Decreased Left Ventricular Coronary Artery Density in Pulmonary Atresia and Intact Ventricular Septum

A Rare Coronary Collateral in Pulmonary Atresia and Intact Septum With Coronary Sinusoids

A neonate with pulmonary atresia and intract ventricular septum, ventriculocoronary sinusoids, bilateral coronary ostial atresia, and a rare collateral vessel between the descending thoracic aorta and the coronary system is described. The clinical course in this infant included extracorporeal life support and coil occlusion of the collateral in order to manage multiple ischemic events.

Critical care outcomes in pulmonary atresia and intact ventricular septum undergoing single-ventricle palliation

OBJECTIVE

To examine early outcomes for pulmonary atresia with intact ventricular septum undergoing single-ventricle palliation and to determine risk factors for mortality.

DESIGN

Retrospective observational study.

SETTING

Tertiary paediatric critical care unit.

INTERVENTION

Risk factors for mortality were sought for infants after the primary intervention whether surgical shunt or ductal stent.

MEASUREMENTS AND MAIN RESULTS

We reviewed outcomes of 19 infants with pulmonary atresia with intact ventricular septum undergoing single-ventricle palliation between July, 2000 and July, 2008. Echocardiograms, cardiac catheterisation findings, anaesthesia, and critical care management, as well as autopsy reports were reviewed. We modelled survival after surgery and looked for predictors of early mortality. A total of 19 infants underwent single-ventricle palliation and seven of these died. The risk of death was increased by a lower arterial pH at induction of anaesthesia (p = 0.01), a lower systolic blood pressure (p = 0.01), and technical problems during surgery (p = 0.03). On admission to the critical care unit, a lower mixed venous saturation (p = 0.02) and presence of tachyarrhythmia (p = 0.02) were associated with the need for mechanical support within the first 48 hours.

CONCLUSIONS

There is a high early mortality for those who undergo single-ventricle palliation. It is higher for those who are haemodynamically compromised before surgery; technical problems, and haemodynamic instability during surgery also increase mortality.