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Wiggins LM, Wang S, Wells W, Starnes V, Cleveland JD. Anatomic considerations in the management of complete atrioventricular canal. Cardiol Young 2024; 34:754-758. [PMID: 37814959 DOI: 10.1017/s1047951123003323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
OBJECTIVE Patients with complete atrioventricular canal have a variable clinical course prior to repair. Many patients balance their circulations well prior to elective repair. Others manifest clinically significant pulmonary over circulation early in life and require either palliative pulmonary artery banding or complete repair. The objective of this study was to assess anatomic features that impact the clinical course of patients. METHODS In total, 222 patients underwent complete atrioventricular canal repair between 2012 and 2022 at a single institution. Twenty-seven (12%) patients underwent either pulmonary artery banding (n = 15) or complete repair (n = 12) at less than 3 months of age (Group 1). The remaining 195 (88%) underwent repair after 3 months of age (Group 2). Patient records and imaging were reviewed. RESULTS The median post-operative length of stay following complete repair was 25 [7,46] days for those patients in Group 1 and 7 [5,12] days for those in Group 2 (p < 0.0001). There was relative hypoplasia of left-sided structures in Group 1 versus Group 2. Mean z-score for the ascending aorta was -1.2 (±0.8) versus -0.3 (±0.9) (p < 0.0001), the aortic isthmus was -2.1 (±0.8) versus -1.4 (±0.8) (p = 0.005). The pulmonary valve to aortic valve diameter ratio was median 1.47 [1.38,1.71] versus 1.38 [1.17,1.53] (p 0.008). CONCLUSIONS Echocardiographic evaluation of the systemic and pulmonary outflow of patients with complete atrioventricular canal may assist in predicting the clinical course and need for early repair vs pulmonary artery banding.
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Affiliation(s)
- Luke M Wiggins
- Division of Pediatric Cardiac Surgery, Heart Institute, Children's Hospital of Los Angeles, Los Angeles, CA, USA
- Division of Cardiothoracic Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Shuo Wang
- Division of Pediatric Cardiology, Heart Institute, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Winfield Wells
- Division of Pediatric Cardiac Surgery, Heart Institute, Children's Hospital of Los Angeles, Los Angeles, CA, USA
- Division of Cardiothoracic Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Vaughn Starnes
- Division of Pediatric Cardiac Surgery, Heart Institute, Children's Hospital of Los Angeles, Los Angeles, CA, USA
- Division of Cardiothoracic Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - John D Cleveland
- Division of Pediatric Cardiac Surgery, Heart Institute, Children's Hospital of Los Angeles, Los Angeles, CA, USA
- Division of Cardiothoracic Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA
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Early repair of complete atrioventricular septal defect has better survival than staged repair after pulmonary artery banding: A propensity score–matched study. J Thorac Cardiovasc Surg 2021; 161:1594-1601. [DOI: 10.1016/j.jtcvs.2020.07.106] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/13/2020] [Accepted: 07/31/2020] [Indexed: 11/23/2022]
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Pulmonary Artery Banding in Post-tricuspid Congenital Cardiac Shunting Defects with High Pulmonary Vascular Resistance. Pediatr Cardiol 2019; 40:719-725. [PMID: 30673799 DOI: 10.1007/s00246-019-02054-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
Abstract
Reports of "treat and repair" of cardiac shunting lesions with inoperably high pulmonary vascular resistance (PVR) mostly concern pre-tricuspid defects; post-tricuspid lesions are different. We report our experience with pulmonary artery (PA) banding ± targeted pulmonary hypertension medications in five patients with a large VSD and inoperably high PVR, and review previous reports of PA banding with post-tricuspid defects. Three of our 5 patients had mean PAP > 50 mmHg after banding and no or only a transient fall in PVR. Two patients had mean PAP < 50 mmHg and lower PVR after banding; they had closure of their VSDs but have since had a progressive increase in PVR (follow-up after closure, 3.5 and 7.7 years). Previous reports have also documented difficulty in achieving sufficient band gradient. Of previously reported patients, only one became operable only after banding and targeted therapy, and was repaired; follow-up after repair was short-term (16 months). Our and previous experience demonstrate the difficulty in placing a PA band sufficiently tight to substantially reduce PA pressure. Reported attempts to "treat and repair" post-tricuspid defects are few and have met with limited success, and we found that PVR may increase significantly over time after repair. But more information is needed. Accurate interpretation of experience with "treat and repair" requires: careful characterization of the pulmonary circulation prior to "treating"; considering spontaneously reversible factors at pre-treatment catheterization before ascribing reduction in PVR to medical therapy; and long-term observation of PVR in patients who have had defect closure.
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Buratto E, Khoo B, Ye XT, Daley M, Brizard CP, d'Udekem Y, Konstantinov IE. Long-Term Outcome After Pulmonary Artery Banding in Children With Atrioventricular Septal Defects. Ann Thorac Surg 2018; 106:138-144. [PMID: 29627386 DOI: 10.1016/j.athoracsur.2018.02.086] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 02/26/2018] [Accepted: 02/27/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with atrioventricular septal defect (AVSD) may require pulmonary artery banding (PAB), either as a part of a staged univentricular palliation or to allow delayed biventricular repair in patients presenting with early heart failure. The long-term outcomes of PAB in children with AVSD have not been previously reported. METHODS All children with AVSD who underwent PAB at a single institution were included in the study. Data were obtained from medical records and correspondence with general practitioners and cardiologists. RESULTS A total of 68 patients with complete AVSD underwent PAB, of whom 58.8% of patients (40 of 68) had balanced AVSD (bAVSD) and underwent PAB with intent to subsequently perform biventricular repair. The remaining 41.2% of patients (28 of 68) had unbalanced AVSD (uAVSD) and underwent PAB as part of staged univentricular repair. PAB was not associated with a short-term increase in atrioventricular valve (AVV) regurgitation (p = 0.24). In patients with bAVSD, 83.8% (95% confidence interval [CI]: 67.4% to 92.4%) achieved biventricular repair. Survival was 73.4% (95% CI: 54.3% to 85.5%) and freedom from left AVV operation was 60.0% (95% CI: 36.1% to 77.4%) at 20 years of follow-up. In patients with uAVSD, 61.9% (95% CI: 40.5% to 77.5%) had achieved Fontan completion at 10 years of follow-up. Survival was 60.9% (95% CI: 36.2% to 78.5%) and freedom from AVV operation was 78.6% (95% CI: 55.5% to 90.6%) at 20 years. CONCLUSIONS PAB can be used in patients with AVSD without compromising AVV function. Most patients with bAVSD progress to biventricular repair, albeit with a high rate of AVV reoperation. Patients with uAVSD who undergo PAB have similar outcomes to the overall uAVSD population.
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Affiliation(s)
- Edward Buratto
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Brandon Khoo
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Xin Tao Ye
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Michael Daley
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Christian P Brizard
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Yves d'Udekem
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Igor E Konstantinov
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
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5
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Jalal Z, Roubertie F, Fournier E, Dubes V, Benoist D, Naulin J, Delmond S, Durand M, Haissaguerre M, Bernus O, Thambo JB. Unexpected Internalization of a Pulmonary Artery Band in a Porcine Model of Tetralogy of Fallot. World J Pediatr Congenit Heart Surg 2016; 8:48-54. [PMID: 28033087 DOI: 10.1177/2150135116668828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND We report our experience of an unexpected complication of internalization of a pulmonary artery (PA) band in the vascular lumen, which occurred in a chronic porcine model of repaired tetralogy of Fallot (TOF). METHODS Twelve piglets were divided into 3 groups: (1) TOF model animals (PA band plus pulmonary valvotomy, n = 4), (2) pulmonary insufficiency (PI) animals (pulmonary valvotomy, n = 4), and (3) control animals (n = 4). A nonabsorbable, coated braided polyester tape was used to perform the main pulmonary artery banding. Echocardiography was performed 4 months postoperatively. After each animal was euthanized, PA histological analysis was performed in animals with band internalization. RESULTS Significant postsurgical pulmonary regurgitation and right ventricular enlargement were present in the TOF and PI, compared with control animals, whereas no significant pulmonary stenosis was observed in TOF animals when compared with PI group. Postmortem examination of all TOF animals revealed the constricting band to be intact but partially internalized into the PA lumen, allowing blood flow around the stenosis. Histological sections of the banded PA in the area of internalization showed a significant disorganization of the medial layer, with significant scarring and fibrotic reaction surrounding the outside of the band and the presence of inflammatory cells suggesting a significant inflammatory response during band internalization. CONCLUSIONS Band internalization may occur after PA banding using a nonabsorbable, coated braided polyester tape in a chronic porcine model of repaired TOF. This unusual complication was likely due to the type of material used for banding.
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Affiliation(s)
- Zakaria Jalal
- 1 Department of Paediatric and Adult Congenital Heart defects, University Hospital of Bordeaux, Bordeaux, France.,2 L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux, France.,3 Inserm U1045 CRCTB, Université de Bordeaux, Bordeaux, France
| | - François Roubertie
- 1 Department of Paediatric and Adult Congenital Heart defects, University Hospital of Bordeaux, Bordeaux, France.,2 L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux, France.,3 Inserm U1045 CRCTB, Université de Bordeaux, Bordeaux, France
| | - Emmanuelle Fournier
- 1 Department of Paediatric and Adult Congenital Heart defects, University Hospital of Bordeaux, Bordeaux, France.,2 L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux, France.,3 Inserm U1045 CRCTB, Université de Bordeaux, Bordeaux, France
| | - Virginie Dubes
- 2 L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux, France.,3 Inserm U1045 CRCTB, Université de Bordeaux, Bordeaux, France
| | - David Benoist
- 2 L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux, France.,3 Inserm U1045 CRCTB, Université de Bordeaux, Bordeaux, France
| | - Jerome Naulin
- 2 L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux, France.,3 Inserm U1045 CRCTB, Université de Bordeaux, Bordeaux, France
| | | | | | - Michel Haissaguerre
- 1 Department of Paediatric and Adult Congenital Heart defects, University Hospital of Bordeaux, Bordeaux, France.,2 L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux, France.,3 Inserm U1045 CRCTB, Université de Bordeaux, Bordeaux, France
| | - Olivier Bernus
- 2 L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux, France.,3 Inserm U1045 CRCTB, Université de Bordeaux, Bordeaux, France
| | - Jean-Benoit Thambo
- 1 Department of Paediatric and Adult Congenital Heart defects, University Hospital of Bordeaux, Bordeaux, France.,2 L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux, France.,3 Inserm U1045 CRCTB, Université de Bordeaux, Bordeaux, France
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6
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Dhannapuneni RRV, Gladman G, Kerr S, Venugopal P, Alphonso N, Corno AF. Complete atrioventricular septal defect: Outcome of pulmonary artery banding improved by adjustable device. J Thorac Cardiovasc Surg 2011; 141:179-82. [DOI: 10.1016/j.jtcvs.2010.03.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2009] [Revised: 02/22/2010] [Accepted: 03/14/2010] [Indexed: 10/19/2022]
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7
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Waragai T, Awa S, Akagi M, Andou Y, Watanabe N, Hosaki A, Kawamata H. Clinical implication of main pulmonary artery Windkessel size after banding operation. Pediatr Int 2009; 51:84-90. [PMID: 19371284 DOI: 10.1111/j.1442-200x.2008.02695.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Windkessel model, proposed in 1895 by O. Frank, successfully explained systemic and abnormal pulmonary hemodynamics of congenital cardiac defects. The model is essentially a functional one and describes only hemodynamics, not anatomical or geographic structures. Because pulmonary arterial banding (PAB) adds a substantial resistance proximal to arterioles, it provides an ideal anatomical structure of the Windkessel model, namely, an elastic reservoir of much dilated main pulmonary artery (mPA) followed by a substantial artificial resistance of banding. METHODS The pulmonary artery (PA) Windkessel size (WS) of 10 patients, several months to years after PAB, were estimated both in peak systole (WSs) and minimum diastole (WSd), as the product of Windkessel compliance and proximal to distal pulmonary arterial pressure difference at each cardiac phase. They were compared to cineangiogram-determined corresponding volumes (Vs, Vd) of PA proximal to the band or mPA. RESULT WSs and WSd correlated well with Vs and Vd, respectively, with the correlation coefficient of 0.91 and 0.62, indicating that the Windkessel in these patients corresponds to mPA. Among five patients whose resistance at the band comprised more than half of the whole PA resistance, the coefficients proved even better. CONCLUSION Much bigger secondarily developed Windkessel, as placed proximal to the band on top of a substantial resistance at PAB, contributed much to alleviate the stress downstream at the periphery caused by greatly increased systolic stroke volume into mPA in these cardiac defects.
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Affiliation(s)
- Tadashi Waragai
- Department of Pediatrics, Kyorin University School of Medicine, Tokyo, Japan.
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8
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Freedom RM, Yoo SJ, Russell J, Perrin D, Williams WG. Designing therapeutic strategies for patients with a dominant left ventricle, discordant ventriculo-arterial connections, and unobstructed flow of blood to the lungs. Cardiol Young 2004; 14:630-53. [PMID: 15679999 DOI: 10.1017/s1047951104006080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The palliation of the cyanotic child with a dominant morphologically left ventricle, discordant ventriculo-arterial connections, and obstruction to the pulmonary outflow tract has continued to evolve and mature. The evolution began in the early days of surgical palliation with the Blalock-Taussig shunt, extended to construction of cavopulmonary shunts, if required, and then to the Fontan procedure and its subsequent modifications. This journey took nearly 30 years to complete. There is increasing clinical data to document the beneficial effects of this approach, with ever-improving outcomes. Some aspects of the history of the cavopulmonary shunt have been previously reviewed in this journal and elsewhere, as have analysis of outcomes for some groups of patients considered for surgical completion of the Fontan circulation. While there has been some ongoing interest in ventricular septation since the early success of Sakakibara et al., this approach has largely been abandoned. Considerably more challenges and debate resonate in the surgical algorithms defined for patients whose hearts are characterized by a dominant left ventricle, discordant ventriculo-arterial connections, and unobstructed flow of blood to the lungs. This latter group will be the focus of this review, as will the aetiology of the myocardial hypertrophy that is particularly frequent in this group of patients, its clinical recognition, indeed its anticipation, and the multiple surgical strategies designed to prevent or treat it. All these manoeuvres are considered to optimise suitability for, and outcome from, creation of the Fontan circulation.
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Affiliation(s)
- Robert M Freedom
- Division of Cardiology of the Department of Pediatrics, The Hospital for Sick Children, The University of Toronto Faculty of Medicine, Toronto, Canada.
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9
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Cheung DLC, Au WK, Chiu WH, Chui SW, Lee WT. Post-Banding Pulmonary Artery Pseudoaneurysm. Asian Cardiovasc Thorac Ann 1998. [DOI: 10.1177/021849239800600119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Following pulmonary artery banding and left subclavian aortoplasty, a neonate developed a staphylococcal wound infection and a pseudoaneurysm of the pulmonary artery. She died of uncontrolled sepsis.
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Affiliation(s)
- David LC Cheung
- Division of Cardiothoracic Surgery Department of Surgery Grantham Hospital Hong Kong, People's Republic of China
| | - Wing Kuk Au
- Division of Cardiothoracic Surgery Department of Surgery Grantham Hospital Hong Kong, People's Republic of China
| | - Wing Hung Chiu
- Division of Cardiothoracic Surgery Department of Surgery Grantham Hospital Hong Kong, People's Republic of China
| | - Shui Wah Chui
- Division of Cardiothoracic Surgery Department of Surgery Grantham Hospital Hong Kong, People's Republic of China
| | - Wai Tsun Lee
- Division of Cardiothoracic Surgery Department of Surgery Grantham Hospital Hong Kong, People's Republic of China
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10
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Vince DJ, Leblanc JG, Culham JA, Taylor GP. Dilatable prosthesis for banding the main pulmonary artery: human clinical trials. INTERNATIONAL JOURNAL OF CARDIAC IMAGING 1996; 12:205-12. [PMID: 8915722 DOI: 10.1007/bf01806224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The objectives of this trial are to assess the safety and effectiveness of the prosthesis and to establish the ability of the dilatable band to provide a nonsurgical option for dilatation. Forty-six patients received dilatable bands. All had congenital heart defects requiring banding of the main pulmonary artery. Dilatation was performed on 7 patients. This was successful in 6 and uncomplicated in all. In one patient the dilatable band was adjusted too tightly at implantation. In one patient the band was adjusted to loosely. In 7 patients the dilatable band was placed too distally and partially obstructed the right or left pulmonary artery. Distal migration of the dilatable band after implantation did not occur. One band was distorted during implantation. This did not compromise its function. Surgical sepsis resulted in a mycotic aneurysm and erosion of the pulmonary artery in one patient. Surgical pulmonary arterioplasty was performed in all 18 patients who had total correction and in 11 of the 13 patients who had bidirectional Glenn procedure and Damus-Stanzell connection. There were 13 deaths. None of the deaths were related to the dilatable band. Thirty-two prostheses were surgically explanted readily and completely in 31 patients. Five bands were removed at postmortem examination. Examination of all 37 of the dilatable bands revealed no evidence of wear or damage. Scanning electron microscopy evaluation was conducted on 5 of the explanted devices which had been implanted 158 to 1139 (mean 422) days. No component failure was identified. The dilatable band prostheses was effective and safe and provided a non-surgical option for dilatation.
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Affiliation(s)
- D J Vince
- University of British Columbia, Vancouver, Canada
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Kuribayashi R, Sekine S, Aida H, Seki K, Meguro A, Shibata Y, Sakurada T, Sato M, Abe T. Long-term results of primary closure for ventricular septal defects in the first year of life. Surg Today 1994; 24:389-92. [PMID: 8054807 DOI: 10.1007/bf01427029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The long-term results of primary closure for large ventricular septal defects (VSDs) in infants under 1 year of age with severe symptoms were studied over a period of more than 10 years. Between January, 1971 and March, 1982, 49 infants underwent primary closure of a VSD through a right ventriculotomy using complete cardiopulmonary bypass with mild hypothermia. There were four hospital deaths but no late deaths. Two of four infants with residual shunts had a left ventricular-right atrial shunt which necessitated reoperation. Surgical heart block occurred in two infants who recovered sinus rhythm in the late period. The cardiothoracic ratio decreased from 60.5% preoperatively to 50.6% in the late postoperative period. Examination by cardiac catheterization revealed that the pulmonary-to-systemic pressure ratio (Pp/Ps) of 23 patients with a Pp/Ps of over 0.75 fell from 0.89 +/- 0.09 preoperatively to 0.42 +/- 0.12 by 1 month postoperatively, then to 0.27 +/- 0.05 in the late postoperative period. The latest values for the cardiac index and left ventricular ejection fraction were 3.4 l/min per m2 and 64.4%, respectively. More than 10 years after their operation, all the survivors were growing normally and maintaining a good quality of life, which supports our recommendation that primary repair should be performed in the first year of life for infants with large VSDs.
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Affiliation(s)
- R Kuribayashi
- Department of Cardiovascular Surgery, Akita University School of Medicine, Japan
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12
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Hardin JT, Muskett AD, Canter CE, Martin TC, Spray TL. Primary surgical closure of large ventricular septal defects in small infants. Ann Thorac Surg 1992; 53:397-401. [PMID: 1540054 DOI: 10.1016/0003-4975(92)90257-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Herein, a policy of primary surgical closure of large ventricular septal defects in infants is reviewed. Forty-eight infants met criteria for inclusion in the study, and were divided into two groups based on weight: group 1 infants weighted 4 kg or less (n = 23), and group 2 infants weighed more than 4 kg (n = 25). Both groups had similar variation in ventricular septal defect location (paramembranous versus muscular) and number (single versus multiple), as well as incidence of major associated extracardiac diseases. No early deaths occurred in group 1, compared with 1 infant (4%) in group 2. Major complications occurred similarly in both groups (9% versus 12%). There were two late deaths in group 1 (9%) and none in group 2. No surviving patients have required a second ventricular septal defect operation, and the majority no longer receive anticongestive therapies. These results indicate that primary surgical closure of large ventricular septal defects, even multiple muscular defects, can be performed in very small infants with no difference in mortality or serious complication rates compared with larger infants. Protracted medical efforts to achieve larger size before primary repair and palliative pulmonary artery banding are not necessary.
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Affiliation(s)
- J T Hardin
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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13
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Abstract
A child is presented who had pulmonary artery bands that eroded or cut-through to the point where congestive heart failure and pulmonary arterial hypertension recurred. A summary of previously reported cases of band erosion or cut-through is presented, noting that many of these children died. Pulmonary artery banding is now mainly used in infants with complex defects where mortality of early repair is prohibitive or where the Fontan procedure is the only "repair" possible. To obtain good results, a normal pulmonary vascular resistance is preferred; therefore, it is important that the pulmonary artery band is truly protective over the period of time needed. The occurrence of pulmonary vascular disease can cause a decrease in left-to-right shunting and allow a child to clinically improve, thus duplicating the response to a successful banding. If noninvasive evaluation cannot provide clear-cut proof that the band is protective, then measurement of pulmonary artery pressure and flow must be done.
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14
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Burczynski PL, McKay R, Arnold R, Mitchell DR, Sabino GP. Homograft replacement of the pulmonary artery bifurcation. J Thorac Cardiovasc Surg 1989. [DOI: 10.1016/s0022-5223(19)34367-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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15
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Horowitz MD, Culpepper WS, Williams LC, Sundgaard-Riise K, Ochsner JL. Pulmonary artery banding: analysis of a 25-year experience. Ann Thorac Surg 1989; 48:444-50. [PMID: 2476086 DOI: 10.1016/s0003-4975(10)62881-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A 25-year experience (May 1962 through April 1987) with pulmonary artery banding in 183 patients was reviewed and analyzed. Pulmonary artery banding was performed in a heterogeneous group of patients aged two days to 60 months (median, 10 weeks; mean, 21.8 weeks) and weighing 1.4 to 13.8 kg (mean, 4.2 kg). Diagnosis was ventricular septal defect in 76 (41.5%) and atrioventricular communis in 41 (22.4%). Pulmonary artery banding was also used in patients with d-transposition of the great vessels with ventricular septal defect, double-outlet right ventricle, univentricular heart, tricuspid atresia, and truncus arteriosus. Early death occurred in 39 of 175 patients who underwent pulmonary artery banding at Ochsner Foundation Hospital (22.3%). Definitive operation has been performed in 37 of the patients who underwent pulmonary artery banding since 1979 with excellent outcome in 32 (86.5%). Pulmonary artery banding is a useful palliative procedure for a diverse group of patients with congenital cardiac anomalies and unrestricted pulmonary blood flow. With improved results of primary repair of intracardiac anomalies in small infants, however, pulmonary artery banding should be reserved for severely ill patients with complex lesions not amenable to early definitive correction. Currently, pulmonary artery banding is indicated in patients with excessive pulmonary blood flow and single ventricle or tricuspid atresia. Pulmonary artery banding is also appropriate in certain patients with atrioventricular communis and in patients with muscular or multiple ventricular septal defects. Pulmonary artery banding is an option in patients with ventricular septal defect and coarctation of the aorta.
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Affiliation(s)
- M D Horowitz
- Department of Surgery, Ochsner Clinic, New Orleans, Louisiana 70121
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16
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Abstract
Pulmonary artery (PA) banding to reduce pulmonary blood flow was described by Muller and Dammann in 1952. This review describes the outcome of 170 children who had PA banding at the University of Virginia Medical Center between 1955 and 1988. One hundred and one of the patients were banded between 1958 and 1970; fewer bands were placed in later years because early total correction was feasible for certain conditions. When analyzed by preoperative diagnoses, the data reveal that children with a single ventricle undergoing banding had a significantly lower 30-day mortality rate of 12% compared to other preoperative diagnoses, including atrioventricular canal, truncus arteriosus, and ventricular septal defect (VSD) at 30% (p less than 0.05). The late overall mortality for all patients was approximately 10%, an attrition rate of 1% per year. PA banding still has a role in management of patients with congenital heart disease, particularly for infants with a single ventricle. Actuarial survival at 10 years for patients with this condition is 92%. Interestingly, this indication for pulmonary banding is the same one cited in the original report.
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Affiliation(s)
- I L Kron
- Department of Surgery, University of Virginia Health Sciences Center, Charlottesville 22908
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17
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Abstract
This article focuses on the clinical evaluation of children with cardiovascular diseases associated with Down syndrome. Recent advances in diagnosis and management are discussed and the medical or surgical approach to the patient with severe cardiovascular malformations is presented.
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MESH Headings
- Child, Preschool
- Down Syndrome/complications
- Down Syndrome/physiopathology
- Down Syndrome/therapy
- Ductus Arteriosus, Patent/complications
- Ductus Arteriosus, Patent/physiopathology
- Ductus Arteriosus, Patent/therapy
- Echocardiography
- Electrocardiography
- Endocardial Cushion Defects/complications
- Endocardial Cushion Defects/physiopathology
- Endocardial Cushion Defects/therapy
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/physiopathology
- Heart Defects, Congenital/therapy
- Heart Septal Defects, Ventricular/complications
- Heart Septal Defects, Ventricular/physiopathology
- Heart Septal Defects, Ventricular/therapy
- Humans
- Hypertension, Pulmonary/complications
- Hypertension, Pulmonary/physiopathology
- Hypertension, Pulmonary/therapy
- Infant
- Prognosis
- Pulmonary Artery/physiopathology
- Tetralogy of Fallot/etiology
- Tetralogy of Fallot/physiopathology
- Tetralogy of Fallot/therapy
- Vascular Diseases/complications
- Vascular Diseases/physiopathology
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18
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Barber G, Hagler DJ, Edwards WD, Puga FJ, Danielson GK, McGoon DC, Driscoll DJ. Surgical repair of univentricular heart (double inlet left ventricle) with obstructed anterior subaortic outlet chamber. J Am Coll Cardiol 1984; 4:771-8. [PMID: 6541233 DOI: 10.1016/s0735-1097(84)80405-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The results of operation in all patients with univentricular heart and an obstructed anterior subaortic outlet chamber who were operated on utilizing extracorporeal circulation at the Mayo Clinic from 1973 through 1983 were reviewed. Ten of the 18 patients died during the immediate postoperative period and there was one late death. Factors significantly related to operative and immediate postoperative mortality were age at operation, cardiothoracic ratio on X-ray examination, degree of ST depression on electrocardiogram and pressure gradient across the outlet foramen at catheterization. Autopsy in eight cases revealed significant hypertrophy of ventricular myocardium and a small outlet foramen that was considered stenotic relative to either body surface area or aortic root area. The ventricular myocardium showed histologic changes of chronic ischemia that predated the surgical procedure.
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19
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Foale RA, King ME, Gordon D, Marshall JE, Weyman AE. Pseudoaneurysm of the pulmonary artery after the banding procedure: two-dimensional echocardiographic description. J Am Coll Cardiol 1984; 3:371-4. [PMID: 6198348 DOI: 10.1016/s0735-1097(84)80021-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This report describes an infant with double-outlet right ventricle who underwent pulmonary artery banding as palliation for excessive left to right shunting through a ventricular septal defect. Three weeks after this procedure, there was abrupt clinical deterioration, and two-dimensional echocardiography clearly defined a large pseudoaneurysm arising from a breach in the posterior pulmonary artery wall, just proximal to the band. The diagnosis was confirmed at surgery, during which total correction was performed with successful outcome. The two-dimensional echocardiographic features of a pseudoaneurysm of the pulmonary artery are shown and the role of this noninvasive technique in the evaluation of pulmonary artery bands is discussed.
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20
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Freedom RM, Pongiglione G, Williams WG, Trusler GA, Moes CA, Rowe RD. Pulmonary vein wedge angiography: indications, results, and surgical correlates in 25 patients. Am J Cardiol 1983; 51:936-41. [PMID: 6829468 DOI: 10.1016/s0002-9149(83)80169-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Pulmonary vein wedge angiography was applied to 25 patients ranging in age from 4 months to 16 years. The indications for this technique include (1) determination of the presence or absence of central (intrapericardial or mediastinal) pulmonary arteries in patients with pulmonary atresia where standard anterograde injections of contrast medium do not demonstrate these, (2) determination of the patency and caliber of a nonvisualized pulmonary artery when there is distal "occlusion" by a systemic-to-pulmonary artery anastomosis, (3) determination of the patency and caliber of a nonvisualized pulmonary artery when previous pulmonary arterial banding has led to acquired pulmonary artery atresia, and (4) determination of the presence of a mediastinal pulmonary artery in patients with so-called isolated congenital unilateral absence of a pulmonary artery. Surgical correlates to the interpretation of pulmonary vein wedge angiograms are provided in 18 patients. The present data suggest that pulmonary vein wedge angiography is a safe technique that provides considerable information about (1) the caliber of the parenchymal pulmonary arteries, (2) their sizes at the hilum of the lung, and (3) the presence or absence of a mediastinal confluence of pulmonary arteries. This technique may also complement those anatomic findings derived from anterograde injection of contrast material in patients with pulmonary atresia of a congenital or acquired nature.
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Thiene G, Mazzucco A, Grisolia EF, Bortolotti U, Stellin G, Chioin R, Pellegrino PA, Gallucci V. Postoperative pathology of complete atrioventricular defects. J Thorac Cardiovasc Surg 1982. [DOI: 10.1016/s0022-5223(19)37185-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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Mavroudis C, Weinstein G, Turley K, Ebert PA. Surgical management of complete atrioventricular canal. J Thorac Cardiovasc Surg 1982. [DOI: 10.1016/s0022-5223(19)37205-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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23
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Richardson JV, Schieken RM, Lauer RM, Stewart P, Doty DB. Repair of large ventricular septal defects in infants and small children. Ann Surg 1982; 195:318-22. [PMID: 7059241 PMCID: PMC1352638 DOI: 10.1097/00000658-198203000-00012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
It is possible to achieve excellent results for primary closure of ventricular septal defects regardless of the age of the patients when surgical intervention is required. Thirty-two severely symptomatic patients, age 1-24 months, with large ventricular septal defects (m Qp/Qs = 3.4, m R VSD = 4.0), had primary repair of the defects with one (3%) hospital death. Seven patients (22%) had increased pulmonary vascular resistance ranging from 5.4 to 12 units/m2. It was possible to close the ventricular septal defect through the right atrium in 26 patients (81%). Pulmonary artery banding was not performed in any patient with isolated ventricular septal defect during the period of this study. The 31 survivors have been followed an average of four years, and 30 of them are remarkably improved and remain New York Heart Association Class I or II. Only one patient, with obstructive pulmonary vascular disease (pulmonary resistance = 12 U/m2), died suddenly 16 months after operation. Follow-up catheterization was offered to all patients, and to date, 18 (60%) have been restudied. These hemodynamic data show that pulmonary vascular resistance after surgery is usually normal or only minimally elevated; except for one patient with a large residual ventricular septal defect, functionally significant left to right shunts were eliminated. These results and the analysis of results of combined series reported in the literature for primary and staged operations for the continued practice of primary repair of isolated large ventricular septal defects in infants and children who require surgery.
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Arciniegas E, Farooki ZQ, Hakimi M, Perry BL, Green EW. Surgical closure of ventricular septal defect during the first twelve months of life. J Thorac Cardiovasc Surg 1980. [DOI: 10.1016/s0022-5223(19)37699-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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25
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Abstract
Twenty-nine patients at out institution have undergone repair of complete atrioventricular canal since 1969. There were 3 operative and 5 late deaths, 4 of which were of infectious etiology. Age at operation ranged from 2 months to 12 years (mean, 50 months). Weight ranged from 3.6 kg to 30 kg (mean, 12 kg). Before repair, catheterization studies revealed pulmonary hypertension in all patients with unobstructed pulmonary arteries. Pulmonary to systemic flow ratio ranged from 1.5 to 10.6 (mean, 3.5). Pulmonary vascular resistance (PVR) ranged from 0.7 to 21.7 (mean, 5.3) Wood units/m2. At repair, 14 patients had Rastelli type A anatomy, 14 had type C, and 1 patient had a variant with crossing chordae and double-outlet right ventricle (DORV). Postoperative catheterization has been done in 16 patients 2 months to 8 years (mean, 30 months) after repair. One patient had residual ventricular shunting and later underwent successful repair. A 2-year-old patient had severe mitral regurgitation and died following mitral valve replacement. One patient required a permanent pacemaker. The 21 surviving patients have been followed from 7 months to 10 years 7 months and have excellent hemodynamic status. Long-term studies are needed to assess the ultimate effect on patients with high PVR.
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26
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Garcia EJ, Riggs T, Hirschfeld S, Liebman J. Echocardiographic assessment of the adequacy of pulmonary arterial banding. Am J Cardiol 1979; 44:487-92. [PMID: 474429 DOI: 10.1016/0002-9149(79)90401-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Thirty-one echocardiograms of 21 patients who had pumonary arterial banding were analyzed to assess the aequacy of surgery. In 5 patients the echocardiograms were obtained before and after banding and in 16 patients only after surgery. Right and left ventricular systolic time intervals were measured echographically. The ratios of the right ventricular preejection period to right ventricular ejection time (RPEP/RVET) were correlated with both diastolic (r = 0.94) and systolic (r = 0.86) pulmonary arterial pressures distal to the band. The analysis of right ventriclar systolic time intervals, especially the RPEP/RVET ratio, clearly differentiated patients with an adequate band (distal pulmonary arterial diastolic pressure less than 15 mm Hg) from patients with an inadequate band (distal pulmonary arterial diastolic pressure equal to or greater than 30 mm Hg). The results indicate that echocardiography is a useful noninvasive tool in evaluating the adequacy of the pulmonary arterial band and facilitates the follow-up of patients after banding.
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27
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Epstein ML, Moller JH, Amplatz K, Nicoloff DM. Pulmonary artery banding in infants with complete atrioventricular canal. J Thorac Cardiovasc Surg 1979. [DOI: 10.1016/s0022-5223(19)38157-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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28
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Abstract
Sixty-three patients who underwent banding of the pulmonary artery between 1968 and 1975 were studied. Mortality among patients who underwent the banding procedure was 22%, and among those with ventricular septal defect it was 7%. Thirty-eight of the 49 survivors of the banding procedure were investigated for abnormalities of the pulmonary outflow tract caused by the band. Seventy-one percent of these 38 patients had an identifiable abnormality of the pulmonary valve or artery. These complications occurred more frequently in patients banded at a very young age (less than 2 months old) and in patients in whom the band was in place more than two years. Corrective operations have been performed in 24 of the 49 patients who survived banding. Seventy-six percent of the patients with ventricular septal defect survived corrective operation, while only 29% of the patients with more complex lesions survived.
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Keeton BR, Lie JT, McGoon DC, Danielson GK, Ritter DG, Wallace RB. Anatomy of coronary arteries in univentricular hearts and its surgical implications. Am J Cardiol 1979; 43:569-80. [PMID: 420106 DOI: 10.1016/0002-9149(79)90015-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The coronary arterial anatomy in 26 univentricular hearts, its relation to the morphologic characteristics of the ventricles and rudimentary chambers, and its surgical implications were analyzed. All of the hearts except two had been operated on; 18 had septation with or without an extracardiac conduit and 6 had had palliative procedures. Twenty-one univentricular hearts with a left ventricular type main chamber had an anterior outlet chamber (17 left-sided subaortic, 3 right-sided subaortic and 1 right-sided subpulmonary). Right and left delimiting arteries outlined the outlet chamber in 16 hearts (76 percent). In 20 of the 21 hearts, large delimiting parallel branches of the right coronary artery course over the anterior wall of the heart; 13 of these vessels had been injured surgically with resultant ischemic myocardial necrosis. Five univentricular hearts did not have an outlet chamber; two had a left ventricular type main chamber and three had a morphologically right ventricular main chamber. Three of the five hearts had rudimentary pouches, located anteriorly in one and posteriorly in two. The two rudimentary pouches lying posteriorly were not outlined by delimiting arteries. Two of the five univentricular hearts without an outlet chamber also had injured coronary arteries. Thus, the identification of outlet chambers and rudimentary pouches in univentricular hearts is facilitated by the determination of coronary anatomy. The presence of major delimiting parallel branches over the usually favored ventriculotomy sites renders them vulnerable to surgical injury; such mishaps occurred in 15 of the 24 hearts that had either corrective or palliative operations.
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Laursen HB, Lomholt P. Congenital heart disease in the first month of life. SCANDINAVIAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 1979; 13:111-8. [PMID: 472669 DOI: 10.3109/14017437909100975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
During the years 1963--73, 276 children with congenital heart disease were admitted to this hospital during their first month of life. Ventricular septal defect was the most common cardiac anomaly and this lesion, together with transposition of the great arteries, comprised 35% of all cardiovascular malformations. Extracardiac malformations were found in 86 patients. The cumulative survival rate for all patients was 66% in the first month of life and 33% in the first year. Forty-three patients were operated upon, but it is estimated from necropsy reports and available clinical data that another 74 patients, who died without operation, would have been suitable candidates for total corrective surgery.
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Abstract
Operative mortality associated with complete atrioventricular canals has decreased from 75 per cent to as low as 10 per cent. The present report reviews the UCLA Hospital experience with the six children who underwent repair of this defect in the past two years. Emphasis is placed on preoperative assessment, operative technics, and postoperative management.
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McNicholas K, Bowman F, Hayes C, Edie R, Malm J. Surgical management of ventricular septal defects in infants. J Thorac Cardiovasc Surg 1978. [DOI: 10.1016/s0022-5223(19)41260-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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33
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McGoon DC, Danielson GK, Ritter DG, Wallace RB, Maloney JD, Marcelletti C. Correction of the univentricular heart having two atrioventricular valves. J Thorac Cardiovasc Surg 1977. [DOI: 10.1016/s0022-5223(19)41378-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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34
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Rein JG, Freed MD, Norwood WI, Castaneda AR. Early and late results of closure of ventricular septal defect in infancy. Ann Thorac Surg 1977; 24:19-27. [PMID: 879875 DOI: 10.1016/s0003-4975(10)64563-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Fifty infants ranging in age from 13 days to 18 months (mean age 6 months) and weighing from 1.7 to 8.2 kg (mean weight 4.5 kg) underwent patch closure of a ventricular septal defect (VSD) with use of deep hypothermic circulatory arrest. Seventeen infants were under 3 months of age. The principal indication for operation was intractable chronic congestive heart failure; All infants were below the third percentile for weight preoperatively; Three patients (6%) died postoperatively within the second month of life. There was no late mortality. Seven infants (14%) had seizures; these were associated with a low output state in 2 infants, with hypoxic episodes in 4 infants, and occurred postoperatively in 1 infant. Postoperatively, 8 (17%) of the surviving infants developed right bundle-branch block and left anterior hemiblock, and 16 (32%) developed right bundle-branch block alone. One year postoperatively, catheterization studies in 24 children revealed normal pulmonary artery pressure and pulmonary vascular resistance in all; there were no significant residual ventricular septal defects. Because of these results we continue to be enthusiastic about primary closure of VSD irrespective of age or weightk0
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35
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Abstract
Eight infants less than 1 year of age with an atrioventricular (A-V) canal defect (five with the complete form and three with the partial form) had definitive surgical correction performed because of intractable congestive heart failure. At operation, the infants weighed 2.9 to 6.5 kg. There was one operative death and one late death. The six surviving children were all doing well when followed up 10 months to more than 4 years postoperatively. This small series demonstrates that complete connection of A-V canal is possible even in very small infants and that chances of success are excellent. The infant with this defect who is not progressing with medical management should undergo definitive surgical correction, and a strong argument can be made for elective complete repair in all patients with this lesion, who have severe pulmonary hypertension, during the first 1 or 2 years of life.
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36
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Abstract
The incidence and time of occurrence of pulmonary vascular disease were studied in 67 children with the complete form of atrioventricular (A-V) canal defect. Advanced pulmonary vascular disease begins to develop during the first year of life, with intimal fibrosis (grade 3 cahnges) noted between age 6 months to 1 year. Vascular dilatation with plexiform lesions (grade 4 changes) can be found by age 1 year. These changes can be found in some patients in spite of hemodynamic findings usually considered to indicate lesser degrees of vascular disease. After age 2 years advanced pulmonary vascular disease is commonly found and may persist after surgical correction of the defects. A similar rapid progression of pulmonary vascular disease was noted in 40 children who had a large ventricular septal defect without A-V canal in whom systemic pressure was transmitted directly to the pulmonary vascular bed. Thirty-six of the 67 children had trisomy-21. No difference was noted in the speed of progression of pulmonary vascular disease between these children and those without trisomy 21. Palliative or corrective surgery should be performed in these patients by age 1 year to prevent development of advanced pulmonary vascular disease.
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37
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Freedom RM, Sondheimer H, Sische R, Rowe RD. Development of "subaortic stenosis" after pulmonary arterial banding for common ventricle. Am J Cardiol 1977; 39:78-83. [PMID: 556661 DOI: 10.1016/s0002-9149(77)80015-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Progressive narrowing of the bulboventricular foramen is documented in four patients with single ventricle. The morphologic features in each case corresponded to single left ventricle with infundibular chamber. Two patients had a D-ventricular loop and the other two an L-loop. All four patients had transposition of the great arteries. Restriction of the bulboventricular foramen thus resulted in functional subaortic stenosis because the aorta originated above the infundibular chamber. The development of subaortic obstruction was documented by serial cardiac catheterization studies in two infants, one of whom underwent unsuccessful surgical enlargement of the bulboventricular foramen. In the other two patients the initial cardiac catheterization revealed no pressure gradient between the ventricle and aorta, but examination at necropsy revealed very severe obstruction at the bulboventricular foramen, thus suggesting that the obstruction had been acquired. In each patient, the progressive narrowing of the bulboventricular foramen occurred after pulmonary arterial banding and may have been causally related to this procedure. This functional subaortic obstruction developed in 4 of 31 patients (12.9 percent) with single left ventricle, transposition of the great arteries and pulmonary arterial banding. Clinical recognition of this development is predicated on (1) awareness that narrowing of the bulboventricular foramen in patients with single ventricle and pulmonary arterial banding may be common; (2) presence of symptoms such as angina; and (3) lack of continued clinical improvement in a patient whose pulmonary arterial band has significantly reduced pulmonary blood flow. Management of this subaortic stenosis requires surgical intervention. In the infant, a ventriculotomy in the outlet chamber will usually provide excellent exposure of the bulboventricular foramen, and surgical enlargement can be accomplished. In the older child with severe obstruction, marked muscle hypertrophy may obliterate the ventricular cavity, making ventricular partitioning difficult if not impossible.
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38
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Mistrot JJ, Varco RL, Nicoloff DM. Palliation of infants with truncus arteriosus through creation of a pulmonary artery ostial stenosis. Ann Thorac Surg 1976; 22:495-7. [PMID: 63271 DOI: 10.1016/s0003-4975(10)64461-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A surgical procedure for palliation of infants with truncus arteriosus and excessive pulmonary blood flow (types I, II, and III) is described. The technique involves the production of ostial stenosis of the pulmonary artery from within the truncus using cardiopulmonary bypass. This method has advantages over pulmonary artery banding, which in general has produced disappointing results.
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Mori A, Ando F, Setsuie N, Yamaguchi K, Oku H, Kanzaki Y, Kawai J, Shirotani H, Makino S, Yokoyama T. Operative indication for corrective surgery in cases of complete transposition of the great arteries associated with large ventricular septal defect. J Thorac Cardiovasc Surg 1976. [DOI: 10.1016/s0022-5223(19)40155-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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40
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41
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Appelbaum A, Bargeron LM, Pacifico AD, Kirklin JW. Surgical treatment of truncus arteriosus, with emphasis on infants and small children. J Thorac Cardiovasc Surg 1976. [DOI: 10.1016/s0022-5223(19)40214-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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42
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43
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Dooley KJ, Parisi-Buckley L, Fyler DC, Nadas AS. Results of pulmonary arterial banding in infancy. Survey of 5 years' experience in the New England Regional Infant Cardiac Program. Am J Cardiol 1975; 36:484-8. [PMID: 1190054 DOI: 10.1016/0002-9149(75)90898-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The results of pulmonary arterial banding in 238 infants, 12 percent of the infants admitted to the New England Regional Infant Cardiac Program, is reviewed. Overall survival to age 1 year was 63 percent. Survival was least likely (37 percent) in those who required banding within the 1st month of life. Additional surgery decreased the survival rate in those operated on after 1 month of age. Infants with anomalies for which no corrective surgical procedure is available (23 of 238) have only a 30 percent chance of survival. Those with lesions correctable within the 1st year (133 of 238) have a 74 percent survival rate; 52 percent (82 of 238) of those for whom a curative operation is available after the 1st year survive. These pulmonary arterial banding data coupled with results of primary correction should provide the data base required for an intelligent decision in respect to appropriate surgical treatment of infants with critical heart disease.
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Abstract
Intracardiac correction of VSD in infants should be indicated if the mortality and morbidity of the operation at this age group is lower than cumulative mortality of pulmonary artery banding plus second-staged procedure mortality. Experience with closure of VSD in 23 patients under 1 yr of age with 4% mortality and low morbidity is presented. Indications for operation are: (1) intractable heart failure; (2) persistence or progression of pulmonary hypertension; and (3) failure of banding procedure. Deep hypothermia and circulatory arrest facilitated the intracardiac repair in all patients. Mortality and morbidity related to the banding procedure are emphasized, and it is suggested that banding be restricted only to patients with associated coarctation of the aorta or to patients with multiple muscular ventricular septal defects in whom left ventriculotomy can be safely performed at an older age.
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45
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Amplatz K, Formanek A, Knight L, Tadavarthy SM, Gypser G, Bardach G. Radiographic changes in the postoperative patient. Prog Cardiovasc Dis 1975; 17:403-38. [PMID: 1144775 DOI: 10.1016/s0033-0620(75)80002-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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46
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47
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Johnson DC, Cartmill TB, Celermajer JM, Hawker RE, Stuckey DS, Bowdler JD, Overton J. Intracardiac repair of large ventricular septal defect in the first year of life. Med J Aust 1974; 2:193-6. [PMID: 4417531 DOI: 10.5694/j.1326-5377.1974.tb70702.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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48
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Behrendt DM, Kirsh MM, Stern A, Sigmann J, Perry B, Sloan H. The surgical therapy for pulmonary artery--right ventricular discontinuity. Ann Thorac Surg 1974; 18:122-37. [PMID: 4621027 DOI: 10.1016/s0003-4975(10)64337-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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49
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Hoeffel JC, Henry M, Worms AM, Genot P, Pernot C. Results of catheterization following banding of the pulmonary artery: a report of 27 cases. AUSTRALIAN PAEDIATRIC JOURNAL 1974; 10:168-74. [PMID: 4421920 DOI: 10.1111/j.1440-1754.1974.tb01115.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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50
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