Document Detail


Perforation of the atretic pulmonary valve. Long-term follow-up.
MedLine Citation:
PMID:  12706938     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We evaluated the long-term results of perforation of the pulmonary valve in patients with pulmonary atresia with an intact ventricular septum (PA-IVS). BACKGROUND: Interventional perforation of the pulmonary valve is considered the elective first stage treatment for PA-IVS, particularly in patients with a tripartite right ventricle (RV) and normal coronary circulation. However, the long-term results of this procedure are lacking. METHODS: Between January 1991 and December 2001, 39 newborns with a favorable form of PA-IVS underwent attempted perforation of the pulmonary valve. We evaluated the early and long-term outcomes. RESULTS: Median tricuspid and pulmonary z values were -1.2 and -2.4, respectively. Perforation was successful in 33 patients. Among them, 17 needed neonatal surgery, 13 did not need any surgery, and 3 had elective surgery after the first month of life. There were two procedure-related deaths, seven nonfatal procedural complications, and four postsurgical deaths. Compared with patients needing neonatal surgery, those having no or elective surgery had a higher incidence of a tripartite RV and a higher median tricuspid z value (92% vs. 53%, p = 0.04 and -1.7 vs. -0.5, p = 0.03). At a median follow-up of 5.5 years (range 0.5 to 11.5), survival was 85% and freedom from surgery was 35%. Five patients, four of whom had neonatal surgery, underwent a partial cavo-pulmonary connection. CONCLUSIONS: Our results show that this technique, although burdened by non-negligible mortality and morbidity, is effective in selected patients with a normal-sized RV. Preselection of patients allows interventional or surgical biventricular correction in the majority of cases.
Authors:
Gabriella Agnoletti; Jean François Piechaud; Philipp Bonhoeffer; Yacine Aggoun; Tony Abdel-Massih; Younes Boudjemline; Christine Le Bihan; Damien Bonnet; Daniel Sidi
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  41     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2003 Apr 
Date Detail:
Created Date:  2003-04-22     Completed Date:  2003-04-30     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1399-403     Citation Subset:  AIM; IM    
Affiliation:
Service de Cardiologie Pédiatrique, Necker Enfants Malades, Paris, France. gabriella.agnoletti@nck.ap-hop-paris.fr
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MeSH Terms
Descriptor/Qualifier:
Cardiac Surgical Procedures* / adverse effects
Follow-Up Studies
Heart Catheterization* / adverse effects
Heart Septum
Heart Ventricles
Humans
Infant, Newborn
Predictive Value of Tests
Pulmonary Atresia / mortality,  physiopathology,  surgery*
Pulmonary Valve / physiopathology
Surgical Procedures, Elective
Time Factors
Treatment Outcome
Tricuspid Valve / physiopathology
Vascular Surgical Procedures* / adverse effects

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


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