PubMed · 5905430
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L M McKay. 1966. Transventricular mitral valvutome.. https://pubmed.ncbi.nlm.nih.gov/5905430/
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BACKGROUND: After total repair of tetralogy of Fallot (TOF-R) with transannular patching (TAP), severe pulmonary regurgitation (PR) is reported to develop in up to 30% of patients at a follow-up of 20 years, and 10-15% or more need pulmonary valve replacement (PVR). In this study, time-related progression of PR and right ventricular (RV) dilatation, and functional recovery of the RV after PVR are analyzed, and the possible causes of PR and timing of PVR are discussed. METHODS: Eighteen patients, who late after TOF-R with TAP underwent PVR for severe PR, were chosen for the study. NYHA class, QRS duration, RV dilatation index (RVDI = RVEDD/LVEDD), and RV-distal pulmonary artery (PA) peak systolic gradient were reviewed and retrospectively analyzed. RESULTS: TOF-R was performed at a mean age of 5.1 +/- 3.9 years (range: 0.6-12.8 years); the mean time interval from TOF-R to PR grade 3 onset was 11.8 +/- 7.0 years (range: 3.3-27.4 years), and from TOF-R to PVR was 18.5 +/- 7.8 years (range: 8.7-37.1 years). At PVR, 11 patients were in NYHA class II-III, all patients had severe PR (grade 3/3) and severe RV enlargement, 4 patients had ventricular arrhythmias, 7 patients significant distal pulmonary artery stenosis, and 2 patients small nonrelevant residual VSD. The mean preoperative RVDI (normal: 0.5) was 0.99 +/- 0.14 (range: 0.75-1.3), the mean QRS duration 170 +/- 24 ms (140-220 ms), and the mean RV-distal PA peak systolic pressure gradient 33.3 +/- 19.0 mmHg (range: 10-60 mmHg). Patients aged at TOF-R> 5 years had considerably longer redo-free intervals than their younger counterparts: mean 23.1 years (range 8.7-37.1 years) vs 14.8 years (range: 9.3-21.2 years), respectively. The redo-free intervals and the duration of severe PR correlated inversely with the RV-PA gradient. At a mean follow-up of 1.3 years (2 weeks-5 years), the mean RVDI decreased from 0.99 +/- 0.14 to 0.69 +/- 0.15, the mean validity class improved from 2.5 to 1.1. One patient died. CONCLUSIONS: After TOF-R with TAP, the progression of PR has very individual dynamics, resulting in extremely varying redo-free intervals. Concomitant pulmonary stenosis seems to exaggerate progression of PR. PVR results in effective reduction of diastolic dimensions of severely dilated RV and in improvement of validity class. Referred PVR in no-risk cases seems to be justified.
OBJECTIVES: The goal of this study was to assess a new approach to stent the arterial duct in neonates with a duct-dependent pulmonary circulation. BACKGROUND: Previous attempts to stent the neonatal arterial duct were unsatisfactory. Learning from these failures, we speculated that covering the complete length of the duct with current low-profile stents might avoid previous problems. METHODS: Ten neonates with duct-dependent pulmonary circulations through a short straight duct were treated with stent implantation. The duct was crossed with an atraumatic 0.014-inch wire. A low-profile premounted coronary stent (outer diameter <4F, length 13 to 24 mm, diameter 3.0 to 4.0 mm) was positioned within the duct, not protected by a sheath; care was taken to cover the complete length of the duct from the aortaductal junction until well within the pulmonary trunk. RESULTS: All stents could safely be deployed with adequate pulmonary flow at early- and medium-term follow-up. There were no procedure-related complications; one patient died early from sepsis. All patients had adequate relief of cyanosis for at least three to four months. During follow-up, the pulmonary vasculature bed had grown without distortion. Acute occlusion of a stented duct was not observed. Ductal flow progressively decreased slowly over several months by luminal narrowing, until the stented duct had either become redundant or was dilated/restented or until elective staged surgery was performed. CONCLUSIONS: With current technology, complete stenting of a short straight duct is a safe and effective palliation, allowing adequate growth of the pulmonary arteries.
OBJECTIVES: To determine 18-month neurodevelopmental outcome of survivors of complex open heart surgery at </=6 weeks of age through an interprovincial program and to explore preoperative, operative, and postoperative outcome predictors. Study design Of 85 children from this inception cohort (21% mortality), 67 18-month-old survivors received multidisciplinary assessment including the Bayley Scales of Infant Development-II. Cumulative risk for adverse outcome was determined through univariate and multivariate analyses. RESULTS: Survival of the 85 children included 23 of 23 after arterial switch, 16 of 26 after Norwood, six of six after total anomalous pulmonary venous drainage repair, and 22 of 30 after miscellaneous repair. Outcomes were as follows: in-hospital death, 14 (16%); postdischarge death, four (5%); motor/sensory disability, three (4%); motor/mental delay (<70), 21 (25%); and intact survivors, 43 (50%). Cohort mental (84+/-17) and motor (80+/-22) scores were lower for those with chromosomal abnormalities, 67+/-16 and 61+/-17, respectively. Fifty-five percent of the outcome variance was explained by duration of preoperative ventilation, 18%; genetic anomaly, 5%; intraoperative variables, 18%; and postoperative variables, 14%. CONCLUSIONS: Risk for adverse outcome is cumulative, with preoperative determinants contributing significantly to total variance. Potentially modifiable variables should be sought in an attempt to improve outcome.