Replacement of valved right ventricular to pulmonary artery conduits: an observational study with focus on right ventricular geometry.
Clin Res Cardiol
; 97(3): 169-75, 2008 Mar.
Article
em En
| MEDLINE
| ID: mdl-18046528
ABSTRACT
OBJECTIVE:
Timing of the operation for exchange of right ventricular (RV) to pulmonary artery (PA) conduits is a matter of considerable debate. We aimed to study the course of right ventricular dimension in patients undergoing conduit exchange. PATIENTS ANDMETHODS:
We retrospectively studied all patients who underwent implantation and or replacement of RV/PA conduits during the time period between 1990 and 2005. Clinical and echocardiographic data were recorded as obtained at follow-up visits.RESULTS:
A total of 229 (144 boys and 85 girls) underwent surgery for implantation and or replacement of RV/PA conduits during the study period. Patients were assigned to three age groups including 37 infants, 125 children aged 1-10 years and 67 patients more than 10 years of age. 185 pulmonary (81%) and 44 aortic homografts (19%) were implanted. Fifty-eight of these 185 patients (25%) required exchange of conduits after a median time of 6.4 (8 months-12 years) (median (range)). The follow-up was 7.55 (0.1-17) years. The survival of the patients after homograft change was 98%. Freedom from failure for aortic and pulmonary homografts at an interval of 10 years for all patients was 38.5% for aortic and 56.2% for pulmonary homografts (P = 0.018; Mann-Whitney). Age at conduit exchange (coefficient -4.917; P < 0.001) and right ventricular end-diastolic dimension (RVDD) before conduit exchange (coefficient 8.255; P < 0.001) were related to RVDD as measured by M-mode echocardiography at follow-up ("best subset" regression analysis; R squared = 0.746). RVDD decreased in 48/58 patients, remained unchanged in 8/58 and increased in 2/59 patients at follow-up. An increased RVDD was positively correlated to the duration of artificial ventilation after the operation for conduit exchange (R = 0.56; P < 0.001).CONCLUSIONS:
Reoperation for exchange of degenerated conduits should be performed early to prevent the development of irreversible structural myocardial changes and persistence of right ventricular dilatation.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Artéria Pulmonar
/
Obstrução do Fluxo Ventricular Externo
/
Procedimentos Cirúrgicos Cardíacos
Tipo de estudo:
Diagnostic_studies
/
Observational_studies
Limite:
Adolescent
/
Child
/
Child, preschool
/
Humans
/
Infant
Idioma:
En
Revista:
Clin Res Cardiol
Ano de publicação:
2008
Tipo de documento:
Article