-
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 04/2013; 32(4):719-21. · 1.25 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVES: We sought to examine our long-term results of mitral valve (MV) repair with expanded polytetrafluoroethylene (ePTFE) sutures and to determine the predictors for the outcome of this procedure. METHODS: Between 1995 and 2011, MV repair with chordal reconstruction by artificial chordae was achieved in 78 patients (34 males and 44 females). Median age at repair was 1.5 years (range 3.6 months-13.4) and weight was 9.1 kg (2.5-31.4). The mean follow-up was 8.3 years. A Cox proportional hazards model was used to analyse the risk factors for a composite outcome of death, conversion to other MV repair techniques or MV replacement, reoperation on MV and recurrent mitral regurgitation (MR). RESULTS: According to Carpentier classification, 65 (83.3%) patients were Type 2 and 13 (16.7%) were Type 3. Mitral annuloplasty was performed in all cases, except 2. During MV repair, 8 (10.3%) patients were ineffective with artificial chordae and converted to other techniques. Six (7.7%) patients underwent MV reoperation (three repairs and three replacements). Freedom from MV reoperation was 92.5 and 90.4% at 5 and 10 years, respectively. There was 1 in-hospital death. At the latest follow-up, moderate or more MR was observed in 3 (3.8%) patients. Risks for the composite outcome were low body weight at operation and Carpentier classification Type 3. CONCLUSIONS: MV repair with artificial chordae in infants and children is safe and effective and associated with a low reoperation rate. Further investigation into the long-term durability and biological adaptation of ePTFE sutures after patient growth is mandatory.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 03/2013; · 2.40 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Aortic regurgitation in association with aortic stenosis is rare in the fetus. Findings have shown that severe aortic regurgitation is worsened by the increase in systemic vascular resistance after birth, resulting in low cardiac output, hypoxemia, and neonatal death. This report describes a unique case of aortic regurgitation with aortic stenosis, severe mitral regurgitation, retrograde flow in the aortic arch, and an enormous left atrium with a restrictive foramen ovale in a fetus. In this case, aortic regurgitation was diminished immediately after birth, indicating that spontaneous improvement in aortic regurgitation after birth should be taken into account when the final prognosis is predicted.
Pediatric Cardiology 05/2012; · 1.30 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We reviewed our 28 years of experience of arterial switch operation (ASO) for transposition of the great arteries to investigate late sequelae of this procedure.
387 patients who underwent ASO from 1984 to 2010 were included in this retrospective study. The longitudinal data were estimated by the Kaplan-Meier method and compared using a log-rank test. Risk factors for late sequelae were analysed by the multivariable Cox proportional hazards model.
The mean follow-up time was 10.0 years. There were 13 early deaths and 17 late deaths. All late deaths were within 1 year, except for three patients. Actuarial survival was 92.2 and 91.6% at 10 and 20 years, respectively. Sixty-six patients (17.1%) had developed pulmonary stenosis (PS) and 29 patients (7.5%) had developed moderate or more aortic insufficiency (AI) during follow-up. Selective coronary angiography was performed in 210 patients (54.3%) at 9.6 ± 5.1 years after ASO. Left main tract occlusion was found in 2 patients (2/210; 1.0%) and hypoplastic left coronary artery was found in 10 patients (10/210; 4.8%). Among these 12 patients, 8 patients were asymptomatic. Re-operation was performed in 76 patients (19.6%), pulmonary artery plasty for PS in 58 patients (15.0%), aortic valve replacement for AI including two Bentall operations in 9 patients (2.3%) and others. Freedom from re-operation was 78.2 and 62.8% at 10 and 20 years, respectively. The risk factor for PS was the use of equine pericardium for reconstruction (P < 0.0001). Factors associated with moderate or more AI was the presence of left ventricular outflow tract obstruction (P = 0.004). There were no risk factors for late coronary lesions. Three hundred and forty surviving patients (340/357; 95.2%) were in NYHA functional class I. Treadmill test, which was performed on 217 patients (56.1%) at 14.3 ± 5.4 years after ASO, revealed that the maximum heart rate was 97.5 ± 7.6% of normal and peak oxygen consumption was 105.2 ± 20.5% of normal.
ASO was performed with satisfactory results in the overall survival and functional status. PS was the main reason for re-operation. Coronary lesions can appear late without any symptoms. Benefits of ASO can be achieved by long-term follow-ups of PS, AI and coronary lesions.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 02/2012; 42(4):674-9. · 2.40 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This report describes a case of Ebstein anomaly in a fetus with cardiomegaly, severe tricuspid regurgitation, pulmonary regurgitation, and retrograde ductal flow that showed a marked increase in the size of the right atrium with advancing gestational age. Elective preterm delivery was performed at 35 weeks gestation. The prostaglandin E1 infusion resulted in more pronounced systemic hypotension and acidosis secondary to circular shunt across the patent ductus arteriosus as well as pulmonary regurgitation and tricuspid regurgitation. Emergency surgical intervention consisting of main pulmonary artery ligation, ductus arteriosus ligation, central shunt creation, and plication of the right atrium without cardiopulmonary bypass was performed 4 h after birth. At the age of 16 days, the Starnes procedure was performed. The infant's postoperative course was uneventful. A fetus that has Ebstein anomaly associated with pulmonary regurgitation is at risk for circular shunt across the patent ductus arteriosus after delivery. Planned delivery and surgical intervention without delay after birth are useful for the treatment of such cases.
Pediatric Cardiology 09/2011; 33(2):343-6. · 1.30 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Modifications of the Fontan procedure are applied to a wide range of complex congenital heart defects with single ventricle physiology. We examined the pathway and the clinical results of extracardiac conduit-total cavopulmonary connection (EC-TCPC) for a malpositioned heart with apicocaval juxtaposition.
Of the 365 patients who underwent EC-TCPC since 1994, 56 patients with a malpositioned heart with apicocaval juxtaposition were included in this retrospective study (group 1). The pathway for the EC was selected after careful consideration of the results of preoperative angiography and computed tomography, as well as intra-operative findings. A concurrent group of 299 patients undergoing EC-TCPC without apicocaval juxtaposition was used as a control group (group 2). The mean follow-up periods for groups 1 and 2 were 5.5 years (range: 0-12 years) and 5.5 years (range: 0-14 years), respectively.
The mean age at operation was 4.2±3.2 years and the median size of the conduit was 18 mm (range: 16-20mm). In 30 patients, the conduit was placed between the inferior vena cava (IVC) and the opposite side of the pulmonary artery crossing the vertebra. In another 25 patients, the conduit was positioned behind the ventricle between the IVC and on the same side as the pulmonary artery (PA). There was one patient who had a Y-style conduit placed between the IVC and right and left PAs behind the ventricle. In group 1, there were no early deaths; three patients died in the intermediate term due to gastric bleeding in one, haemoptysis in another and sudden death in yet another. None of the patients developed conduit stenosis or pulmonary venous obstruction, and no patient required re-operation. Three patients developed late complications, including arrhythmias requiring medication in two and subdural haematoma in one. The incidence of death or late complications did not differ among the pathways of conduits. In group 2, there were eight late deaths, and 27 patients developed late complications. The Kaplan-Meier survival rate was 93.5% at 5 and 10 years in group 1, and 97.3% at 5 years and 96.1% at 10 years in group 2 (log-rank test, P=0.29). The haemodynamics in groups 1 and 2 during the intermediate term were identical with respect to IVC pressure (8.9 ± 2.5 in group 1 and 9.6 ± 2.6mmHg in group 2), left ventricular end-diastolic pressure (4.4 and 4.3 mmHg, respectively), cardiac index (3.3 and 3.4 l min(-1)m(-2), respectively) and arterial oxygen saturation (94 and 94.2%, respectively). No patient in either group had a pressure gradient >2 mmHg between the IVC and central PA. Postoperative catheterisation data showed no significant differences in haemodynamics between the conduit pathways in group 1.
EC-TCPC can be performed in children with apicocaval juxtaposition with excellent mid-term outcomes compared with other Fontan candidates. Based on individual cardiac anatomy, the pathway of the EC behind the ventricle or crossing the vertebra can be used without conduit stenosis or pulmonary venous obstruction.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 10/2010; 38(4):439-44. · 2.40 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To compare the haemodynamics and perioperative course of initial palliation with bilateral pulmonary artery banding (PAB) and the Norwood procedure.
Between April 2004 and December 2007, 43 consecutive children with hypoplastic left heart syndrome (HLHS) or a variant underwent initial palliation (PAB, n=18; Norwood, n=25). Clinical perioperative data were analysed. In the PAB group, lipo-prostaglandin E1 administration was continued with hospitalisation until stage 2 palliation with a bi-directional Glenn shunt and the Norwood procedure.
There were no significant differences in the age and operative weight of patients who received stage 1 palliation (PAB, 12+/-9 days, 2.7+/-0.6 kg; Norwood, 12+/-8 days, 2.8+/-0.4 kg). The PAB group had more high-risk patients than the Norwood group (PAB, 83%; Norwood, 48%, p=0.04). Increased early and inter-stage mortality were observed in patients who underwent the Norwood procedure (early mortality with PAB, 6% vs Norwood, 12%; inter-stage mortality, 6% vs 27%, respectively). Mortality between stages 1 and 2 was 11% for the PAB group and 36% for the Norwood group. The Kaplan-Meier survival estimate at 1 year did not differ between groups (77% for the PAB group, 64% for the Norwood group). Ductal stenosis was found in one patient in the PAB group during the follow-up period. Twenty-eight patients underwent stage 2 reconstruction, and the patients in the PAB group were younger at the time of surgery (PAB, 116 days; Norwood, 224 days). There were no significant differences between groups in pulmonary artery index regarding body surface area (BSA) (PAB, 179 mm(2)BSA(-1); Norwood, 194 mm(2)BSA(-1)) and the incidence of ventricular dysfunction after stage 2 construction (PAB, 21%; Norwood, 21%).
Bilateral PAB with continuous lipo-prostaglandin E1 administration may improve early and intermediate mortality in infants with HLHS. Intimate care with hospitalisation may contribute to the results.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 08/2009; 36(6):973-9. · 2.40 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Intermediate/long-term results after aortic valve replacement using bileaflet mechanical valve in children should be clarified as a standard of treatment of aortic valve disease in children.
Forty-five patients aged under 15 years underwent 46 aortic valve replacements using bileaflet mechanical prosthetic valve. Patients' ages ranged from 1 to 15 years (9 years as a median value), and follow-up period was 9.2 years as a median value (maximum 19 years).
In situ valve replacement was performed in 21 procedures, while annular enlargement was required in 25 procedures (Nicks 10, Yamaguchi 3, Manouguian 2, Konno 10). All patients except two received prosthesis 19mm or larger in size. There was one operative death and two late deaths. Two episodes of cerebral infarction, two valve thrombosis, two re-operations, one infective endocarditis, and one sudden death were recognized as valve-related complications in five patients. The reasons for re-operation were prosthesis-patient mismatch in one (Ross procedure) and valve thrombosis in one (re-replacement). At 15 years after the operation, re-replacement free rate, valve-related event free rate and actuarial survival rate were 94+/-4%, 86+/-6% and 92+/-4%, respectively. The transprosthetic flow velocity estimated by Doppler echocardiography at the final follow-up was well correlated with manufactured valve area index (cm(2)/body surface area).
Although aortic annular enlargement was required in more than half of the cases, intermediate-term results after aortic valve replacement using bileaflet mechanical prosthetic valve in children was satisfactory. Indications for alternative treatment such as Ross procedure might be considered in limited cases.
European Journal of Cardio-Thoracic Surgery 08/2008; 34(1):42-7. · 2.55 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We describe a new technique for coronary transfer in the repair of anomalous origin of the left coronary artery from the pulmonary artery. The left coronary artery is elongated with the native pulmonary artery wall to form a spiral-shaped coronary cuff to construct an unstretched new left coronary artery system from the ascending aorta. A postoperative angiographic scan showed good flow of the left coronary artery without any kinking or narrowing. This technique is considered useful when an anomalous coronary artery arises a long way from the ascending aorta.
The Annals of thoracic surgery 08/2008; 86(2):667-8. · 3.74 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In a total cavopulmonary connection (TCPC) with an extracardiac conduit, the future development of stenosis in the venous pathway and distortion of the pulmonary artery according to the somatic growth of the patients is a major concern for surgeons and pediatricians.
Thirty patients who underwent extracardiac TCPC (EC-TCPC) between 1990 and 1998 and who had received at least two postoperative angiograms were enrolled in this study. To evaluate the postoperative change in the anastomosis, the cross-sectional area of the venous root at three different points was measured on the first and second angiograms after the EC-TCPC. Further, to evaluate the somatic growth of the autologous tissue, 12 patients who grew more than 10 cm in height after the completion of the EC-TCPC were selected among the 30 patients. We measured the length of three different parts, the diameter of the pulmonary artery, length of the artificial graft, and length between the branching point of the hepatic vein and artificial graft's anastomotic site to the inferior vena cava.
The cross-sectional area at each point did not change during the follow-up, and the pressure gradient across the grafts has not been observed. The diameter of the pulmonary artery and length of the inferior vena cava above the hepatic vein insertion grew similarly during the follow-up.
The mid-term clinical results after the completion of the EC-TCPC, including the somatic growth of the venous pathway, were satisfactory.
Journal of Cardiac Surgery 06/2008; 23(5):454-8. · 0.87 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Pulmonary artery (PA) distortion significantly compromises the outcome of the staged approach to the Fontan operation in patients with hypoplastic left heart syndrome (HLHS). This retrospective study was designed to investigate the influence of the initial operation on postoperative PA anatomy.
Forty-nine patients with HLHS and its variant were enrolled in this study. As an initial palliation, the Norwood operation with a modified Blalock-Taussig (BT) shunt was performed in 12, the Norwood operation with a right ventricle to pulmonary artery (RV-PA) shunt in 31, and bilateral PA banding in 6. The incidence and risk factors of postoperative central pulmonary artery stenosis (PS) were investigated, and the PA configuration was followed up until post-Fontan status.
Twenty-two patients (51.2%) had developed central PS after the Norwood operation (33.3% with a BT shunt vs. 58.1% with a RV-PA shunt). The RV-PA shunt with a polytetrafluoroethylene (PTFE) patch at the distal pulmonary stump significantly decreased the central PS (P = 0.035). The PA index after the Norwood operation was not statistically different between the BT and RV-PA shunt groups, although in the RV-PA group it was significantly higher in patients with a PTFE patch on the distal PA stump. PA plasty was performed in 16 patients in the second-stage palliation and in 15 with the Fontan completion. Freedom from PA plasty was significantly lower in the RV-PA shunt group than in the BT shunt group (63.5% vs. 31.1% at 5 years, P = 0.034). Six patients initially palliated with bilateral PA banding had no stenosis at the banding site in the Norwood + Glenn operation, and one patient required stent placement for left PS in the Fontan completion. Post-Fontan catheterization (n = 31) showed central venous pressure of 11.5 +/- 2.6 mmHg, cardiac index of 3.6 +/- 0.8 l/kg/min, and PA index of 194.0 +/- 58.4 mm(2)/m(2); there was no difference between the groups.
The incidence of central PS after the Norwood operation was significant, and the shunt type and procedure for the distal PA stump influenced the postoperative configuration of the central PA. With an aggressive surgical approach to central PS, PA anatomy was satisfactory with good hemodynamic variables after Fontan completion. Bilateral PA banding did not cause later vascular deformity.
General Thoracic and Cardiovascular Surgery 03/2008; 56(2):54-61.
-
[show abstract]
[hide abstract]
ABSTRACT: Extracardiac conduit total cavopulmonary connection has shown good early results; however, its long-term outcome has yet to be reported.
Of 282 patients who underwent extracardiac conduit total cavopulmonary connection since 1994, 126 patients who have been followed up for more than 5 years were included in this retrospective study. Actuarial survival rate, incidence of late complications, hemodynamic variables, and results of exercise tolerance test were reviewed.
Follow-up time was 96.4 +/- 23.0 months. There was 1 operative death and 6 late deaths. Actuarial survival rate was 95.2% and 93.6% at 5 and 10 years, respectively. Seven patients had late complications including new-onset supraventricular arrhythmia in 3, protein-losing enteropathy in 2, thromboembolism in 1, and bleeding complication in 1. Seven patients underwent reoperation not related to the conduit. Freedom from Fontan-related events was 88.8% at 5 years and 84.3% at 10 years. Late cardiac catheterization in 119 survivors showed central venous pressure of 9.9 +/- 2.9 mm Hg, cardiac index of 3.6 +/- 0.8 L x min(-1) x m(-2) and arterial oxygen saturation of 94.5 +/- 2.3%. No patient showed conduit stenosis. Plasma concentration of atrial and brain natriuretic peptide (pg/mL) were 28.9 +/- 20.0 and 25.8 +/- 44.5. Exercise test performed in 101 patients showed endurance time of 75.7 +/- 12.9% of normal value, peak heart rate of 92.3 +/- 14.4% of normal, and peak oxygen consumption of 90.0 +/- 20.0% of normal. The latest echocardiogram showed ejection fraction of 60.4 +/- 11.7%. Three patients had pacemaker rhythm, 1 had junctional rhythm, and 115 patients had sinus rhythm.
Midterm outcome of extracardiac conduit total cavopulmonary connection was satisfactory with low incidence of late mortality and morbidity, and excellent hemodynamic state.
The Annals of thoracic surgery 12/2007; 84(5):1619-25; discussion 1625-6. · 3.74 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: No specific prosthetic material is currently recognized as being the most suitable for right ventricular outflow tract reconstruction for congenital heart defects. Prosthetic valves are subject to wear and stress because they do not create vortex flow, which helps natural valves to close. We designed a fan-shaped expanded polytetrafluoroethylene valved conduit and patch with bulging sinuses that create vortex flow, making them more reliable over the long term.
Bulging sinuses were formed on a sheet of expanded polytetrafluoroethylene using a specially designed mold. Fan-shaped expanded polytetrafluoroethylene sheets (0.1 mm thick) were anastomosed to the edge of the bulging sinuses as valve leaflets, creating monocuspid, bicuspid, or tricuspid valves. These valves were implanted in 157 patients undergoing right ventricular outflow tract reconstruction (age 16 days to 45.4 years, median 2.0 years), in 48 patients as a conduit, and in 109 patients as a patch. Valve function was followed up by echocardiography for 5.6 to 63.7 months (mean 20.8 months).
There was no mortality or morbidity, and no patients required reoperation during follow-up. No patients had stenosis, and regurgitation was less than mild in all patients with conduits and moderate in 15 patients (13.8%) with patches, but moderate regurgitation did not further develop during follow-up. Valve motion was fully maintained in all patients.
The expanded polytetrafluoroethylene valved conduits and patches with bulging sinuses showed excellent early-to-midterm results. The valved conduits and patches seem to be promising alternatives to homografts in right ventricular outflow tract reconstruction. Their function will be followed up further.
The Journal of thoracic and cardiovascular surgery 09/2007; 134(2):327-32. · 3.41 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Aortic valve replacement with a pulmonary autograft (Ross procedure) was pioneered by Donald Ross in 1967. The advantages of the autograft valve include freedom from anticoagulation, hemolysis, and infection, optimal hemodynamic performance, and growth potential. Various materials have been used for the right ventricular outflow tract (RVOT). Currently, a cryopreserved pulmonary allograft is accepted worldwide as a useful material for this procedure. Pulmonary allografts cannot be utilized in Japan, and thus other valves and materials must be used instead. The acceptance of these procedures has been slow because of the technical demands of the operations and the inherent need for reconstruction of the RVOT, thereby placing two valves at risk. In the past 20 years, the Ross procedure has been increasingly considered for pediatric patients with a wide spectrum of congenital abnormalities.
Nippon Geka Gakkai zasshi 04/2007; 108(2):80-4.
-
[show abstract]
[hide abstract]
ABSTRACT: Introduction of the bidirectional Glenn procedure (BDG) in low-risk Fontan candidates would improve clinical outcomes. Over the last decade, not only high-risk Fontan candidates, but all candidates underwent BDG and staged Fontan operation (TCPC) in our hospital.
Three hundred and thirty-three consecutive patients (age range, 42 days to 16 years old) underwent BDG at Fukuoka Children's Hospital Medical Center from 1992 to 2004. Diagnoses included hypoplastic left heart syndrome in 47, pulmonary atresia with intact ventricular septum in 32, tricuspid valve atresia in 35, and other complex univentricular heart defects in 219 patients (right dominant in 166, left dominant in 53).
There were three hospital deaths and 27 late deaths (five after TCPC). Six patients underwent takedown operation. Two hundred and thirty patients underwent TCPC, while 66 patients were waiting for TCPC. In five patients, completion of TCPC was contraindicated. A univariate analysis revealed that for patients less than six months old, diagnoses besides tricuspid atresia, right ventricular morphology, mean pulmonary arterial pressure, pulmonary vascular resistance, ventricular end-diastolic pressure, atrioventricular valve regurgitation greater than moderate, atrioventricular valvuloplasty/valve replacement in concomitant procedure, and total anomalous pulmonary venous connection repair in concomitant procedure were significant predictors of death, takedown, or out of indication for completion of TCPC. A stepwise logistic regression analysis showed that mean pulmonary arterial pressure and heterotaxy were independent predictors.
The staged strategy used for all Fontan candidates provides excellent clinical results. The main risk factor for death, takedown, or out of indication for completion of TCPC was elevated pulmonary arterial pressure. Appropriate surgical interventions such as atrioventricular valvuloplasty and total anomalous pulmonary venous connection repair, before and/or on BDG for the control of pulmonary circulation are of great importance to prevent elevation of pulmonary arterial pressure.
Interactive cardiovascular and thoracic surgery 03/2007; 6(1):97-101.
-
[show abstract]
[hide abstract]
ABSTRACT: Arrhythmia and late cardiac deaths are thought to be major complications in patients after right ventricle (RV) to pulmonary artery (PA) conduit repair, although the incidence and predictors of these complications remain unknown. The aim of this study was to clarify the incidence and risk factors for arrhythmia and late deaths in patients with the RV to PA conduit repair through a Japanese multicenter study.
Three hundred fifty-one hospital survivors who underwent the RV to PA conduit repair before 1995 were studied.
Survival rate after repair was 92% at 10 years, 88% at 20 and 25 years, respectively. Late death was observed in 30 (8.5%) including 4 patients with sudden death (SD). Higher right ventricular pressure (p = 0.02), larger cardio-thoracic ratio after repair (p = 0.02) and higher incidence of brady- or tachy-arrhythmia and SD (9/30) were associated with late death. Six (1.7%) patients developed ventricular tachycardia or ventricular fibrillation (VT/Vf). There were 22 patients who had 23 new-onset supraventricular tachy-arrhythmia (SVT). Right ventricular hypertension (p = 0.04) was associated with VT/Vf or SD. Male sex (p < 0.01), absence of previously aorto-pulmonary shunt (p < 0.05), older age at repair (p < 0.01) or longer length of follow-up (p < 0.01) were associated with SVT.
Arrhythmia and late sudden death are relatively common late after the RV to PA conduit repair. Our data support recent surgical strategies of earlier primary operation and timely reoperation for progressive right ventricular outflow stenosis that may reduce the incidence of late arrhythmias and SD.
International Journal of Cardiology 02/2006; 106(3):373-81. · 7.08 Impact Factor
-
Journal of Thoracic and Cardiovascular Surgery 10/2005; 130(3):942-4. · 3.41 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Since 2002, we have performed bilateral pulmonary artery banding for stage I palliation and maintained systemic flow by prostaglandin E1 infusion or a main pulmonary artery to the descending aorta shunt, and here report our experience. Three of the 4 patients were diagnosed with aortic atresia/mitral atresia and 1 with aortic stenosis/mitral stenosis. Balloon atrial septostomy was performed in 2 before stage I. Bilateral pulmonary artery banding (right circumference: 10 or 14, left circumference: 10.5 to 14 mm) was performed from 7 to 19 days after birth. Systemic flow was maintained by prostaglandin E1 infusion in 2 patients and a Van Praagh procedure was performed in the other 2. Balloon atrial septostomy was required in 2 patients, and an atrial septal defect enlargement was in one during the interstage before stage II palliation, which was performed at ages 3 to 9 months. Bidirectional cavopulmonary shunt with aortic arch and coronary flow reconstruction was also performed. For patients younger than 4 months, we do not require pulmonary arterioplasty in stage II. All patients are alive and well and waiting for Fontan completion. Excellent early results were obtained for this surgical strategy that avoids the stage I Norwood palliation.
Interactive cardiovascular and thoracic surgery 09/2005; 4(4):352-5.
-
European Journal of Pediatrics 08/2005; 164(7):461-2. · 1.88 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Despite that surgical outcomes of patients with hypoplastic left heart syndrome have improved, one of the problems remaining is the high interstage mortality after a stage I Norwood procedure. The purpose of this study was to determine the hemodynamic characteristics of hypoplastic left heart syndrome after a Norwood procedure. We examined the perioperative hemodynamic differences of the staged operation between the first stage of the Norwood procedure and systemic pulmonary shunt for single right ventricle patients.
Data from 39 patients who underwent a Norwood procedure (right ventricle to pulmonary artery conduit: 19, Blalock-Taussig shunt, 20) were analyzed. There were nine early and seven interstage deaths. Bidirectional cavopulmonary shunt was performed in 15 patients and the Fontan procedure in 9 (group H). We defined the control group as 26 patients who underwent the first stage of a systemic pulmonary shunt for a single ventricle. Bidirectional cavopulmonary shunt was performed in 14 patients and the Fontan procedure in 8 (group C). We compared the perioperative hemodynamics of the staged operation between the two groups.
Cardiothoracic ratio and single ventricular diastolic dimension before bidirectional cavopulmonary shunt were acutely increased in group H (P=0.02, <0.001). There was no significant difference between the two different types of Norwood procedures. The pulmonary artery index for the right heart bypass operation was lower in group H than in group C (P<0.001). Oxygen saturation before bidirectional cavopulmonary shunt in group H decreased (P<0.001) and thus was lower than that in group C (P=0.003). Mortality and the postoperative clinical parameters of the right heart bypass operation were not different between the two groups.
Patients with hypoplastic left heart syndrome showed hemodynamic instability of acutely increased cardiothoracic ratio, and single ventricular diastolic dimension despite decreased oxygen saturation interstage after stage I of a Norwood procedure. This suggests that this hemodynamic characteristics in hypoplastic left heart syndrome correlates with the higher mortality before second stage palliation than in found with single right ventricle patients.
European Journal of Cardio-Thoracic Surgery 06/2005; 27(6):968-74. · 2.55 Impact Factor
