Document Detail

Pulmonary atresia with ventricular septal defects and major aortopulmonary collateral arteries: unifocalization brings no long-term benefits.
MedLine Citation:
PMID:  16307989     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: We sought to evaluate the contribution of unifocalization procedures in the management of patients with pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries. METHODS: From 1975 through 1995, 82 consecutive patients were entered in a multistage approach and had 189 sternotomies and thoracotomies to perform 119 shunts, 130 major aortopulmonary collateral artery transplantations, and 76 major aortopulmonary collateral artery ligations. The serial angiographies and the follow-up of these patients were reviewed. RESULTS: The concurrent follow-up rate was 80%. The hospital mortality of the preliminary procedures was 4% (7/189). Fifty-three (65%) patients had a complete repair. The hospital mortality of the repair was 8% (4/53), and 9 late deaths occurred after repair, all of which were cardiac related. The overall survival of all patients to the age of 30 years was 58% +/- 7%. Survival 12 years after complete repair was 51% +/- 14%. On angiography, central shunts promoted growth of central pulmonary arteries in all cases (29 patients). Sixty unifocalized major aortopulmonary collateral arteries were identified in 31 patients. After a mean of 3.2 +/- 4 years, 26 thrombosed, and 12 presented with a stenosis of greater than 50%. Serial measurements of 29 major aortopulmonary collateral arteries showed no signs of growth (P = .25). CONCLUSION: Long-term survival into adulthood of patients with pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries has been achieved with a multistage approach. However, late survival depends exclusively on the growth of the native pulmonary circulation. The few unifocalized major aortopulmonary collateral arteries that did not thrombose failed to grow.
Yves d'Udekem; Nelson Alphonso; Martin A Nørgaard; Andrew D Cochrane; Leeanne E Grigg; James L Wilkinson; Christian P Brizard
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  130     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2005-11-25     Completed Date:  2006-03-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1496-502     Citation Subset:  AIM; IM    
Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia.
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MeSH Terms
Abnormalities, Multiple / surgery*
Aorta, Thoracic / abnormalities*,  surgery*
Cardiac Surgical Procedures / methods
Child, Preschool
Follow-Up Studies
Heart Septal Defects, Ventricular / complications*,  surgery*
Infant, Newborn
Neovascularization, Pathologic / complications,  surgery
Pulmonary Artery / abnormalities*,  surgery*
Pulmonary Atresia / complications*,  surgery*
Time Factors
Vascular Surgical Procedures / methods

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

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