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Petit CJ, Glatz AC, Goldstone AB, Law MA, Romano JC, Maskatia SA, Chai PJ, Zampi JD, Meadows JJ, Nicholson GT, Shahanavaz S, Qureshi AM, McCracken CE, Mascio CE, Batlivala SP, Asztalos IB, Healan SJ, Smith JD, Pettus JA, Beshish A, Raulston JEB, Hock KM, Pajk AL, Goldstein BH. Pulmonary Artery Hypoplasia in Neonates With Tetralogy of Fallot. J Am Coll Cardiol 2023; 82:615-627. [PMID: 37558375 DOI: 10.1016/j.jacc.2023.05.051] [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] [Received: 12/14/2022] [Revised: 04/27/2023] [Accepted: 05/22/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Neonates with symptomatic tetralogy of Fallot (sTOF) with hypoplastic pulmonary arteries (hPA) are considered high risk. Data are needed to inform the impact of hPA on outcomes, and the ideal management strategy. OBJECTIVES The objectives of this study were to quantify the impact of hPA on outcomes in neonates with sTOF and measure the impact of strategy on pulmonary artery (PA) growth in this population. METHODS Neonates with sTOF from 2005 to 2017 were reviewed from the Congenital Cardiac Research Collaborative. Criteria for hPA included a unilateral PA z score <-2.0 and contralateral PA z score <0. Primary outcome was mortality. Secondary outcomes included reintervention and PA growth. RESULTS We included 542 neonates with sTOF, including 188 (35%) with hPA and 354 (65%) with normal PA, with median follow-up of 4.1 years. Median right and left hPA z scores were -2.19 (25th-75th percentile: -2.55 to -1.94) and -2.23 (25th-75th percentile: -2.64 to -1.91), respectively. Staged repair (vs primary TOF repair) was less common in the hPA cohort (36 vs 44%; P = 0.07). Survival was similar between groups (unadjusted P = 0.16; adjusted P = 0.25). Reintervention was more common in the hPA group (HR: 1.28; 95% CI: 1.01-1.63; P = 0.044); there was no difference after definitive repair (HR: 1.21; 95% CI: 0.93-1.58; P = 0.16). PA growth at 1 year was greater in the hPA cohort, particularly for the right PA (P < 0.001). CONCLUSIONS Despite perception, the presence of hPA in neonates with sTOF conferred no increase in overall hazard of mortality or reintervention after definitive repair. PA growth was superior in the hPA cohort. These findings suggest that the presence of hPA does not adversely impact outcomes in sTOF.
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Affiliation(s)
- Christopher J Petit
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA; Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
| | - Andrew C Glatz
- Division of Pediatric Cardiology, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Division of Pediatric Cardiology, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Missouri, USA
| | - Andrew B Goldstone
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Mark A Law
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Jennifer C Romano
- University of Michigan School of Medicine, Mott Children's Hospital, Ann Arbor, Michigan, USA
| | - Shiraz A Maskatia
- University of California San Francisco School of Medicine, Benioff Children's Hospital, San Francisco, California, USA
| | - Paul J Chai
- Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Jeffrey D Zampi
- University of Michigan School of Medicine, Mott Children's Hospital, Ann Arbor, Michigan, USA
| | - Jeffery J Meadows
- University of California San Francisco School of Medicine, Benioff Children's Hospital, San Francisco, California, USA
| | - George T Nicholson
- Division of Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shabana Shahanavaz
- Division of Pediatric Cardiology, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Missouri, USA; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Athar M Qureshi
- Baylor College of Medicine, Texas Children's Hospital, Waco, Texas, USA
| | - Courtney E McCracken
- Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Christopher E Mascio
- Division of Pediatric Cardiology, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; University of West Virginia School of Medicine, Morgantown, West Virginia, USA
| | | | - Ivor B Asztalos
- Division of Pediatric Cardiology, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Steven J Healan
- Division of Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Justin D Smith
- University of Michigan School of Medicine, Mott Children's Hospital, Ann Arbor, Michigan, USA
| | - Joelle A Pettus
- Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Asaad Beshish
- Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - James E B Raulston
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Krissie M Hock
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Amy L Pajk
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Bryan H Goldstein
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Patel K, Gajjar T. Lesson learnt about right ventricle to pulmonary artery shunt for older children and young adults with ventricular septal defect, pulmonary atresia, and hypoplastic pulmonary arteries. Indian J Thorac Cardiovasc Surg 2022; 38:572-573. [PMID: 36050983 PMCID: PMC9424471 DOI: 10.1007/s12055-022-01380-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 10/18/2022] Open
Affiliation(s)
- Kartik Patel
- Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Centre (affiliated to BJ Medical College, Ahmedabad), Civil Hospital Campus, Asarwa, Ahmedabad, 380016 Gujarat India
| | - Trushar Gajjar
- Department of Paediatric Cardiovascular Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Centre (affiliated to BJ Medical College, Ahmedabad), Civil Hospital Campus, Asarwa, Ahmedabad, 380016 Gujarat India
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