Document Detail


The influence of pulmonary artery morphology on the results of operations for major aortopulmonary collateral arteries and complex congenital heart defects.
MedLine Citation:
PMID:  14752437     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Congenital heart defects with major aortopulmonary collateral arteries show marked variability in the size and distribution of native pulmonary arteries. We sought to classify the size and distribution of native pulmonary arteries and to determine their influence on surgical outcome. METHODS: Between 1989 and 2002, 164 patients underwent surgical intervention for congenital heart defects with major aortopulmonary collateral arteries (median age, 10 months). Three patterns of native pulmonary arteries were identified: intrapericardial native pulmonary arteries present (group I); confluent intrapulmonary native pulmonary arteries without intrapericardial native pulmonary arteries (group II); and nonconfluent intrapulmonary native pulmonary arteries (group III). Thirty-seven (23%) patients had single-stage and 76 (47%) patients had multistage complete repair. Thirty (18%) patients await septation, and 8 (5.0%) patients are not septatable. Follow-up is 98% complete (median follow-up, 5.8 years). RESULTS: In the 164 patients there were 15 (9.1%) early and 12 (7.3%) late deaths. Early mortality after complete repair was 4.4% (n = 5). Actuarial survival was 90% +/- 3% and 85% +/- 4% at 1 and 10 years, respectively. Actuarial freedom from surgical or catheter reintervention in septated patients was 77% +/- 4% and 45% +/- 8% at 1 and 10 years, respectively. On multivariate analysis, the morphology of the native pulmonary arteries was the only factor that influenced actuarial survival after complete repair (P =.04). Group III had the highest risk of death after septation (P =.008). Group II fared better than group III after the initial operation (P <.05). CONCLUSIONS: Current classifications of congenital heart defects with major aortopulmonary collateral arteries are based on the presence or absence of intrapericardial pulmonary arteries. We have identified a subgroup without intrapericardial native pulmonary arteries but with confluent intrapulmonary native pulmonary arteries. This group has a better outcome than those with nonconfluent intrapulmonary native pulmonary arteries.
Authors:
Massimo Griselli; Simon P McGuirk; David S Winlaw; Oliver Stümper; Joseph V de Giovanni; Paul Miller; Rami Dhillon; John G Wright; David J Barron; William J Brawn
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  127     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2004 Jan 
Date Detail:
Created Date:  2004-01-30     Completed Date:  2004-03-03     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  251-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiac Surgery, Diana, Princess of Wales Children's Hospital, Birmingham, United Kingdom.
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MeSH Terms
Descriptor/Qualifier:
Abnormalities, Multiple / diagnosis,  mortality,  surgery*
Adolescent
Adult
Cardiac Surgical Procedures / adverse effects,  methods*
Child
Child, Preschool
Cohort Studies
Collateral Circulation
Confidence Intervals
Echocardiography, Transesophageal
Female
Great Britain
Heart Catheterization
Heart Defects, Congenital / diagnosis,  mortality*,  surgery*
Humans
Infant
Infant, Newborn
Male
Middle Aged
Multivariate Analysis
Postoperative Complications / mortality
Probability
Prognosis
Pulmonary Artery / anatomy & histology*,  surgery
Pulmonary Circulation / physiology*
Retrospective Studies
Risk Assessment
Survival Analysis
Treatment Outcome

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


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