Document Detail

Predictors for biventricular repair in pulmonary atresia with intact ventricular septum.
MedLine Citation:
PMID:  20824586     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Pulmonary atresia with intact ventricular septum (PA-IVS) is a complex congenital heart defect with a large variety of right heart-sided morphologies.
METHODS: We undertook a retrospective review of 86 patients with PA-IVS with a special emphasis on the angiographic findings. The aim of the study was to determine predictors for biventricular repair. Initial surgical procedures depended on the right ventricular morphology, the tricuspid valve size and coronary anomalies.
RESULTS: Fifty-five patients (64%) underwent decompression of the right ventricle (RV) as an initial procedure; 16 of them required an additional systemic-to-pulmonary artery shunt. Twenty-six patients (30%) had only a systemic-to-pulmonary artery shunt as their initial procedure. Five patients underwent interventional procedures performed by pediatric cardiologists. Biventricular repair was possible in 56 patients (65%). Univentricular palliation was achieved in 16 patients. Fourteen patients had only palliation with a systemic-to-pulmonary artery shunt. Mean tricuspid valve size was significantly bigger in patients with biventricular repair (z-score -3.6 +/- 2.6) than in patients who did not undergo biventricular repair (-5.2 +/- 1.7, P = 0.003). Predictors for biventricular repair were right ventricular decompression with or without systemic-to-pulmonary artery shunt ( P < 0.001), tripartite right ventricle ( P < 0.001) and the absence of coronary fistulae ( P < 0.001). Long-term survival was 80% +/- 13% at 25 years for patients undergoing biventricular repair.
CONCLUSIONS: Decompression of the RV as an initial surgical procedure improves the possibility of achieving biventricular repair with good long-term results. However, morphological factors such as right ventricular size and the absence of coronary fistulae are significant predictors for biventricular repair.
J Cleuziou; C Schreiber; A Eicken; J Hörer; R Busch; K Holper; R Lange
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Publication Detail:
Type:  Journal Article     Date:  2010-09-07
Journal Detail:
Title:  The Thoracic and cardiovascular surgeon     Volume:  58     ISSN:  1439-1902     ISO Abbreviation:  Thorac Cardiovasc Surg     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-08     Completed Date:  2010-12-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7903387     Medline TA:  Thorac Cardiovasc Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  339-44     Citation Subset:  IM    
Copyright Information:
Georg Thieme Verlag KG Stuttgart, New York.
Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany.
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MeSH Terms
Cardiac Surgical Procedures* / adverse effects,  mortality
Chi-Square Distribution
Coronary Angiography
Coronary Vessel Anomalies / complications,  radiography
Decompression, Surgical
Heart Ventricles / radiography,  surgery
Hospital Mortality
Kaplan-Meier Estimate
Palliative Care
Pulmonary Atresia / complications,  mortality,  radiography,  surgery*
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Tricuspid Valve / radiography
Vascular Fistula / complications,  radiography

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

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