| Autor: |
Pieter Woestijne, Mostafa Mokhles, Ingrid Beynum, Peter Jong, Jeroen Wilschut, Ad Bogers |
| Přispěvatelé: |
Cardiothoracic Surgery, Pediatrics, Public Health |
| Rok vydání: |
2021 |
| Předmět: |
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| Zdroj: |
Journal of Cardiac Surgery, 37(4), 960-966. Wiley-Blackwell Publishing Ltd |
| ISSN: |
0886-0440 |
| DOI: |
10.22541/au.163275129.98299783/v1 |
| Popis: |
Objectives Pulmonary atresia (PA) with ventricular septal defect (VSD) and systemic-pulmonary collateral arteries (SPCA’s) has a variable anatomy with regard to the pulmonary vasculature, asking for an individualized surgical treatment. A protocol was applied consisting of staged unifocalization and correction. Methods Since 1989 39 consecutive patients were included (median age at first operation 13 months). In selected cases a central aorto-pulmonary shunt was performed as first procedure. Unifocalization procedures were performed through a lateral thoracotomy. Correction consisted of shunt takedown, VSD closure and interposition of an allograft between the right ventricle and the reconstructed pulmonary artery. Postoperatively and at follow up echocardiographic data were obtained. Results In 39 patients 66 unifocalization procedures were performed. Early mortality was 5%. Seven patients were considered not suitable for correction, four of them died. One patient is awaiting further correction. Correction was done successfully in 28 patients. Operative mortality was 3% and late mortality 11%. Median follow-up after correction was 19 years. Eleven patients needed homograft replacement. Freedom from conduit replacement was 88%, 73% and 60% at 5, 10 and 15 years respectively. Right ventricular function was reasonable or good in 75 % of the patients. Conclusions After complete unifocalization 30/37 patients (81%) were considered correctable. The main reasons for palliative treatment without correction were pulmonary hypertension and/or inadequate outgrowth of pulmonary arteries. Staged approach of PA, VSD and SPCA’s results in adequate correction and good functional capacity. RV function after correction remains reasonable or good in the majority of patients. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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