Document Detail


Management evolution of pulmonary atresia and intact ventricular septum.
MedLine Citation:
PMID:  8498376     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
To examine the impact on survival and clinical course of incorporating the morphologic classification of the right ventricle into the evolving management strategy for babies with pulmonary atresia and intact ventricular septum, the surgical results and follow-up status of the first 62 consecutive patients managed in this hospital between 1979 and 1990 were reviewed. Before 1984, all 23 babies from group I underwent primary right ventricular outflow reconstruction irrespective of right ventricular morphology and size. Since 1984, depending on the morphology and size of the right ventricle, 39 babies from group II had either closed transventricular pulmonary valvotomy (n = 31) or a shunt operation (n = 8). There were 10 hospital (43%) and 2 late deaths (total mortality 52%) in our group I patients. Three of the 11 long-term survivors had cyanosis at rest but none had any residual pressure gradient across the pulmonary outflow. Group II had 6 hospital (15%) and 4 late deaths (total mortality = 26%). Of the 29 long-term survivors, 9 had a second-stage right ventricular outflow reconstruction, 8 had balloon valvuloplasty and 2 had successful Fontan operation. At the latest follow-up, 5 children from this group have cyanosis at rest, 1 has a residual gradient (55 mm Hg) across the infundibulum, and 3 have right ventricular dysfunction. The hospital and total mortality for babies in group II was significantly lower than that in group I (p < 0.01). These data suggest that tailoring the treatment to the right ventricular anatomy results in a lower overall mortality although long term postoperative hemodynamic abnormalities are observed in both groups.
Authors:
M P Leung; C K Mok; J Lee; R N Lo; H Cheung; C Chiu
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of cardiology     Volume:  71     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  1993 Jun 
Date Detail:
Created Date:  1993-06-24     Completed Date:  1993-06-24     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1331-6     Citation Subset:  AIM; IM    
Affiliation:
Department of Paediatrics, Grantham Hospital, University of Hong Kong, Aberdeen.
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MeSH Terms
Descriptor/Qualifier:
Abnormalities, Multiple / mortality,  surgery*
Follow-Up Studies
Heart Septal Defects, Atrial
Heart Septum / pathology
Heart Ventricles / abnormalities*,  pathology,  surgery*
Humans
Infant
Infant, Newborn
Pulmonary Valve / abnormalities*,  surgery*
Treatment Outcome
Tricuspid Valve / abnormalities

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


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