Document Detail


Results of a right ventricular outflow patch for pulmonary atresia with intact ventricular septum.
MedLine Citation:
PMID:  1385009     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Although overall outcome has improved, pulmonary atresia with intact septum remains a difficult surgical and clinical problem. To determine whether an early right ventricular outflow patch will result in biventricular repair for this lesion, we reviewed the long-term follow-up (5.8 +/- 0.8 years) of 19 newborns who underwent repair between 1979 and 1990. METHODS AND RESULTS: An early right ventricular outflow patch was placed in 15 of 19 newborns; in the remaining four, this was preceded by an aortopulmonary shunt. Prostaglandin E1 infusion postoperatively eliminated the need for shunt in 14 of 15. Coronary sinusoids were ligated in three newborns. Based on right ventricular morphology, the newborns were divided into two groups: group 1 (tripartite, n = 9) and group 2 (bipartite and monopartite, n = 10). Before surgery, group 1 had significantly larger right ventricular volumes (23.6 +/- 3.7 versus 5.2 +/- 1.1 ml/m2, p < 0.002). Five-year survival was 79% for the entire series. Four infants, all group 2, died within 12 months of their initial surgery. Fourteen of 15 survivors (nine group 1 and five group 2) currently are acyanotic and New York Heart Association functional class I. A biventricular repair was achieved in 12 of 15, and three other children are awaiting evaluation. All 15 survivors had significant right ventricular and tricuspid annulus growth. CONCLUSIONS: Our data suggest that early placement of a right ventricular outflow patch in infants with pulmonary atresia and intact ventricular septum, regardless of right ventricular anatomy, results in an excellent chance for biventricular repair.
Authors:
J Steinberger; J M Berry; J L Bass; J E Foker; E A Braunlin; K A Krabill; A P Rocchini
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Publication Detail:
Type:  Journal Article    
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:  II167-75     Citation Subset:  AIM; IM    
Affiliation:
Division of Pediatric Cardiology, University of Minnesota, Minneapolis.
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MeSH Terms
Descriptor/Qualifier:
Alprostadil / therapeutic use
Echocardiography
Female
Follow-Up Studies
Heart Defects, Congenital / mortality,  surgery*
Humans
Infant, Newborn
Male
Palliative Care / methods*
Pericardium / transplantation
Pulmonary Valve / abnormalities*
Survival Rate
Time Factors
Ventricular Function, Right / physiology
Chemical
Reg. No./Substance:
745-65-3/Alprostadil

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


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