Document Detail


Clinical implications of major aortopulmonary collateral arteries in patients with right isomerism.
MedLine Citation:
PMID:  16798206     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  82     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2006 Jul 
Date Detail:
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    
Other Details:
Languages:  eng     Pagination:  153-7     Citation Subset:  AIM; IM    
Affiliation:
Department of Pediatrics, National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan.
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MeSH Terms
Descriptor/Qualifier:
Abnormalities, Multiple / mortality,  pathology,  physiopathology*,  surgery
Adolescent
Adult
Aorta / abnormalities
Arteriovenous Shunt, Surgical
Blood Pressure
Body Patterning
Child
Child, Preschool
Cohort Studies
Collateral Circulation*
Embolization, Therapeutic
Female
Fontan Procedure
Heart Defects, Congenital / physiopathology,  surgery
Heart Failure / etiology
Humans
Hypertension, Pulmonary / etiology
Infant
Infant, Newborn
Life Tables
Male
Palliative Care
Postoperative Complications / etiology,  mortality
Prevalence
Pulmonary Artery / abnormalities,  surgery
Pulmonary Atresia / pathology,  physiopathology,  surgery
Pulmonary Circulation*
Pulmonary Valve Stenosis / pathology,  physiopathology,  surgery
Pulmonary Veins / abnormalities
Retrospective Studies
Treatment Outcome
Venae Cavae / abnormalities,  surgery

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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