michael Ma
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California.
| | - Alisa Arunamata
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Lynn F Peng
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Lisa Wise-Faberowski
- Department of Anesthesiology, Stanford University School of Medicine, Stanford, California
| | - Frank L Hanley
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Doff B McElhinney
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California; Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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9
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Twenty-Year Experience with Truncus Arteriosus Repair: Changes in Risk Factors in the Current Era. Pediatr Cardiol 2021; 42:123-130. [PMID: 32995903 DOI: 10.1007/s00246-020-02461-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
Although the clinical outcomes of truncus arteriosus (TA) repair have been improving, few data are available on long-term outcomes after truncus arteriosus repair in the current era. This study evaluated long-term outcome after repair of TA. Fifty-one patients underwent total correction from April 1982 to June 2018. Since 2003, perioperative strategy has changed to minimal priming volume, modified ultrafiltration, and early total repair (n = 26). Mortality and reoperation rates were analyzed before and after 2003. There were 8 hospital deaths after initial operation, all before 1997. During the mean follow-up of 9.8 years, there were 2 deaths. The Kaplan-Meier estimate of survival among all hospital survivors was 94.7% at 5 years and 88.0% at 20 years. A significant independent risk factor for early mortality was operation before 2003 (Hazard ratio (HR) 9.710, p = 0.041) and REV operation (HR 8.000, p = 0.028). Freedom from reoperation for conduit change and TV repair were 88.3% and 41% at 1 and 5 years, and 96.2% and 85.4% at 1 and 5 years, respectively. After 2003, younger age and conduit choice were risk factors for conduit-related reoperation. Initial preoperative TV regurgitation was independent risk factor for sequential TV repair. Patients with TA can undergo total repair of TA with excellent results, especially in current era. Most of the patients require conduit-related reoperations. Younger age and the methods of RVOT reconstruction were risk factors for conduit-related reoperations. TV repair is necessary in limited patients, and initial regurgitation was a risk factor.
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10
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Gellis L, Binney G, Alshawabkeh L, Lu M, Landzberg MJ, Mayer JE, Mullen MP, Valente AM, Sleeper LA, Brown DW. Long-Term Fate of the Truncal Valve. J Am Heart Assoc 2020; 9:e019104. [PMID: 33161813 PMCID: PMC7763736 DOI: 10.1161/jaha.120.019104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/02/2020] [Indexed: 11/16/2022]
Abstract
Background Long-term survival in patients with truncus arteriosus is favorable, but there remains significant morbidity associated with ongoing reinterventions. We aimed to study the long-term outcomes of the truncal valve and identify risk factors associated with truncal valve intervention. Methods and Results We retrospectively reviewed patients who underwent initial truncus arteriosus repair at our institution from 1985 to 2016. Analysis was performed on the 148 patients who were discharged from the hospital and survived ≥30 days postoperatively using multivariable competing risks Cox regression modeling. Median follow-up time was 12.6 years (interquartile range, 5.0-22.1 years) after discharge from full repair. Thirty patients (20%) underwent at least one intervention on the truncal valve during follow-up. Survival at 1, 10, and 20 years was 93.1%, 87.0%, and 80.9%, respectively. The cumulative incidence of any truncal valve intervention by 20 years was 25.6%. Independent risk factors for truncal valve intervention included moderate or greater truncal valve regurgitation (hazard ratio [HR], 4.77; P<0.001) or stenosis (HR, 4.12; P<0.001) before full truncus arteriosus repair and moderate or greater truncal valve regurgitation at discharge after full repair (HR, 8.60; P<0.001). During follow-up, 33 of 134 patients (25%) progressed to moderate or greater truncal valve regurgitation. A larger truncal valve root z-score before truncus arteriosus full repair and during follow-up was associated with worsening truncal valve regurgitation. Conclusions Long-term rates of truncal valve intervention are significant. At least moderate initial truncal valve stenosis and initial or residual regurgitation are independent risk factors associated with truncal valve intervention. Larger truncal valve root z-score is associated with significant truncal valve regurgitation and may identify a subset of patients at risk for truncal valve dysfunction over time.
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Affiliation(s)
- Laura Gellis
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
| | | | - Laith Alshawabkeh
- Sulpizio Cardiovascular InstituteUniversity of California San DiegoLa JollaCA
| | - Minmin Lu
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
| | - Michael J. Landzberg
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of MedicineBrigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - John E. Mayer
- Department of Cardiac SurgeryBoston Children’s HospitalBostonMA
- Department of SurgeryHarvard Medical SchoolBostonMA
| | - Mary P. Mullen
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
| | - Anne Marie Valente
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of MedicineBrigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - Lynn A. Sleeper
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
| | - David W. Brown
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
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11
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Hirsig LE, Sharma PG, Verma N, Rajderkar DA. Congenital Pulmonary Artery Anomalies: A Review and Approach to Classification. J Clin Imaging Sci 2018; 8:29. [PMID: 30147993 PMCID: PMC6085843 DOI: 10.4103/jcis.jcis_9_18] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/02/2018] [Indexed: 12/04/2022] Open
Abstract
Congenital pulmonary artery anomalies are infrequent but given improved prenatal diagnosis and care, and neonatal surgical advances, over the past two decades are not uncommonly encountered by cardiothoracic imagers. An understanding of their etiology, classifications, associated anomalies, and surgical management can be helpful to avoid under or overdiagnosis. Timely diagnosis assisted by familiarity with imaging findings across modalities and recognition of surgical findings allows for medical management and surgical planning for these patients, with more patients reaching adulthood than ever before.
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Affiliation(s)
- Leslie E Hirsig
- Department of Radiology, Division of Pediatric Imaging, University of Florida College of Medicine, Gainesville, FL 32608, USA
| | - Priya G Sharma
- Department of Radiology, Division of Pediatric Imaging, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Nupur Verma
- Department of Radiology, Division of Cardiac Imaging, University of Florida College of Medicine, Gainesville, FL 32608, USA
| | - Dhanashree A Rajderkar
- Department of Radiology, Division of Pediatric Imaging, Medical University of South Carolina, Charleston, SC 29425, USA
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12
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Outcomes of truncus arteriosus repair with bovine jugular vein conduit. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:365-369. [PMID: 32082765 DOI: 10.5606/tgkdc.dergisi.2018.14841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 03/15/2018] [Indexed: 11/21/2022]
Abstract
Background In this study, we aimed to evaluate the outcomes of truncus arteriosus repair in patients undergoing Rastelli type truncus arteriosus. Methods A total of 13 patients (7 males, 6 females; median age 37 days; range, 16 to 60 days) underwent repair of truncus arteriosus using Contegra conduits between January 2011 and March 2 017. P reoperative d iagnosis w as t runcus a rteriosus type 1 (Edwards-Collett) in eight, type 2 in three, type 3 in one, and type 4 in one patient. Contegra conduits used for operations were 14 mm (n=5), 12 mm (n=7), and 16 mm (n=1). Results Early death was seen in two patients (15.4%). The median intensive care and hospital stays were 10 (range, 6 to 14) and 20 (range, 14 to 41) days, respectively. The median follow-up was 36 (range, 2 to 66) months. In four patients (31%), the conduit sizes severely increased during follow-up and reached 23 mm in two patients and 20 mm in one patient, and 18 mm in the other patient. Three patients had moderate distal conduit stenosis. Moderate pulmonary insufficiency was detected in four patients and severe pulmonary insufficiency in one patient. Two patients had moderate truncal valve insufficiency and one patient had moderate residual ventricular septal defect. None of the patients needed reoperation. Conclusion Contegra conduit is a good alternative for repair of truncus arteriosus in infants; however close follow-up is necessary, as distal conduit stenosis and conduit dilatation may develop.
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13
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Louis C, Swartz MF, Simon BV, Cholette JM, Atallah-Yunes N, Wang H, Gensini F, Alfieris GM. Modified Repair of Type I and II Truncus Arteriosus Limits Early Right Ventricular Outflow Tract Reoperation. Semin Thorac Cardiovasc Surg 2018; 30:199-204. [DOI: 10.1053/j.semtcvs.2018.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2018] [Indexed: 11/11/2022]
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14
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Yoshitake S, Kaneko Y, Yakuwa K, Achiwa I. Successful Truncal Valve Replacement With a Mechanical Valve After Bilateral Pulmonary Artery Banding. World J Pediatr Congenit Heart Surg 2017; 10:384-387. [DOI: 10.1177/2150135117690110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Surgical management of truncus arteriosus, or common arterial trunk, has expanded over the past three decades to include earlier surgical intervention, initially during infancy and now chiefly in the neonatal period. Many studies have shown that preoperative truncal valve insufficiency is an independent risk factor for mortality. We herein present the case of a five-month-old boy with severe truncal valve insufficiency who underwent repair of common arterial trunk and prosthetic replacement of the truncal valve with associated annular enlargement after initial stabilization in the newborn period via palliative bilateral pulmonary artery banding. We believe that initial bilateral pulmonary artery banding represents a viable option for some cases of common arterial trunk involving truncal valve insufficiency.
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Affiliation(s)
- Shuichi Yoshitake
- Division of Cardiovascular Surgery, National Center for Child Health and Development, Setagaya, Tokyo, Japan
| | - Yukihiro Kaneko
- Division of Cardiovascular Surgery, National Center for Child Health and Development, Setagaya, Tokyo, Japan
| | - Kazuki Yakuwa
- Division of Cardiovascular Surgery, National Center for Child Health and Development, Setagaya, Tokyo, Japan
| | - Ikuya Achiwa
- Division of Cardiovascular Surgery, National Center for Child Health and Development, Setagaya, Tokyo, Japan
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Asagai S, Inai K, Shinohara T, Tomimatsu H, Ishii T, Sugiyama H, Park IS, Nagashima M, Nakanishi T. Long-term Outcomes after Truncus Arteriosus Repair: A Single-center Experience for More than 40 Years. CONGENIT HEART DIS 2016; 11:672-677. [DOI: 10.1111/chd.12359] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Seiji Asagai
- Department of Pediatric Cardiology; Heart Institute, Tokyo Women's Medical University; Tokyo Japan
| | - Kei Inai
- Department of Pediatric Cardiology; Heart Institute, Tokyo Women's Medical University; Tokyo Japan
| | - Tokuko Shinohara
- Department of Pediatric Cardiology; Heart Institute, Tokyo Women's Medical University; Tokyo Japan
| | - Hirofumi Tomimatsu
- Department of Pediatric Cardiology; Heart Institute, Tokyo Women's Medical University; Tokyo Japan
| | - Tetsuko Ishii
- Department of Pediatric Cardiology; Heart Institute, Tokyo Women's Medical University; Tokyo Japan
| | - Hisashi Sugiyama
- Department of Pediatric Cardiology; Heart Institute, Tokyo Women's Medical University; Tokyo Japan
| | - In-Sam Park
- Department of Pediatric Cardiology; Heart Institute, Tokyo Women's Medical University; Tokyo Japan
| | - Mitsugi Nagashima
- Department of Cardiovascular Surgery; Heart Institute, Tokyo Women's Medical University; Tokyo Japan
| | - Toshio Nakanishi
- Department of Pediatric Cardiology; Heart Institute, Tokyo Women's Medical University; Tokyo Japan
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16
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de Siena P, Ghorbel M, Chen Q, Yim D, Caputo M. Common arterial trunk: review of surgical strategies and future research. Expert Rev Cardiovasc Ther 2014; 9:1527-38. [DOI: 10.1586/erc.11.170] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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17
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Restrepo CS, Melendez-Ramirez G, Kimura-Hayama E. Multidetector Computed Tomography of Congenital Anomalies of the Thoracic Aorta. Semin Ultrasound CT MR 2012; 33:191-206. [DOI: 10.1053/j.sult.2011.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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18
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Baraona F, Valente AM, Porayette P, Pluchinotta FR, Sanders SP. Coronary Arteries in Childhood Heart Disease: Implications for Management of Young Adults. ACTA ACUST UNITED AC 2012. [PMID: 24294539 DOI: 10.4172/2155-9880.s8-006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Survival of patients with congenital heart defects has improved dramatically. Many will undergo interventional catheter or surgical procedures later in life. Others will develop atherosclerotic or post-surgical coronary heart disease. The coronary artery anatomy in patients with congenital heart disease differs substantially from that seen in the structurally normal heart. This has implications for diagnostic procedures as well as interventions. The unique epicardial course seen in some defects could impair interpretation of coronary angiograms. Interventional procedures, especially at the base of the heart, risk injuring unusually placed coronary arteries so that coronary artery anatomy must be delineated thoroughly prior to the procedure. In this review, we will describe the variants of coronary artery anatomy and their implications for interventional and surgical treatment and for sudden death during late follow-up in several types of congenital heart defects including: tetralogy of Fallot, truncus arteriosus, transposition of the great arteries, double outlet right ventricle, congenitally corrected transposition of the great arteries and defects with functionally one ventricle. We will also discuss the coronary abnormalities seen in Kawasaki disease.
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Affiliation(s)
- Fernando Baraona
- Department of Cardiology, Children's Hospital Boston, Boston, MA 02115, USA ; Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
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19
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Lund AM, Vogel M, Marshall AC, Emani SM, Pigula FA, Tworetzky W, McElhinney DB. Early reintervention on the pulmonary arteries and right ventricular outflow tract after neonatal or early infant repair of truncus arteriosus using homograft conduits. Am J Cardiol 2011; 108:106-13. [PMID: 21530938 DOI: 10.1016/j.amjcard.2011.03.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Revised: 03/03/2011] [Accepted: 03/03/2011] [Indexed: 11/30/2022]
Abstract
Patients with truncus arteriosus often require pulmonary arterial (PA) and/or right ventricular outflow tract (RVOT) reintervention within the first year of repair. However, little is known about the risk factors for early reintervention on the PAs or RVOT in this population. The objective of the present retrospective cohort study was to determine the risk factors for early PA or RVOT reintervention after repair of truncus arteriosus in neonates and young infants. Of 156 patients ascertained (median age at repair 14 days; 143 early survivors), reinterventions on the RVOT and/or PAs were performed in 109. The first reintervention was catheter therapy in 73 patients (conduit dilation/stenting in 29, PA dilation/stenting in 31, both in 13) and conduit reoperation in 36 patients. The freedom from any RVOT or PA reintervention was 68 ± 4% at 1 year and 48 ± 5% at 2 years. The factors associated with early reintervention (shorter 1-year freedom from reintervention) on univariate analysis were repair quartile, neonatal repair, smaller weight at repair, and smaller implanted conduit size. On multivariable analysis, only smaller conduit size remained significant (multivariable hazard ratio 0.66/mm, range 0.53 to 0.83; p <0.001). The freedom from conduit reoperation was 92 ± 3% at 1 year and 76 ± 4% at 2 years. Overall, the left and right PA sizes were modestly larger than normal by the 1-sample t test, and PA Z scores and the PA area index were not associated with the risk of reintervention. Early reintervention for PA and/or RVOT conduit obstruction is common after neonatal and early infant repair of truncus arteriosus using homograft conduits. A smaller conduit size was associated with early RVOT/PA reintervention. The branch PA size was normal before surgery, suggesting that the PA stenosis in these patients resulted from factors other than intrinsic stenosis or hypoplasia.
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Affiliation(s)
- Amalia M Lund
- Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts, USA
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20
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Long-term follow-up after primary complete repair of common arterial trunk with homograft: A 40-year experience. J Thorac Cardiovasc Surg 2010; 140:325-9. [DOI: 10.1016/j.jtcvs.2009.12.052] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Revised: 11/27/2009] [Accepted: 12/20/2009] [Indexed: 11/18/2022]
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21
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Long-term results after correction of persistent truncus arteriosus in 83 patients. Eur J Cardiothorac Surg 2010; 37:1278-84. [DOI: 10.1016/j.ejcts.2009.12.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 12/01/2009] [Accepted: 12/07/2009] [Indexed: 11/20/2022] Open
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22
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Kimura-Hayama ET, Meléndez G, Mendizábal AL, Meave-González A, Zambrana GFB, Corona-Villalobos CP. Uncommon congenital and acquired aortic diseases: role of multidetector CT angiography. Radiographics 2010; 30:79-98. [PMID: 20083587 DOI: 10.1148/rg.301095061] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
State-of-the-art multidetector computed tomographic (CT) technology has replaced invasive angiography for evaluation of patients suspected to have aortic disease. Although most aortic disease is associated with atherosclerosis (ie, aneurysms and dissection), the spectrum of aortic disease is vast and includes various congenital and acquired entities. Radiologists should also be familiar with uncommon aortic diseases, which are divided into those that are congenital in origin and acquired disorders, and with their findings at multidetector CT. The first group includes patent ductus arteriosus, aortic hypoplasia, aortic coarctation, interrupted aortic arch, aortopulmonary window, common arterial trunk, supravalvular aortic stenosis, and vascular rings. The acquired disorders include aortic dissection due to extension of a coronary artery dissection, Marfan syndrome, large-vessel vasculitis such as Takayasu arteritis, and mycotic aneurysms. Finally, specific conditions associated with therapeutic maneuvers--such as recoarctation, stent-graft rupture, and endoleaks--can also be assessed with multidetector CT. Multidetector CT is an alternative tool helpful in establishing the primary diagnosis, defining anatomic landmarks and their relationships, and identifying associated cardiovascular anomalies. It is also an adjunct in the evaluation of complications during follow-up.
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Affiliation(s)
- Eric T Kimura-Hayama
- Department of Radiology, Division of Computed Tomography, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Col. Sección XVI, Mexico City, Mexico.
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23
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Benjacholamas V, Namchaisiri J, Khongphatthanayothin A, Lertsapcharoen P. Bicuspidized Pulmonary Homograft for Truncus Arteriosus Repair. Asian Cardiovasc Thorac Ann 2008; 16:189-93. [DOI: 10.1177/021849230801600303] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Primary repair is preferable to palliation in infants with truncus arteriosus. At our institute, an appropriately small homograft valved conduit is not available for every patient; a bicuspidized pulmonary valve homograft is an alternative. Between December 1996 and August 2005, 24 patients aged 28 days to 21 months with truncus arteriosus underwent primary repair with a homograft valved conduit; bicuspidized homografts were used in 15 of them. In the 18 (75%) patients who survived to hospital discharge, 5-year survival was 94% (75% for tricuspid homografts and 100% for bicuspidized homografts, which was not significantly different). Freedom from reoperation or balloon angioplasty in all 18 survivors was 89% at 5 years. Freedom from reoperation in tricuspid and bicuspidized homograft groups at 5 years was 67% and 100%, respectively; the difference was not statistically significant. Bicuspidized homografts worked as well as tricuspid conduits in the intermediate term. The remodeled homografts showed excellent hemodynamic characteristics and appear to be a reasonable alternative when an appropriate size of valved homograft is unavailable.
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Affiliation(s)
| | | | - Apichai Khongphatthanayothin
- Cardiac Unit, Department of Pediatrics, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Pornthep Lertsapcharoen
- Cardiac Unit, Department of Pediatrics, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
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24
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Henaine R, Azarnoush K, Belli E, Capderou A, Roussin R, Planché C, Serraf A. Fate of the Truncal Valve in Truncus Arteriosus. Ann Thorac Surg 2008; 85:172-8. [DOI: 10.1016/j.athoracsur.2007.07.039] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2007] [Revised: 07/12/2007] [Accepted: 07/12/2007] [Indexed: 10/22/2022]
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25
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Affiliation(s)
- Thomas M Bashore
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
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26
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Honjo O, Kotani Y, Akagi T, Osaki S, Kawada M, Ishino K, Sano S. Right Ventricular Outflow Tract Reconstruction in Patients With Persistent Truncus Arteriosus A 15-Year Experience in a Single Japanese Center. Circ J 2007; 71:1776-80. [DOI: 10.1253/circj.71.1776] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Osami Honjo
- Division of Cardiovascular Surgery, The Hospital for Sick Children
| | - Yasuhiro Kotani
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine and Dentistry
| | - Teiji Akagi
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine and Dentistry
| | - Satoru Osaki
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine and Dentistry
| | - Masaaki Kawada
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine and Dentistry
| | - Kozo Ishino
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine and Dentistry
| | - Shunji Sano
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine and Dentistry
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27
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28
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Brown JW, Ruzmetov M, Okada Y, Vijay P, Turrentine MW. Truncus arteriosus repair: outcomes, risk factors, reoperation and management. Eur J Cardiothorac Surg 2001; 20:221-7. [PMID: 11463535 DOI: 10.1016/s1010-7940(01)00816-8] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES Truncus arteriosus (TA) continues to be associated with significant morbidity and mortality, but there have been clinically significant improvements with early repair. METHODS Sixty patients underwent physiological correction of TA between November 1978 and January 2000. The average age was 76 days (range, 3 days--20 months). Associated cardiac anomalies were frequently encountered, the most common being severe truncal valve regurgitation (n=7), interrupted aortic arch (n=6), coronary artery anomalies (n=6), non-confluent pulmonary arteries (n=4), and total anomalous pulmonary venous return (n=1). Truncal valve replacement was performed initially or subsequently in seven patients with severe regurgitation (mechanical prostheses in six patients and a cryopreserved aortic homograft in one patient). Right ventricle--pulmonary artery continuity was established with an aortic (n=16) or pulmonary homograft (n=32) in 48 patients, a Dacron polyester porcine valved conduit in five, a non-valved polytetrafluoroethylene (PTFE) tube in three, direct anastomosis to the right ventricle with anterior patch arterioplasty in three, and a bovine jugular venous valve conduit in one patient. RESULTS There were ten hospital deaths (17%; 70% confidence limit, 7--25%). Multivariate and univariate analyses demonstrated a relationship between hospital mortality and associated cardiac anomalies. In the 43 patients without these associated cardiac anomalies, the early survival was 91% (group I). In the 17 patients with one or more of these risk factors, the survival was 71% (group II, P=0.002). There was one late death. Twenty-three patients (46%) required reoperation for right ventricular outflow tract (RVOT) obstruction at a mean follow-up time of 59.1 months. In 23 patients, the RVOT reconstruction was performed with a PTFE monocusp, and six patients had of a variety of replacement conduits inserted. Postoperatively, there were 34 (68%) patients in New York Heart Association functional class I and 16 (32%) in class II. Twenty-eight surviving patients are reported as doing well without any medication. The freedom of reoperation in the 39 hospital survivors (group I) without risk factors was 64% at 7 years; and 36% at 10 years in the 11 patients (group II) surviving with risk factors. CONCLUSIONS Associated cardiac anomalies were risk factors for death after the repair of TA. In the absence of these associated lesions, TA can be repaired with an excellent surgical outcome in the neonatal and early infancy period.
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Affiliation(s)
- J W Brown
- Section of Cardiothoracic Surgery, Indiana University Medical Center, 545 Barnhill Drive, EH 215, Indianapolis, IN 46202-5123, USA.
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Thompson LD, McElhinney DB, Reddy M, Petrossian E, Silverman NH, Hanley FL. Neonatal repair of truncus arteriosus: continuing improvement in outcomes. Ann Thorac Surg 2001; 72:391-5. [PMID: 11515872 DOI: 10.1016/s0003-4975(01)02796-5] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Repair of truncus arteriosus in the neonatal and early infant periods has become standard practice at many centers. We reviewed our recent experience with repair of truncus arteriosus in neonates, with a focus on early and intermediate outcomes. METHODS From July 1992 to December 1999, 65 patients 1 month of age or less underwent primary complete repair of truncus arteriosus. Median age was 10 days, and median weight was 3.2 kg. Major associated anomalies included moderate or severe truncal valve regurgitation in 15 patients (23%), interrupted aortic arch in 8 (12%), coronary artery abnormalities in 12 (18%), and nonconfluence of the pulmonary arteries in 3 (5%). Median durations of cardiopulmonary bypass and cardioplegic arrest were 172 minutes and 90 minutes, respectively. Circulatory arrest was employed only in 7 patients undergoing concomitant repair of interrupted arch. Reconstruction of the right ventricular outflow tract was achieved with an aortic (n = 39) or pulmonary (n = 26) allograft valved conduit (median diameter, 12 mm). Replacement (n = 6) or repair (n = 5) of a regurgitant truncal valve was performed in 11 patients, and interrupted arch was repaired in 8. RESULTS There were three early deaths (5%). Early reoperations included reexploration for bleeding in 3 patients, emergent replacement of a pulmonary outflow conduit that failed acutely in 1 patient, and placement of a permanent pacemaker in 1. Mechanical circulatory support was required in 1 patient. During the median follow-up of 32 months, there were two deaths. The Kaplan-Meier estimate of survival was 92% at 1 year and beyond. The only demographic, diagnostic, or operative factors significantly associated with poorer survival over time were operative weight of 2.5 kg or less (p = 0.01) and truncal valve replacement (p = 0.009). Actuarial freedom from conduit replacement among early survivors was 57% at 3 years. CONCLUSIONS Repair of truncus arteriosus in the neonatal period can be performed routinely with excellent survival, even in patients with major associated abnormalities.
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Affiliation(s)
- L D Thompson
- Division of Cardiothoracic Surgery, University of California, San Francisco 94143-0118, USA
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