|Clinical implications of major aortopulmonary collateral arteries in patients with right isomerism.|
|PMID: 16798206 Owner: NLM Status: MEDLINE|
|BACKGROUND: The presence of major aortopulmonary collateral arteries (MAPCA) in patients with right isomerism may alter the prognosis, which is still unclear. METHODS: From 1994 to 2003, 138 out of 155 patients (89%) with right isomerism had pulmonary stenosis or pulmonary atresia and constituted the study population. RESULTS: Two groups of patients were identified, one with MAPCA and the other without. The MAPCA originating from descending thoracic aorta or aortic arch was noted in 9 patients (6.5%), with a median number of MAPCA being 3 (range, 2 to 4). Patients with MAPCA commonly had congestive heart failure (8/9, 89%) and frequent lower airway infection (6/9, 67%). In comparison with patients with MAPCA and without, the intrapericardial pulmonary artery was more frequently absent (2 of 9 vs 1 of 129, p < 0.001), and the pulmonary arterial size was smaller (McGoon ratio <1.5, 8 of 9 vs 57 of 129, p = 0.009) in the MAPCA group. The mean pulmonary arterial pressure measured was often higher than the suggested limit for Fontan circulation. Major aortopulmonary collateral arteries were addressed at a median of 6 months old (2 to 19 months old) in 5 patients. Although surgical mortality was not different for first-stage palliation and Glenn shunt in both groups, total cavopulmonary connection could only be performed in one patient with MAPCA with poor results. However, the 5-year survival of patients with and without MAPCA was not statistically different (74.1% vs 55.2%, p = 0.19). CONCLUSIONS: The presence of MAPCA was uncommon but still noted in patients with right isomerism. It may cause heart failure and a less favorable pulmonary vasculature for a complete Fontan-type operation.|
|Jui-Yu Hsu; Jou-Kou Wang; Ming-Tai Lin; En-Ting Wu; Sheunn-Nan Chiu; Chun-An Chen; Hung-Chi Lue; Mei-Hwan Wu|
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|Type: Comparative Study; Journal Article|
|Title: The Annals of thoracic surgery Volume: 82 ISSN: 1552-6259 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2006 Jul|
|Created Date: 2006-06-26 Completed Date: 2006-08-14 Revised Date: 2007-11-15|
Medline Journal Info:
|Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: Netherlands|
|Languages: eng Pagination: 153-7 Citation Subset: AIM; IM|
|Department of Pediatrics, National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan.|
|APA/MLA Format Download EndNote Download BibTex|
Aorta / abnormalities
Arteriovenous Shunt, Surgical
Heart Defects, Congenital / physiopathology, surgery
Heart Failure / etiology
Hypertension, Pulmonary / etiology
Postoperative Complications / etiology, mortality
Pulmonary Artery / abnormalities, surgery
Pulmonary Atresia / pathology, physiopathology, surgery
Pulmonary Valve Stenosis / pathology, physiopathology, surgery
Pulmonary Veins / abnormalities
Venae Cavae / abnormalities, surgery
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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