Staged biventricular repair of pulmonary atresia or stenosis with intact ventricular septum

Shunji Sano, Kozo Ishino, Masaaki Kawada, Emi Fujisawa, Masahiro Kamada, Shin-ichi Ohtsuki

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background. Since 1991 we have performed a multistage palliative approach to biventricular repair of pulmonary atresia or critical pulmonary stenosis with intact ventricular septum in infants with a detectable right ventricular infundibulum. Methods. A total of 25 patients (19 pulmonary atresia and 6 critical pulmonary stenosis) underwent initial palliation consisting of a transarterial pulmonary valvotomy and a polytetrafluoroethylene shunt between the left subclavian artery and pulmonary trunk. Among the 23 survivors, 15 underwent balloon valvotomy. Six of these patients later required additional palliative surgery that consisted of repeat pulmonary valvotomy, adjustment of an atrial communication, and resection of the hypertrophied muscles in the right ventricle. Results. Of the 25 patients, 23 (92%) survived. In all, 20 patients underwent definitive operations: 18 (90%) biventricular repair (12 pulmonary atresia, and 6 critical pulmonary stenosis), one bidirectional Glenn, and one Fontan procedure. The actuarial probability of achieving a biventricular repair at 36 months of age was 69%. In 18 patients right ventricular end-diastolic volume significantly increased but tricuspid valve diameter did not change. Conclusions. The multistage palliation procedure to promote right ventricular growth makes a definitive biventricular repair of pulmonary atresia or critical pulmonary stenosis with intact ventricular septum possible in the majority of infants with a patent infundibulum. (C) 2000 by The Society of Thoracic Surgeons.

Original languageEnglish
Pages (from-to)1501-1506
Number of pages6
JournalAnnals of Thoracic Surgery
Volume70
Issue number5
DOIs
Publication statusPublished - 2000

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Pulmonary Atresia
Ventricular Septum
Pulmonary Valve Stenosis
Pituitary Gland
Lung
Balloon Valvuloplasty
Fontan Procedure
Social Adjustment
Subclavian Artery
Tricuspid Valve
Polytetrafluoroethylene
Patient Rights
Palliative Care
Stroke Volume
Heart Ventricles
Survivors
Communication
Muscles
Growth

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Staged biventricular repair of pulmonary atresia or stenosis with intact ventricular septum. / Sano, Shunji; Ishino, Kozo; Kawada, Masaaki; Fujisawa, Emi; Kamada, Masahiro; Ohtsuki, Shin-ichi.

In: Annals of Thoracic Surgery, Vol. 70, No. 5, 2000, p. 1501-1506.

Research output: Contribution to journalArticle

Sano, Shunji ; Ishino, Kozo ; Kawada, Masaaki ; Fujisawa, Emi ; Kamada, Masahiro ; Ohtsuki, Shin-ichi. / Staged biventricular repair of pulmonary atresia or stenosis with intact ventricular septum. In: Annals of Thoracic Surgery. 2000 ; Vol. 70, No. 5. pp. 1501-1506.
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AB - Background. Since 1991 we have performed a multistage palliative approach to biventricular repair of pulmonary atresia or critical pulmonary stenosis with intact ventricular septum in infants with a detectable right ventricular infundibulum. Methods. A total of 25 patients (19 pulmonary atresia and 6 critical pulmonary stenosis) underwent initial palliation consisting of a transarterial pulmonary valvotomy and a polytetrafluoroethylene shunt between the left subclavian artery and pulmonary trunk. Among the 23 survivors, 15 underwent balloon valvotomy. Six of these patients later required additional palliative surgery that consisted of repeat pulmonary valvotomy, adjustment of an atrial communication, and resection of the hypertrophied muscles in the right ventricle. Results. Of the 25 patients, 23 (92%) survived. In all, 20 patients underwent definitive operations: 18 (90%) biventricular repair (12 pulmonary atresia, and 6 critical pulmonary stenosis), one bidirectional Glenn, and one Fontan procedure. The actuarial probability of achieving a biventricular repair at 36 months of age was 69%. In 18 patients right ventricular end-diastolic volume significantly increased but tricuspid valve diameter did not change. Conclusions. The multistage palliation procedure to promote right ventricular growth makes a definitive biventricular repair of pulmonary atresia or critical pulmonary stenosis with intact ventricular septum possible in the majority of infants with a patent infundibulum. (C) 2000 by The Society of Thoracic Surgeons.

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