Document Detail


Course in the intensive care unit after 'preparatory' pulmonary artery banding and aortopulmonary shunt placement for transposition of the great arteries with low left ventricular pressure.
MedLine Citation:
PMID:  1385008     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In patients with transposition of the great arteries with low left ventricular pressure, pulmonary artery banding with aortopulmonary shunt placement has been advocated to "prepare" the left ventricle for systemic work before an arterial switch operation. METHODS AND RESULTS: In 28 patients, this preparatory procedure was performed with one death. A successful arterial switch operation was performed at a median of 7 days later in 24 of 27 survivors; one child had a Senning performed, and two others died. During this interval period, the left ventricular-to-right ventricular pressure ratio increased from 48 +/- 8% to 98 +/- 19%, and left ventricular mass (indexed for body surface area) increased from 46 +/- 17 to 72 +/- 23 g/m2. After the preparatory procedure, the initial postoperative period was frequently characterized by a low-output syndrome of variable length and severity. Prolonged mechanical ventilation, extended inotropic support, and/or a significant metabolic acidosis was present in 21 of 28 patients in the immediate postoperative period. CONCLUSIONS: The low-output syndrome is most likely due to a combination of acute (fixed) right ventricular volume overload from the shunt and acute (transient) left ventricular dysfunction from the pulmonary artery band. This low-output syndrome should be anticipated following the preparatory procedure.
Authors:
G Wernovsky; T M Giglia; R A Jonas; S M Mone; S D Colan; D L Wessel
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Circulation     Volume:  86     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1992 Nov 
Date Detail:
Created Date:  1992-12-02     Completed Date:  1992-12-02     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  II133-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, Children's Hospital, Boston, MA 02115.
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MeSH Terms
Descriptor/Qualifier:
Blood Vessel Prosthesis*
Cardiac Output, Low / epidemiology*
Heart Catheterization
Humans
Infant
Intensive Care Units
Palliative Care / methods*
Postoperative Complications / epidemiology*
Pulmonary Artery / surgery*
Respiration, Artificial
Time Factors
Transposition of Great Vessels / physiopathology,  surgery*
Ventricular Function, Left / physiology
Grant Support
ID/Acronym/Agency:
HL-41786/HL/NHLBI NIH HHS

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


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