Limits...
The recent surgical result of total anomalous pulmonary venous return.

Jang SI, Song JY, Kim SJ, Choi EY, Shim WS, Lee C, Lim HG, Lee CH - Korean Circ J (2010)

Bottom Line: Among 17 univentricule patients, mortality was 10, including 7 early deaths, and postoperative pulmonary venous stenosis occurred in 2 patients.Combined palliations were modified Blalock-Taussig (BT) shunts in 7, pulmonary artery banding (PAB) in 3, bidirectional cavopulmonary shunt in 5, and the Fontan procedure in 1.The highest mortality was recorded in patients with a modified BT shunt (85.7%) and next in patients with PAB (66.6%).

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Sejong General Hospital, Bucheon, Korea.

ABSTRACT

Background and objectives: Recent surgical results from total anomalous pulmonary venous return (TAPVR) are reported to have improved; however, mortality and morbidity are still high in the univentricles. This review was performed in order to demonstrate surgical results from TAPVR for recent years in a single institute.

Subjects and methods: A total of 53 patients with TAPVR underwent surgery between January 2000 and December 2008. Preoperative anatomy and hemodynamics were evaluated by 2-dimensional echocardiogram. We reviewed medical records on preoperative management, age, and body weight at time of surgery, postoperative mortality, and pulmonary venous obstruction.

Results: The study included 36 biventricle patients and 17 univentricle patients. Median age and weight at time of surgery were 26 days and 3.5 kg, respectively. During the mean follow up period of 48.2 months, a total of 11 deaths and 8 early deaths occurred. Postoperative pulmonary venous stenosis occurred in 8 patients. Among 36 biventricle patients, mortality occurred in 1 patient and postoperative pulmonary venous stenosis occurred in 6 patients. No statistical significances were observed between postoperative pulmonary venous stenosis and other factors. Among 17 univentricule patients, mortality was 10, including 7 early deaths, and postoperative pulmonary venous stenosis occurred in 2 patients. Combined palliations were modified Blalock-Taussig (BT) shunts in 7, pulmonary artery banding (PAB) in 3, bidirectional cavopulmonary shunt in 5, and the Fontan procedure in 1. The highest mortality was recorded in patients with a modified BT shunt (85.7%) and next in patients with PAB (66.6%). Mortality was not related to anatomy of TAPVR, nor preoperative obstruction, but with significant age and weight at time of surgery.

Conclusion: Despite improvement in operative results from TAPVR, surgery in univentricles is highly risky, especially with low weight and early age, with concomitant palliation.

No MeSH data available.


Related in: MedlinePlus

The relationship between palliative procedure and mortality in univentricular heart. No: no palliation, BT: modified Blalock-Taussig shunt, PAB: pulmonary artery banding, BCPS: bidirectional cavopulmonary shunt.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2812795&req=5

Figure 2: The relationship between palliative procedure and mortality in univentricular heart. No: no palliation, BT: modified Blalock-Taussig shunt, PAB: pulmonary artery banding, BCPS: bidirectional cavopulmonary shunt.

Mentions: The highest mortality was recorded in patients with modified BT shunt (6 of 7; 85.7%), and the next was in patients with PAB (2 of 3; 66.6%). Of 5 BCPS patients of first palliation, 4 underwent the Fontan procedure, with 1 case of late mortality (Fig. 2). The patient who underwent repair of only TAPVR without palliation died. Mortality was high in patients with modified BT shunt and PAB, but with no statistical significance (p=0.116). Postoperative pulmonary stenosis occurred in 8 of 10 mortalities. Univariate analysis showed that mortality was not related to the anatomy of TAPVR, nor preoperative obstruction (Fig. 3), but was significant with regard to age and weight at time of surgery. That is, the age and weight at operation were 42.3±68.5 days and 3.3±1.2 kg, respectively in the mortality group, but 1,066.7±2,156.3 days and 12.7±16.3 kg, respectively in the survival group (p=0.001). However, preoperative arterial oxygen saturation and support were not statistically related to mortality.


The recent surgical result of total anomalous pulmonary venous return.

Jang SI, Song JY, Kim SJ, Choi EY, Shim WS, Lee C, Lim HG, Lee CH - Korean Circ J (2010)

The relationship between palliative procedure and mortality in univentricular heart. No: no palliation, BT: modified Blalock-Taussig shunt, PAB: pulmonary artery banding, BCPS: bidirectional cavopulmonary shunt.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2812795&req=5

Figure 2: The relationship between palliative procedure and mortality in univentricular heart. No: no palliation, BT: modified Blalock-Taussig shunt, PAB: pulmonary artery banding, BCPS: bidirectional cavopulmonary shunt.
Mentions: The highest mortality was recorded in patients with modified BT shunt (6 of 7; 85.7%), and the next was in patients with PAB (2 of 3; 66.6%). Of 5 BCPS patients of first palliation, 4 underwent the Fontan procedure, with 1 case of late mortality (Fig. 2). The patient who underwent repair of only TAPVR without palliation died. Mortality was high in patients with modified BT shunt and PAB, but with no statistical significance (p=0.116). Postoperative pulmonary stenosis occurred in 8 of 10 mortalities. Univariate analysis showed that mortality was not related to the anatomy of TAPVR, nor preoperative obstruction (Fig. 3), but was significant with regard to age and weight at time of surgery. That is, the age and weight at operation were 42.3±68.5 days and 3.3±1.2 kg, respectively in the mortality group, but 1,066.7±2,156.3 days and 12.7±16.3 kg, respectively in the survival group (p=0.001). However, preoperative arterial oxygen saturation and support were not statistically related to mortality.

Bottom Line: Among 17 univentricule patients, mortality was 10, including 7 early deaths, and postoperative pulmonary venous stenosis occurred in 2 patients.Combined palliations were modified Blalock-Taussig (BT) shunts in 7, pulmonary artery banding (PAB) in 3, bidirectional cavopulmonary shunt in 5, and the Fontan procedure in 1.The highest mortality was recorded in patients with a modified BT shunt (85.7%) and next in patients with PAB (66.6%).

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Sejong General Hospital, Bucheon, Korea.

ABSTRACT

Background and objectives: Recent surgical results from total anomalous pulmonary venous return (TAPVR) are reported to have improved; however, mortality and morbidity are still high in the univentricles. This review was performed in order to demonstrate surgical results from TAPVR for recent years in a single institute.

Subjects and methods: A total of 53 patients with TAPVR underwent surgery between January 2000 and December 2008. Preoperative anatomy and hemodynamics were evaluated by 2-dimensional echocardiogram. We reviewed medical records on preoperative management, age, and body weight at time of surgery, postoperative mortality, and pulmonary venous obstruction.

Results: The study included 36 biventricle patients and 17 univentricle patients. Median age and weight at time of surgery were 26 days and 3.5 kg, respectively. During the mean follow up period of 48.2 months, a total of 11 deaths and 8 early deaths occurred. Postoperative pulmonary venous stenosis occurred in 8 patients. Among 36 biventricle patients, mortality occurred in 1 patient and postoperative pulmonary venous stenosis occurred in 6 patients. No statistical significances were observed between postoperative pulmonary venous stenosis and other factors. Among 17 univentricule patients, mortality was 10, including 7 early deaths, and postoperative pulmonary venous stenosis occurred in 2 patients. Combined palliations were modified Blalock-Taussig (BT) shunts in 7, pulmonary artery banding (PAB) in 3, bidirectional cavopulmonary shunt in 5, and the Fontan procedure in 1. The highest mortality was recorded in patients with a modified BT shunt (85.7%) and next in patients with PAB (66.6%). Mortality was not related to anatomy of TAPVR, nor preoperative obstruction, but with significant age and weight at time of surgery.

Conclusion: Despite improvement in operative results from TAPVR, surgery in univentricles is highly risky, especially with low weight and early age, with concomitant palliation.

No MeSH data available.


Related in: MedlinePlus