Pulmonary Artery Hypoplasia in Neonates With Tetralogy of Fallot.

Autor:	Petit CJ; Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA; Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA. Electronic address: cjp2196@cumc.columbia.edu., Glatz AC; Division of Pediatric Cardiology, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Division of Pediatric Cardiology, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Missouri, USA., Goldstone AB; Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA., Law MA; University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA., Romano JC; University of Michigan School of Medicine, Mott Children's Hospital, Ann Arbor, Michigan, USA., Maskatia SA; University of California San Francisco School of Medicine, Benioff Children's Hospital, San Francisco, California, USA., Chai PJ; Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA., Zampi JD; University of Michigan School of Medicine, Mott Children's Hospital, Ann Arbor, Michigan, USA., Meadows JJ; University of California San Francisco School of Medicine, Benioff Children's Hospital, San Francisco, California, USA., Nicholson GT; Division of Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Shahanavaz S; Division of Pediatric Cardiology, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Missouri, USA; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA., Qureshi AM; Baylor College of Medicine, Texas Children's Hospital, Waco, Texas, USA., McCracken CE; Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA., Mascio CE; Division of Pediatric Cardiology, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; University of West Virginia School of Medicine, Morgantown, West Virginia, USA., Batlivala SP; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA., Asztalos IB; Division of Pediatric Cardiology, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA., Healan SJ; Division of Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Smith JD; University of Michigan School of Medicine, Mott Children's Hospital, Ann Arbor, Michigan, USA., Pettus JA; Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA., Beshish A; Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA., Raulston JEB; University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA., Hock KM; University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA., Pajk AL; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA., Goldstein BH; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Jazyk:	angličtina
Zdroj:	Journal of the American College of Cardiology [J Am Coll Cardiol] 2023 Aug 15; Vol. 82 (7), pp. 615-627.
DOI:	10.1016/j.jacc.2023.05.051
Abstrakt:	Background: Neonates with symptomatic tetralogy of Fallot (sTOF) with hypoplastic pulmonary arteries (hPA) are considered high risk. Data are needed to inform the impact of hPA on outcomes, and the ideal management strategy. Objectives: The objectives of this study were to quantify the impact of hPA on outcomes in neonates with sTOF and measure the impact of strategy on pulmonary artery (PA) growth in this population. Methods: Neonates with sTOF from 2005 to 2017 were reviewed from the Congenital Cardiac Research Collaborative. Criteria for hPA included a unilateral PA z score <-2.0 and contralateral PA z score <0. Primary outcome was mortality. Secondary outcomes included reintervention and PA growth. Results: We included 542 neonates with sTOF, including 188 (35%) with hPA and 354 (65%) with normal PA, with median follow-up of 4.1 years. Median right and left hPA z scores were -2.19 (25th-75th percentile: -2.55 to -1.94) and -2.23 (25th-75th percentile: -2.64 to -1.91), respectively. Staged repair (vs primary TOF repair) was less common in the hPA cohort (36 vs 44%; P = 0.07). Survival was similar between groups (unadjusted P = 0.16; adjusted P = 0.25). Reintervention was more common in the hPA group (HR: 1.28; 95% CI: 1.01-1.63; P = 0.044); there was no difference after definitive repair (HR: 1.21; 95% CI: 0.93-1.58; P = 0.16). PA growth at 1 year was greater in the hPA cohort, particularly for the right PA (P < 0.001). Conclusions: Despite perception, the presence of hPA in neonates with sTOF conferred no increase in overall hazard of mortality or reintervention after definitive repair. PA growth was superior in the hPA cohort. These findings suggest that the presence of hPA does not adversely impact outcomes in sTOF. Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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