ABSTRACT
Objective:To sum up the experience of surgical repair for infants with absence of right pulmonary artery(ARPA) in our hospital to improve the treatment of ARPA.Methods:From February 2019 to April 2019, 3 infants with ARPA underwent surgical repair in our hospital, aged from 33-day to 20-month. We took enhanced CT scan with three-dimensional reconstruction and pulmonary vein wedge angiography(PVWA) to confirm the diagnosis and to assess the surgical indications. We explored to mobilize the atresia patent ductus arteriosus(PDA) and adopted "two-segment" technique to reconstruct the absent pulmonary artery. The blood flow in the "neo" pulmonary artery, the improvement of the pulmonary hypertension and anticoagulant therapy were followed up closely after the operation.Results:There were particular traces on CT reconstruction images which were very important cues for cardiac surgeons inferring potential approaches during the operation, such as the aberrant "diverticulum" or "bud" in the position of the base of the innominate artery in all 3 infants which were confirmed as one end of the atresia PDA connecting the right pulmonary hilum; PVWA which can clearly show the development and distribution of the pulmonary vessels within the lung was taken in one patient. Significant alleviation of pulmonary hypertension happened immediately after the RPA reconstruction; 3 patients recovered smoothly. During early follow-up, RPA thrombosis happened in one patient was cured by continuous pumping anticoagulation with heparin. Now warfarin or aspirin was used with close follow-up.Conclusion:ARPA is not "no-fly zone" for surgical correction. Earlier diagnosis and pulmonary reconstruction in infant could get excellent early result. Some particular aberrant "diverticulum" on CT reconstruction images are important cues with PVWA still being the golden standard for diagnosis and assessment.
ABSTRACT
Objective To compare the two different ways of right ventricular outflow tract(RVOT) reconstruction at repair of pulmonary atresia with ventricular septal defect,the direct RV-PA anastomosis and pericardial conduit to find the better way.Methods From Jun.2002 to Oct.2012,66 patients underwent pulmonary atresia with ventricular septal defect repair in our hospital,age at operation from 14 days to 272 months.Patients were divided into 2 groups according to the way of RVOT reconstruction.Group 1:31 of them,using direct RV-PA anastomasis,Group 2:35 of them,using pericardial conduit.Paired t test was used to evaluate the growth of pulmonary arteries.Chi-square test and Kaplan-Meier were used to calculate the postoperative mortality,reopemtion situation and survival time.Results There are 3 early hospital death in group 1 (9.7 ％),and 5 in group 2(14.3％),P =0.71.There is a significant difference between the two groups in restenosis rate of the RV-PA anastomasis and autologous pericardial conduit with pulmonary branch artery(Group 1:22.2％,Group 2:55.6％,P =0.01).The diameters of RV-PA anastomasis and the pulmonary artery branches in follow-up were significantly lager than the earlier diameters(P ＜ 0.05) in group 1.There is no growth on diameters of the pericardial conduit and pulmonary branches except the right pulmonary artery in follow-up in group 2.There is no significant difference between the two groups in later survival(P =0.30).Conclusion Both the direct anastomasis of RV-PA and pericardial conduit are available for RVOT reconstruction in pulmonary atresia with ventricular setal defect repair.There is lower incidence of RVOT and pulmonary stenosis and anastomosis absolutely has the ability for later growth in the former.
ABSTRACT
Objective To evaluate the right heart function with echocardiography after right ventricle-pulmonary artery (RV-PA) anastomasis for right ventricle outflow (RVOT) reconstruction in patients with different types of pulmonary atresia and ventricle septal defect(PA/VSD).Methods From Nov 2002 to Aug 2013,31 patients with PA/VSD had undergone right ventricle-pulmonary anastomasis to reconstruct RVOT for radical or palliative repair.Related echocardiography indexs including strain/rate etc.were used to evaluate the right heart function and the progress of the right heart valves regurgitation.Results There were 3 early hospital deaths.No later death during follow-up.The echocardiography suggested the pulmonary artery and tricuspid regurgitation were more serious,however,the right heart function was relatively fine.The regurgitation of tricuspid valve was positive correlation with duration of follow-up (P =0.016).Conclusion The right heart function in follow-up keeps relatively well,and tricuspid valve regurgitation needs a long-term follow-up.