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Farhat A, Charanek S, Zareef R, El-Rassi I, Bitar F, Arabi M. Tetralogy of Fallot With Absent Pulmonary Valve Syndrome: The Experience of a Tertiary Care Center in a Developing Country. Echocardiography 2024; 41:e15942. [PMID: 39367769 DOI: 10.1111/echo.15942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 09/07/2024] [Accepted: 09/21/2024] [Indexed: 10/07/2024] Open
Abstract
BACKGROUND Tetralogy of Fallot with an absent pulmonary valve is a very rare variant of tetralogy. It is characterized by absent valve tissue, severe pulmonary regurgitation, and secondary aneurysmal dilatation of the pulmonary arteries. AIM In this study, we aim to investigate the clinical presentations, management strategies, and outcomes of patients with tetralogy of Fallot and absent pulmonary valve. METHODOLOGY We retrospectively reviewed the charts of all patients who presented to the American University of Beirut Medical Center between January 2010 and December 2020 and who were diagnosed with this anomaly. RESULTS A total of 300 cases of tetralogy of Fallot were identified, of which 18 patients had absent pulmonary valves. They were followed up for an average of 8.2 years. Prenatal diagnoses were made in four patients, while 13 patients were identified in the neonatal period, with an average age of 4.5 days. Genetic testing confirmed DiGeorge syndrome in one patient. Five patients underwent surgical intervention in the neonatal period, while the remaining patients were operated on during their early childhood. While overall there were no surgical mortalities nor any need for reinterventions, a variety of morbidities were encountered. CONCLUSION This study provides an overview of this rare anomaly and its management in a developing country.
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Affiliation(s)
- Aziz Farhat
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Sujud Charanek
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rana Zareef
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Issam El-Rassi
- Department of Surgery, Al Jalila Children's Specialty Hospital, Dubai, UAE
| | - Fadi Bitar
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Arabi
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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2
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Lee EY, Xu L, Liszewski MC, Foust AM, Williams-Weekes T, Winant AJ. Respiratory Distress in Children: Review and Update of Imaging Assessment. Semin Roentgenol 2024; 59:267-277. [PMID: 38997181 DOI: 10.1053/j.ro.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/03/2024] [Indexed: 07/14/2024]
Affiliation(s)
- Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Boston, MA.
| | - Limin Xu
- Greensboro Radiology, Greensboro, NC
| | - Mark C Liszewski
- Department of Radiology, Columbia University Irving Medical Center, New York, NY
| | - Alexandra M Foust
- Department of Radiology, Monroe Carell Jr Children's Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, TN
| | | | - Abbey J Winant
- Department of Radiology, Boston Children's Hospital, Boston, MA
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3
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McKinney LM, Escalera RB, Downs EA. Out of the blue: inflammatory myofibroblastic tumour identified during repair of tetralogy of Fallot with absent pulmonary valve. Cardiol Young 2023; 33:2469-2470. [PMID: 37615039 DOI: 10.1017/s1047951123003104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Inflammatory myofibroblastic tumour of the heart is an exceedingly rare benign neoplasm. While benign, without prompt management its impact can be devastating. Tetralogy of Fallot with absent pulmonary valve is a rare form of CHD. We present the first documented case of inflammatory myofibroblastic tumour of the heart in the presence of tetralogy of Fallot with absent pulmonary valve.
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Affiliation(s)
- Lauren M McKinney
- Department of Pediatrics, Children's Hospital of the King's Daughters, Norfolk, VA, USA
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Robert B Escalera
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, USA
- Department of Cardiology, Children's Hospital of the King's Daughters, Norfolk, VA, USA
| | - Emily A Downs
- Department of Cardiac Surgery, Children's Hospital of the King's Daughters, Norfolk, VA, USA
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
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4
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Perez P, Panchangam C. A Fetus with Tetralogy of Fallot with Absent Pulmonary Valve Syndrome. Neoreviews 2023; 24:e603-e606. [PMID: 37653085 DOI: 10.1542/neo.24-9-e603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
- Paulina Perez
- Pediatric Cardiology Fellow, The University of Mississippi Medical Center, Jackson, MS
| | - Chaitanya Panchangam
- Department of Pediatric Cardiology, University of Missouri School of Medicine, Columbia, MO
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5
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Başar EZ, Doğan Y, Şaşmazel A, Babaoğlu K. Rare association of absent pulmonary valve syndrome, complete atrioventricular canal defect, double outlet right ventricle, right aortic arch, and aberrant right subclavian artery in a fetal case. Echocardiography 2022; 39:1359-1362. [PMID: 36126337 DOI: 10.1111/echo.15446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/28/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022] Open
Abstract
Absent pulmonary valve syndrome (APVS) is a rare congenital cardiac anomaly. It is often associated with TOF, but may also be associated with an intact ventricular septum or, more rarely, with tricuspid atresia. It's combination with a complete atrioventricular septal defects and double outlet right ventricle has been reported extremely rare, even in the postnatal period. Herein, we report a 20-week-old fetus with a right aortic arch and an aberrant left subclavian artery with this rare combination. We report a case of a 20-week fetus diagnosed having this rare combination of right aortic arch and aberrant left subclavian artery. The APVS with complete atrioventricular septal defects may represent another type of APVS.
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Affiliation(s)
- Eviç Zeynep Başar
- Department of Pediatric Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Yasemin Doğan
- Department of Perinatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ahmet Şaşmazel
- Department of Pediatric Cardiovascular Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Education Research Hospital, Istanbul, Turkey
| | - Kadir Babaoğlu
- Department of Pediatric Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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6
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Goo HW. Diagnostic imaging for absent pulmonary valve syndrome: an update with an emphasis on cardiothoracic computed tomography. Pediatr Radiol 2022; 52:1167-1174. [PMID: 35039934 DOI: 10.1007/s00247-021-05254-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/11/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
Absent pulmonary valve syndrome is a rare congenital heart disease characterized by partial or complete absence of pulmonary valve cusps which commonly presents with respiratory difficulty during infancy. Because central airway compression by dilated central pulmonary arteries is a key pathology of this syndrome responsible for clinical presentation, severity, and outcome, cardiothoracic computed tomography (CT) is currently regarded as the imaging modality of choice before and after treatment. In addition, tracheobronchomalacia frequently responsible for persistent respiratory problems can be accurately evaluated with conventional two-dimensional cine CT or four-dimensional CT. In this pictorial review, various diagnostic imaging methods used to evaluate absent pulmonary valve syndrome are comprehensively illustrated with an emphasis on a recently spotlighted role of cardiothoracic CT.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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7
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Ilhan O, Gumus E, Hakan N, Istar H, Harmandar B, Olgun H, Karakus SC, Cullu N, Kohlhase J, Sutherland JD, Barrio R. A Genotyped Case of Townes–Brocks Syndrome with Absent Pulmonary Valve Syndrome from Turkey. J Pediatr Genet 2021. [DOI: 10.1055/s-0041-1740371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractTownes–Brocks syndrome (TBS) is a rare syndrome characterized by triad of anal, ear, and thumb anomalies. Further malformations/anomalies include congenital heart diseases, foot malformations, sensorineural and/or conductive hearing impairment, genitourinary malformations, and anomalies of eye and nervous system. Definitive diagnosis for TBS is confirmed by molecular analysis for mutations in the SALL1 gene. Only one known case of TBS with absent pulmonary valve syndrome (APVS) has been previously described to our knowledge. Here, we report a newborn diagnosed with TBS with APVS and tetralogy of Fallot (TOF) who was found to carry the most common pathogenic SALL1 gene mutation c.826C > T (p.R276X), with its surgical repair and postoperative follow-up. To our knowledge, this is the first genotyped case of TBS from Turkey to date. TBS should be suspected in the presence of ear, anal, and thumb malformations in a neonate. If a patient with TBS and TOF-APVS needs preoperative ventilation within the first months of life, this implies prolonged postoperative intubation and increased risk of mortality.
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Affiliation(s)
- Ozkan Ilhan
- Department of Pediatrics, Division of Neonatology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Evren Gumus
- Department of Medical Genetics, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Nilay Hakan
- Department of Pediatrics, Division of Neonatology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Hande Istar
- Department of Cardiovascular Surgery, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Bugra Harmandar
- Department of Cardiovascular Surgery, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Hasim Olgun
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Suleyman Cuneyt Karakus
- Department of Pediatric Surgery, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Nesat Cullu
- Department of Radiology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Juergen Kohlhase
- Center for Human Genetics, SYNLAB MVZ Humangenetik Freiburg GmbH, Freiburg, Germany
| | | | - Rosa Barrio
- CIC bioGUNE, Bizkaia Technology Park, Derio, Spain
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8
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Alankarage D, Szot JO, Pachter N, Slavotinek A, Selleri L, Shieh JT, Winlaw D, Giannoulatou E, Chapman G, Dunwoodie SL. Functional characterization of a novel PBX1 de novo missense variant identified in a patient with syndromic congenital heart disease. Hum Mol Genet 2021; 29:1068-1082. [PMID: 31625560 DOI: 10.1093/hmg/ddz231] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/13/2019] [Accepted: 09/23/2019] [Indexed: 12/17/2022] Open
Abstract
Pre-B cell leukemia factor 1 (PBX1) is an essential developmental transcription factor, mutations in which have recently been associated with CAKUTHED syndrome, characterized by multiple congenital defects including congenital heart disease (CHD). During analysis of a whole-exome-sequenced cohort of heterogeneous CHD patients, we identified a de novo missense variant, PBX1:c.551G>C p.R184P, in a patient with tetralogy of Fallot with absent pulmonary valve and extra-cardiac phenotypes. Functional analysis of this variant by creating a CRISPR-Cas9 gene-edited mouse model revealed multiple congenital anomalies. Congenital heart defects (persistent truncus arteriosus and ventricular septal defect), hypoplastic lungs, hypoplastic/ectopic kidneys, aplastic adrenal glands and spleen, as well as atretic trachea and palate defects were observed in the homozygous mutant embryos at multiple stages of development. We also observed developmental anomalies in a proportion of heterozygous embryos, suggestive of a dominant mode of inheritance. Analysis of gene expression and protein levels revealed that although Pbx1 transcripts are higher in homozygotes, amounts of PBX1 protein are significantly decreased. Here, we have presented the first functional model of a missense PBX1 variant and provided strong evidence that p.R184P is disease-causal. Our findings also expand the phenotypic spectrum associated with pathogenic PBX1 variants in both humans and mice.
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Affiliation(s)
- Dimuthu Alankarage
- Victor Chang Cardiac Research Institute, Department of Embryology, New South Wales, 2010 Sydney, Australia
| | - Justin O Szot
- Victor Chang Cardiac Research Institute, Department of Embryology, New South Wales, 2010 Sydney, Australia
| | - Nick Pachter
- Genetic Services of Western Australia, King Edward Memorial Hospital, Western Australia, 6008 Perth, Australia.,University of Western Australia, School of Paediatrics and Child Health, Western Australia, 6009 Perth, Australia
| | - Anne Slavotinek
- Division of Medical Genetics, Department of Pediatrics, University of California San Francisco, San Francisco, 94158 CA, USA.,Institute of Human Genetics, University of California San Francisco, San Francisco, 94143 CA, USA
| | - Licia Selleri
- Institute of Human Genetics, University of California San Francisco, San Francisco, 94143 CA, USA.,Program in Craniofacial Biology, Department of Orofacial Sciences, University of California San Francisco, San Francisco, 94143 CA, USA.,Department of Anatomy, University of California San Francisco, San Francisco, 94143 CA, USA
| | - Joseph T Shieh
- Division of Medical Genetics, Department of Pediatrics, University of California San Francisco, San Francisco, 94158 CA, USA.,Institute of Human Genetics, University of California San Francisco, San Francisco, 94143 CA, USA
| | - David Winlaw
- Victor Chang Cardiac Research Institute, Department of Embryology, New South Wales, 2010 Sydney, Australia.,Heart Centre for Children, The Children's Hospital at Westmead, New South Wales, 2145 Sydney, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, New South Wales, 2006 Sydney, Australia
| | - Eleni Giannoulatou
- Victor Chang Cardiac Research Institute, Department of Embryology, New South Wales, 2010 Sydney, Australia.,Faculty of Medicine, University of New South Wales, St Vincent's Clinical School, New South Wales, 2010 Sydney, Australia
| | - Gavin Chapman
- Victor Chang Cardiac Research Institute, Department of Embryology, New South Wales, 2010 Sydney, Australia.,Faculty of Medicine, University of New South Wales, St Vincent's Clinical School, New South Wales, 2010 Sydney, Australia
| | - Sally L Dunwoodie
- Victor Chang Cardiac Research Institute, Department of Embryology, New South Wales, 2010 Sydney, Australia.,Faculty of Medicine, University of New South Wales, St Vincent's Clinical School, New South Wales, 2010 Sydney, Australia
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9
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Watanabe H, Kise H, Toda T, Kono Y, Hasebe Y, Yoshizawa M, Sunaga Y, Shimizu T, Kaga S, Hamasaki M, Funayama S, Morisaka H, Motosugi U, Onishi H. Direct Reverse Flow From the Left to Right Pulmonary Arteries in Tetralogy of Fallot With Absent Pulmonary Valve, Evaluated by 4D Flow Magnetic Resonance Imaging. Circ J 2021; 85:1402. [PMID: 34011826 DOI: 10.1253/circj.cj-21-0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Hiroaki Kise
- Pediatric Heart Disease and Adult Congenital Heart Disease Center, Showa University Hospital
| | - Takako Toda
- Department of Pediatrics, University of Yamanashi
| | - Yosuke Kono
- Department of Pediatrics, University of Yamanashi
| | - Yohei Hasebe
- Department of Pediatrics, University of Yamanashi
| | | | - Yuto Sunaga
- Department of Pediatrics, University of Yamanashi
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10
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Verma M, Pandey NN, Ojha V, Jagia P, Kumar S, Kothari SS, Saxena A. Evaluation of cardiovascular morphology and airway-related abnormalities in tetralogy of fallot with absent pulmonary valve syndrome on multidetector computed tomography angiography. J Card Surg 2021; 36:2697-2704. [PMID: 33993521 DOI: 10.1111/jocs.15639] [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] [Received: 03/19/2021] [Revised: 04/10/2021] [Accepted: 04/26/2021] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the cardiovascular, tracheobronchial and pulmonary abnormalities associated with tetralogy of Fallot with absent pulmonary valve syndrome (TOF-APVS) on multidetector computed tomograpgy (MDCT) angiography. MATERIALS AND METHODS We conducted a retrospective review of our electronic database from January, 2014 to December, 2020 to identify pediatric patients diagnosed with TOF-APVS on MDCT angiography. Pulmonary anatomy, associated tracheobronchial and coronary compression, compression of intrapulmonary bronchi, lung parenchymal changes and other associated cardiovascular abnormalities were evaluated. RESULTS Forty-seven patients with TOF-APVS were included in the study. Compression of the airways was observed at multiple levels; 4 (8.5%) patients had carinal compression while right main bronchus and left main bronchus compression was seen in 12 (25.5%) and 16 (34.0%) patients, respectively. Forty-three (91.5%) patients showed abnormal pulmonary arterial branching at the segmental level and compression at the level of intrapulmonary bronchi was seen in 24 (51.1%) patients. Some degree of air trapping was seen in 35 (74.5%) patients whereas atelectasis was observed in 15 (31.9%) patients. Mild coronary arterial compression was seen in 3 (6.4%) patients. CONCLUSION TOF-APVS is characterized by aneurysmal dilatation of pulmonary arteries leading to a varying degree of airway compression. However, even in the absence of compression of the trachea and main bronchi, there can be distal bronchial compression secondary to abnormal pulmonary arterial branching resulting in lung abnormalities in the majority of these patients. This study highlights the importance of dedicated airway assessment in addition to cardiovascular morphological assessment by MDCT angiography, before planning surgery.
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Affiliation(s)
- Mansi Verma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj Nirmal Pandey
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Vineeta Ojha
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Priya Jagia
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam Sunder Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Saxena
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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11
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Sivakumar K, Mohakud AR, Agarwal R. Unusual association of isolation of right pulmonary artery in absent pulmonary valve syndrome. Asian Cardiovasc Thorac Ann 2021; 30:335-338. [PMID: 33789442 DOI: 10.1177/02184923211006309] [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: 11/17/2022]
Abstract
Absence of arterial duct, a sixth aortic arch derivative, plays an important etiologic role in Tetralogy of Fallot with absent pulmonary valve syndrome. When fetal ductus is absent, the large right ventricular stroke volume dilates the pulmonary trunk leading to pulmonary regurgitation. A proximal extension of the embryonic insult to the entire left sixth arch causes absence of the left pulmonary artery, a common association of absent pulmonary valve syndrome. On the contrary, absence of right pulmonary artery is not reported in absent pulmonary valve syndrome. A rare combination of tetralogy, absent pulmonary valve syndrome and isolation of a hypoplastic right pulmonary artery offered challenges to diagnosis and management.
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Affiliation(s)
| | | | - Ravi Agarwal
- Department of Pediatric Cardiology, Madras Medical Mission, Chennai, India
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12
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Moleiro ML, Guedes-Martins L. Prenatal diagnosis of absent pulmonary valve syndrome. BMJ Case Rep 2021; 14:14/1/e240567. [PMID: 33414127 PMCID: PMC7797262 DOI: 10.1136/bcr-2020-240567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Maria Lúcia Moleiro
- Department of Women and Reproductive Medicine, Centro Hospitalar do Porto, Porto, Portugal
| | - Luís Guedes-Martins
- Department of Women and Reproductive Medicine, Centro Hospitalar do Porto, Porto, Portugal
- Department of Experimental Biology, University of Porto, Porto, Portugal
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13
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Nair AK, Haranal M, Elkhatim IM, Dillon J, Hew CC, Sivalingam S. Surgical outcomes of absent pulmonary valve syndrome: An institutional experience. Ann Pediatr Cardiol 2020; 13:212-219. [PMID: 32863656 PMCID: PMC7437628 DOI: 10.4103/apc.apc_111_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/16/2019] [Accepted: 04/24/2020] [Indexed: 11/05/2022] Open
Abstract
Background: Absent pulmonary valve syndrome (APVS) is a variant of tetralogy of Fallot characterized by aneurysmal pulmonary arteries, which compresses the tracheobronchial tree, leading to respiratory symptoms. We report the mid-term outcomes of surgical correction of patients with APVS. Subject and Methods: A total of 27 patients underwent surgery between 2001 and 2015, and they were followed up for a mean period of 6.4 ± 4.1 years. Out of the 27 patients, 14 (51.9%) were infants. The median age at repair was 9.8 months. Preoperative intubation was required in six patients (22.2%), and 11 patients (40.7%) had symptoms of respiratory distress. The pulmonary valve was replaced with a valved conduit in 15 patients (55.6%), monocusp valve in 6 patients (22.2%), and a transannular patch in 6 patients (22.2%). Reduction pulmonary arterioplasty was done in all patients. Results: The overall 10-year survival was 82.1%. There was 81.1% overall freedom from re-intervention at 10 years. No statistically significant difference was found in 10-year survival (P = 0.464) and reoperation rates (P = 0.129) between valved conduit, monocusp, or transannular patch techniques. Older children had statistically significantly longer survival (P = 0.039) and freedom from re-intervention (P = 0.016) compared to infants. Patients without respiratory complications had 100% 10-year survival and 93.3% freedom from reoperation at 10 years compared to 55.6% and 60.1%, respectively, for patients with respiratory complications. Conclusion: There has been improvement in surgical results for APVS over the years. However, it still remains a challenge to manage infants and patients with persistent respiratory problems.
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Affiliation(s)
- Ashvin Krishna Nair
- Department of Cardiothoracic Surgery, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Maruti Haranal
- Department of Cardiothoracic Surgery, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Jeswant Dillon
- Department of Cardiothoracic Surgery, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Chee Chin Hew
- Department of Cardiothoracic Surgery, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Sivakumar Sivalingam
- Department of Cardiothoracic Surgery, Institut Jantung Negara, Kuala Lumpur, Malaysia
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14
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Karaca-Altintas Y, Laux D, Gouton M, Bensemlali M, Roussin R, Hörer J, Raisky O, Bonnet D. Nakata index above 1500 mm2/m2 predicts death in absent pulmonary valve syndrome. Eur J Cardiothorac Surg 2020; 57:46-53. [PMID: 31180449 DOI: 10.1093/ejcts/ezz167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/16/2019] [Accepted: 04/24/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Absent pulmonary valve syndrome is a rare congenital heart disease with severe airway compression due to dilatation of the pulmonary arteries (PAs). We investigated risk factors for death and prolonged mechanical ventilation (>7 days) and a threshold PA size for these outcomes. METHODS This retrospective 2-centre cohort study included 68 patients with complete repair between January 1996 and December 2015. RESULTS Median age at repair was 3.9 months (1.3-8.7 months), and median weight was 5 kg (4-7 kg). The mortality rate before hospital discharge was 12%, and the mortality rate at last follow-up was 19%. In multivariable analysis, risk factors for death were higher Nakata index [hazard ratio (HR) 1.001, 95% confidence interval (CI) 1.001-1.002; P < 0.001] and lower SpO2 (HR 1.06, 95% CI 1.02-1.09; P = 0.002). The accuracy of the Nakata index to predict death was excellent (area under the curve at 6 months: 0.92; P = 0.010). A Nakata index above 1500 mm2/m2 predicted mortality at 6 months with a sensitivity of 98% and a specificity of 82%. Twenty-five patients (37%) had prolonged mechanical ventilation. The only multivariable risk factor for prolonged ventilation was lower weight at repair (odds ratio 2.9, 95% CI 1.3-6.7; P = 0.008). Neither PA plasty nor the LeCompte manoeuvre had a protective effect on mortality or prolonged ventilation. A Nakata index above 1500 mm2/m2 remained a risk factor for mortality (P = 0.022) in patients who had a PA plasty or the LeCompte manoeuvre. CONCLUSIONS In patients with absent pulmonary valve syndrome, the Nakata index predicts mortality with a cut-off of 1500 mm2/m2. Lower weight at repair is the only multivariable risk factor for prolonged ventilation. Neither PA plasty nor the LeCompte manoeuvre had a protective effect on these outcomes.
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Affiliation(s)
- Yasemin Karaca-Altintas
- Department of Pediatric and Congenital Cardiac Surgery, M3C, Hôpital Marie Lannelongue, Le Plessis Robinson, France.,CHU Lille, Pediatric Intensive Care Unit, Lille, France
| | - Daniela Laux
- Department of Pediatric and Congenital Cardiac Surgery, M3C, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Marielle Gouton
- Department of Pediatric and Congenital Cardiac Surgery, M3C, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Myriam Bensemlali
- M3C-Necker, National Reference Center for Complex Congenital Heart Defects, Hôpital Universitaire Necker-Enfants malades, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Régine Roussin
- Department of Pediatric and Congenital Cardiac Surgery, M3C, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Jürgen Hörer
- Department of Pediatric and Congenital Cardiac Surgery, M3C, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Olivier Raisky
- M3C-Necker, National Reference Center for Complex Congenital Heart Defects, Hôpital Universitaire Necker-Enfants malades, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Damien Bonnet
- M3C-Necker, National Reference Center for Complex Congenital Heart Defects, Hôpital Universitaire Necker-Enfants malades, Paris, France
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Wang SS, Xu MG, Zhuang J, Li WB, Zhang ZW, Xu G. Transthoracic Echocardiographic Evaluation of Pulmonary Valve Anomalies in Pediatric Patients. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1091-1096. [PMID: 30294866 DOI: 10.1002/jum.14780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/13/2018] [Indexed: 06/08/2023]
Abstract
The pulmonary valve normally consists of 3 leaflets supported in a semilunar fashion within the sinuses of the pulmonary trunk. Pulmonary leaflet malformations, such as congenital single pulmonary cusp absence, bicuspid pulmonary valve, and quadricuspid pulmonary valve anomalies, as well as pulmonary valve commissural fusion, are seldom identified preoperatively on echocardiography. In this study, we report on 5 children with different types of pulmonary valve malformations diagnosed by transthoracic echocardiography.
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Affiliation(s)
- Shu-Shui Wang
- Department of Pediatric Cardiology, Guangzhou City, China
| | - Ming-Guo Xu
- Department of Pediatric Cardiology, Guangzhou City, China
- Department of Pediatric Cardiology, Shenzhen Children's Hospital, Shenzhen, China
| | - Jian Zhuang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou City, China
| | - Wei-Bin Li
- Department of Pediatric Cardiology, Guangzhou City, China
- Department of Pediatric Cardiology, Shenzhen Children's Hospital, Shenzhen, China
| | - Zhi-Wei Zhang
- Department of Pediatric Cardiology, Guangzhou City, China
| | - Gang Xu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou City, China
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16
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Townsley MM, Windsor J, Briston D, Alegria J, Ramakrishna H. Tetralogy of Fallot: Perioperative Management and Analysis of Outcomes. J Cardiothorac Vasc Anesth 2019; 33:556-565. [DOI: 10.1053/j.jvca.2018.03.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Indexed: 12/14/2022]
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17
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Wang ES, Fan XS, Xiang L, Li SJ, Zhang H. Surgical outcome after complete repair of tetralogy of Fallot with absent pulmonary valve: comparison between bovine jugular vein-valved conduit and monocusp-valve patch. World J Pediatr 2018; 14:510-519. [PMID: 30062647 DOI: 10.1007/s12519-018-0169-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 05/29/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The prognosis of tetralogy of Fallot with absent pulmonary valve (TOF/APV) without operation is poor. We evaluated the surgical outcome of TOF/APV in a single center. METHODS Twenty-two TOF/APV patients underwent complete surgical correction in our hospital. Right ventricular outflow tract reconstruction was performed using bovine jugular vein (BJV)-valved conduit implantation (n = 10), homograft-valved conduit implantation (n = 2), or monocusp-valve patch (n = 10). Health-related quality of life (QOL) was evaluated during follow-up. RESULTS The overall survival at 5 and 10 years was 86.4 ± 7.3% (confidence interval 69.4-97.2%). The survival rates were significantly different between patients with and without bronchial stenosis (40 and 100%, P = 0.0003, log-rank test). The survival of patients aged > 6 months was higher than those ≤ 6 months (100 vs. 40%, P = 0.0003, log-rank test). Patients with BJV-valved conduits had higher systolic gradients from the right ventricle to the pulmonary artery (RV-PA) compared to those with monocusp-valve patches. BJV-valved conduit implantation was a risk factor for post-operative pulmonary-valve stenosis. The QOL score for patients with BJV-valved conduits was lower than those with monocusp-valve patches (P < 0.05). No reoperation was performed during follow-up. CONCLUSIONS Bronchial stenosis and lower age (≤ 6 months) were the main factors influencing post-operative survival. The use of a BJV-valved conduit was a main reason for RV-PA restenosis; thus, the use of a BJV-valved conduit may increase the need for repeat intervention and decrease the post-operative quality of life.
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Affiliation(s)
- En-Shi Wang
- Center for Pediatric Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Xue-Song Fan
- Department of Clinical Laboratory Center, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, China
| | - Li Xiang
- Center for Pediatric Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Shou-Jun Li
- Center for Pediatric Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Hao Zhang
- Center for Pediatric Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
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18
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Gharde P, Aggarwal N, Sharma KP, Gadhinglajkar S, Babu S, Chauhan S, Rajashekar P. Absent Pulmonary Valve in a Case of Tetralogy of Fallot: An Incidental Discovery on Intraoperative Transesophageal Echocardiography. Anesth Analg 2017; 125:1149-1152. [PMID: 28742780 DOI: 10.1213/ane.0000000000002317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Parag Gharde
- From the *Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India; †Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India; and ‡Department of Cardiac Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Jochman JD, Atkinson DB, Quinonez LG, Brown ML. Twenty Years of Anesthetic and Perioperative Management of Patients With Tetralogy of Fallot With Absent Pulmonary Valve. J Cardiothorac Vasc Anesth 2017; 31:918-921. [DOI: 10.1053/j.jvca.2017.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Indexed: 11/11/2022]
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20
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Abstract
Neonates and infants may need a tracheostomy for many different reasons, ranging from airway obstruction to a requirement for long term mechanical ventilator support. Here, we present the pathophysiology of the many congenital and acquired conditions that might be managed with a tracheostomy. Decisions about tracheostomy demand consideration of not only the benefits, but also the potential side-effects, which may differ in the short and long term and may be attributable to underlying conditions as well as the tracheostomy. Evaluation of potential advantages of tracheostomy will influence decisions about optimal timing. In many cases, an infant may 'graduate' from dependence on a tracheostomy and resume a natural airway, although some will require reconstructive airway surgery.
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Affiliation(s)
- Sara B DeMauro
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA; The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Julie L Wei
- Nemours Children's Hospital, Orlando, FL, USA; University of Central Florida College of Medicine, Orlando, FL, USA
| | - Richard J Lin
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA; The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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21
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Hrusca A, Rachisan A, Gach P, Pico H, Sorensen C, Bonello B, Ovaert C, Petit P, Fouilloux V, Mace L, Gorincour G. Detection of pulmonary and coronary artery anomalies in tetralogy of Fallot using non-ECG-gated CT angiography. Diagn Interv Imaging 2016; 97:543-8. [DOI: 10.1016/j.diii.2016.03.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/31/2016] [Indexed: 11/28/2022]
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22
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Echocardiography in the diagnosis of patients with absent pulmonary valve syndrome: a review study of 12 years. Int J Cardiovasc Imaging 2015; 31:1353-9. [DOI: 10.1007/s10554-015-0693-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 06/11/2015] [Indexed: 10/23/2022]
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23
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Zucker EJ, Epelman M, Newman B. Perinatal Thoracic Mass Lesions: Pre- and Postnatal Imaging. Semin Ultrasound CT MR 2015; 36:501-21. [PMID: 26614133 DOI: 10.1053/j.sult.2015.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Chest masses present a common problem in the perinatal period. Advances in prenatal ultrasound, supplemented by fetal magnetic resonance imaging, now allow early detection and detailed characterization of many thoracic lesions in utero. As such, in asymptomatic infants, assessment with postnatal computed tomography or magnetic resonance imaging can often be delayed for several months until the time at which surgery is being contemplated. Bronchopulmonary malformations comprise most of the thoracic masses encountered in clinical practice. However, a variety of other pathologies can mimic their appearances or produce similar effects such as hypoplasia of a lung or both lungs. Understanding of the key differentiating clinical and imaging features can assist in optimizing prognostication and timely management.
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Affiliation(s)
- Evan J Zucker
- Department of Radiology, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, CA.
| | - Monica Epelman
- Department of Medical Imaging, Nemours Children's Hospital, Orlando, FL
| | - Beverley Newman
- Department of Radiology, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, CA
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Abstract
INTRODUCTION Patients with absent pulmonary valve syndrome often present early with airway compression from aneurysmal pulmonary arteries. This study reviews our experience in managing absent pulmonary valve syndrome in later presenting children, and techniques used for managing airway compression. METHODS This study is a retrospective chart review of all patients who underwent repair of absent pulmonary valve syndrome from 2000 to 2012 at our institution. The primary endpoints were post-operative bronchoscopic and clinical evidence of persistent airway compression and need for reinterventions on the pulmonary arteries. RESULTS A total of 19 patients were included during the study period. The mean age at repair was 4.1±3.0 years (range 10 months-11 years). In all, seven patients had pre-operative bronchoscopic evidence of airway compression, which was managed by pulmonary artery reduction plasty in four patients and Lecompte manoeuvre in three patients. There were no peri-operative deaths. In patients with pulmonary artery plasty, two had no post-operative airway compression, one patient had improved compression, and one patient had unchanged compression. In patients managed with a Lecompte manoeuvre, two patients had no or trivial airway compression and one had improved compression. There were six late reinterventions or reoperations on the pulmonary arteries - two out of four in the pulmonary artery plasty group and one out of three in the Lecompte group. CONCLUSIONS Most late-presenting patients with absent pulmonary valve syndrome do not have airway compression. Either pulmonary artery reduction plasty or the Lecompte manoeuvre can relieve proximal airway compression, without a significantly different risk of pulmonary artery reintervention between techniques.
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25
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Avsar MK, Demir T, Demir HB. Absence of Left Pulmonary Artery in Tetralogy of Fallot with Absent Pulmonary Valve Syndrome. J Card Surg 2014; 30:104-7. [DOI: 10.1111/jocs.12461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Mustafa Kemal Avsar
- Department of Cardiovascular Surgery; Medicana International Hospital; Istanbul Turkey
| | - Tolga Demir
- Department of Cardiovascular Surgery; Beylikduzu Kolan Hospital; Istanbul Turkey
| | - Hale Bolgi Demir
- Department of Cardiovascular Surgery; Medicana International Hospital; Istanbul Turkey
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Hraska V, Murin P, Photiadis J, Sinzobahamvya N, Arenz C, Asfour B. Surgery for tetralogy of Fallot - absent pulmonary valve syndrome. Technique of anterior translocation of the pulmonary artery. Multimed Man Cardiothorac Surg 2014; 2010:mmcts.2008.003186. [PMID: 24413304 DOI: 10.1510/mmcts.2008.003186] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Patients with absent pulmonary valve syndrome (APVS) and tetralogy of Fallot represent a particular management's challenge. The distinctive feature of APVS is the airway obstruction caused by tracheobronchial compression that results from massive dilatation of the main pulmonary artery (PA) and its first- and second-order branches. Consequential tracheomalacia and bronchomalacia determine the timing and severity of respiratory compromise, as well as the morbidity and mortality of these patients. Although several techniques have been proposed for decompression of the airways, the method of choice is still controversial. Translocation of the PA anterior to the aorta and away from the airways has the potential to reduce or eliminate bronchial compression. Overall, the intermediate-term functional outcomes using this technique have been encouraging, with zero mortality even in the youngest age group of patients and the disappearance of respiratory symptoms in the majority of them. Nevertheless, failure of the treatment could be expected in symptomatic patients in whom the pathology of the airways extends beyond the proximal PAs.
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Affiliation(s)
- Viktor Hraska
- Department of Pediatric Cardiac Surgery, German Pediatric Heart Centre, Asklepios Clinic Sankt Augustin, Arnold Janssen Str. 29, 53757 Sankt Augustin, Germany
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27
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Solana-Gracia R, Crossland D, Mitchell L, Wren C, Griselli M. Tetralogy of Fallot With Absent Pulmonary Valve Syndrome, Right Aortic Arch, and Disconnected Left Pulmonary Artery. World J Pediatr Congenit Heart Surg 2013; 4:206-9. [DOI: 10.1177/2150135112470960] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present a rare case of a two-week-old infant with tetralogy of Fallot , absent pulmonary valve syndrome , right aortic arch, and disconnected left pulmonary artery (LPA) whose origin was from ductal ligament adjacent to the left subclavian artery. One-stage surgical correction, including closure of ventricular septal defect (VSD), LPA reconstruction and reconnection to the pulmonary trunk, reduction in size of the right pulmonary artery (RPA), and right ventricular outflow tract reconstruction with valved conduit, was successfully performed with good clinical mid-term outcome.
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Affiliation(s)
- Ruth Solana-Gracia
- Department of Paediatric Cardiology, Freeman Hospital, High Heaton, Newcastle upon Tyne, UK
| | - David Crossland
- Department of Paediatric Cardiology, Freeman Hospital, High Heaton, Newcastle upon Tyne, UK
| | - Leslie Mitchell
- Department of Radiology, Freeman Hospital, High Heaton, Newcastle upon Tyne, UK
| | - Christopher Wren
- Department of Paediatric Cardiology, Freeman Hospital, High Heaton, Newcastle upon Tyne, UK
| | - Massimo Griselli
- Department of Paediatric Cardiothoracic Surgery, Freeman Hospital, High Heaton, Newcastle upon Tyne, UK
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28
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Karakurt C, Koçak G, Elkiran O. Prenatal diagnosis of a patient with tetralogy of Fallot and an absent pulmonary valve. Pediatr Cardiol 2011; 32:241-2. [PMID: 21188373 DOI: 10.1007/s00246-010-9861-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 12/06/2010] [Indexed: 11/30/2022]
Affiliation(s)
- Cemşit Karakurt
- Department of Pediatric Cardiology, Faculty of Medicine, Inonu University, Merkez, 042080, Malatya, Turkey.
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29
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Chen P, Ladino-Torres M. Newborn with tetralogy of Fallot and absent pulmonary valve. Pediatr Radiol 2010; 40 Suppl 1:S87. [PMID: 21042795 DOI: 10.1007/s00247-010-1873-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 09/29/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Paul Chen
- Department of Radiology, Section of Pediatric Radiology, University of Michigan Health System, 1500 E. Medical Center Drive, Rm. F3345, Ann Arbor, MI 48109-5252, USA
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30
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Hraska V, Photiadis J, Schindler E, Sinzobahamvya N, Fink C, Haun C, Schneider M, Blaschczok HC, Asfour B. A novel approach to the repair of tetralogy of Fallot with absent pulmonary valve and the reduction of airway compression by the pulmonary artery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2009; 12:59-62. [PMID: 19349015 DOI: 10.1053/j.pcsu.2009.01.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Controversy persists regarding the management of patients suffering from tetralogy of Fallot with absent pulmonary valve syndrome. Airway obstruction caused by the dilated pulmonary arteries is the determining factor in the mortality of symptomatic newborns and infants. A number of surgical techniques for the reduction of bronchial obstruction have been proposed, producing variable results. All strategies have focused on plication and reduction of the anterior or posterior wall of the normally positioned pulmonary arteries, with or without pulmonary valve replacement. An alternative approach is to bring the pulmonary arteries anterior to the aorta and away from the trachea and bronchial tree. This technique has the potential to reduce or eliminate bronchial compression by the central pulmonary arteries. Failure of the treatment could be expected in symptomatic patients, where the pathology of the airways extends beyond the proximal pulmonary arteries.
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Affiliation(s)
- Viktor Hraska
- German Pediatric Heart Center, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany.
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31
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Chen JM, Glickstein JS, Margossian R, Mercando ML, Hellenbrand WE, Mosca RS, Quaegebeur JM. Superior outcomes for repair in infants and neonates with tetralogy of Fallot with absent pulmonary valve syndrome. J Thorac Cardiovasc Surg 2006; 132:1099-104. [PMID: 17059929 DOI: 10.1016/j.jtcvs.2006.05.049] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Revised: 05/12/2006] [Accepted: 05/22/2006] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Primary repair of tetralogy of Fallot with absent pulmonary valve syndrome has been associated with significant mortality, particularly for neonates in respiratory distress. Controversy persists regarding the method of establishing right ventricle-pulmonary artery continuity. METHODS Anatomic and demographic parameters were evaluated for patients undergoing repair of tetralogy of Fallot with absent pulmonary valve syndrome from 1990 to 2005, as were perioperative and late postoperative parameters (airway complications, reoperation or catheter-based intervention, and mortality). RESULTS Twenty-three patients underwent repair. Median age was 15 days (range 2-1154 days). Patients were followed up for 5.3 +/- 3.9 years. Seventeen (85%) required preoperative ventilatory assistance. One patient died within 24 hours; 1 patient died 8 months postoperatively. Four patients received valved homografts, and the remainder had valveless connections. All patients underwent reduction pulmonary arterioplasty and mobilization, unifocalization (in 3), and ventricular septal defect closure. Valveless connection recipients had a transannular hood. No patient underwent a Lecompte maneuver. Four patients underwent reoperation for conversion to valveless connection (n = 1), reduction arterioplasty (n = 1), and repair of pulmonary stenosis (n = 2). Three patients required catheter-based intervention, with balloon angioplasty (n = 3) and stent placement (n = 1); 2 now demonstrate equal quantitative lung perfusion. No patient has had significant debility from airway compromise. All patients demonstrate free pulmonary insufficiency and good biventricular function. CONCLUSIONS We report excellent overall survival (89%) and low postoperative morbidity for neonates and infants undergoing primary repair of tetralogy of Fallot with absent pulmonary valve syndrome. Our recent experience supports the use of a valveless right ventricle-pulmonary artery connection, which, combined with catheter-based intervention, reduces the likelihood of reoperation necessitated by homograft placement.
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Affiliation(s)
- Jonathan M Chen
- Department of Cardiothoracic Surgery, Weill Medical School at Cornell University, New York, NY 10021, USA.
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Hraska V. Repair of tetralogy of Fallot with absent pulmonary valve using a new approach. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2005:132-4. [PMID: 15818369 DOI: 10.1053/j.pcsu.2005.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Although several techniques for the correction of tetralogy of Fallot (TOF) with absent pulmonary valve have been described, the method of choice is controversial. Symptomatic infants, in particular, have a poor prognosis because of severe central pulmonary artery dilatation and bronchial compression. An alternative technique for primary repair of TOF with absent pulmonary valve syndrome is suggested. Apart from correction of TOF, this approach includes translocation of the pulmonary artery anterior to the aorta and away from the airways. This technique has a potential to reduce or eliminate bronchial compression by the pulmonary artery. Insertion of valve homograft with anterior and/or posterior plication of the pulmonary artery is considered especially in symptomatic newborns and infants. The intermediate-term functional outcomes have been encouraging, with zero mortality events even in the youngest age group of patients and with the disappearance of respiratory symptoms in the majority of them.
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Affiliation(s)
- Viktor Hraska
- Department of Pediatric Cardiac Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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