| Severe airflow limitation after the unifocalization procedure: clinical and morphological correlates. | |
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MedLine Citation:
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PMID: 11082377 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: While unifocalization techniques have improved the treatment options in patients with pulmonary atresia, ventricular septal defect (PA-VSD), and major aortopulmonary collaterals (MAPCAs), severe airflow limitation contributes to significant early postoperative morbidity and mortality. Although this has been attributed to bronchospasm, characteristically it is refractory to bronchodilators, suggesting that other mechanisms may play a role. METHODS AND RESULTS: The clinical course and preoperative angiograms of patients who underwent unifocalization were reviewed. Patients who developed airflow limitation early after surgery underwent fiberoptic bronchoscopy. In addition, the anatomy of the MAPCAs was examined in 14 heart-lung blocks from patients with PA-VSD. Twenty-two procedures were performed in 16 children. Three developed marked airflow limitation early after surgery, necessitating prolonged high-pressure ventilation. Bronchoscopy demonstrated tracheobronchial epithelial necrosis in 2 and signs of tracheobronchial ischemia in the third. Two were successfully extubated after 15 and 16 days, but the third died after 57 days of ventilatory support. Review of the preoperative angiograms demonstrated an extensive peribronchial arterial supply arising from a MAPCA in 1 of the patients who developed severe airway necrosis after unifocalization. This was also obvious in a second patient, but the MAPCA was not included in the unifocalization. In 7 autopsy specimens, MAPCAs contributed to a peribronchial or peritracheal vascular network. Dissection of the distribution of these branches in 2 specimens revealed extensive intrapulmonary peribronchial anastomoses. CONCLUSIONS: Airflow limitation early after unifocalization is related to airway ischemia resulting from interruption of the tracheobronchial blood supply during mobilization of MAPCAs. |
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Authors:
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I Schulze-Neick; S Y Ho; A Bush; M Rosenthal; R C Franklin; A N Redington; D J Penny |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Circulation Volume: 102 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2000 Nov |
Date Detail:
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Created Date: 2000-11-22 Completed Date: 2000-12-28 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: III142-7 Citation Subset: IM |
Affiliation:
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Great Ormond Street Hospital for Children NHS Trust, London, England. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Abnormalities, Multiple
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pathology,
surgery Adolescent Adult Airway Obstruction / diagnosis, etiology*, therapy Angiography Bronchi / blood supply, pathology Bronchoscopy Cardiovascular Surgical Procedures / adverse effects*, mortality Child Child, Preschool Collateral Circulation Female Heart Septal Defects, Ventricular / complications, surgery* Humans Infant Male Pulmonary Atresia / complications, surgery* Respiration, Artificial Trachea / blood supply, pathology |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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