Pulmonary arterial reconstruction for pulmonary coarctation in early infancy
Takeshi Shinkawa1, Masaaki Yamagishi, Keisuke Shuntoh
1Department of Pediatric Cardiovascular Surgery, Children's Research Hospital, Kyoto, Japan.
Insights
Pulmonary arterial reconstruction in infants with pulmonary atresia and coarctation significantly improves pulmonary artery development. This early intervention promotes balanced growth, essential for long-term outcomes in complex congenital heart disease.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Thoracic Surgery
Background:
- Pulmonary atresia with pulmonary coarctation can impede lung development.
- Surgical intervention aims to achieve sufficient and balanced pulmonary arterial growth.
Purpose of the Study:
- To evaluate the outcomes of pulmonary arterial reconstruction in infants.
- To assess the impact on pulmonary artery development in patients with pulmonary atresia and coarctation.
Main Methods:
- Retrospective review of 15 infants (<4 months) undergoing pulmonary arterial reconstruction (2001-2005).
- Comparison of pre- and post-operative pulmonary arterial index and minimum diameter.
- Analysis of outcomes for biventricular and Fontan repair candidates.
Main Results:
- No early or in-hospital deaths; no pulmonary artery mal-development post-surgery.
- Significant increase in mean pulmonary arterial index (103 to 343 mm²/m²) and minimum diameter (2.02 to 4.45 mm).
- Successful completion of initial repair stages for most patients, with some requiring reintervention.
Conclusions:
- Early pulmonary arterial reconstruction effectively promotes sufficient and balanced pulmonary arterial development.
- This procedure is crucial for managing pulmonary atresia with pulmonary coarctation in infancy.
Background:
Pulmonary atresia with pulmonary coarctation may complicate diminished and unbalanced pulmonary development. The aim of this study is to assess the outcome of pulmonary arterial reconstruction with cardiopulmonary bypass in early infancy for sufficient and balanced pulmonary development.
Methods:
We performed a retrospective review of 15 patients with pulmonary coarctation younger than 4 months of age who underwent pulmonary arterial reconstruction between 2001 and 2005. The mean age and weight were 42.2 days and 3.62 kg, respectively. The patient population included 5 biventricular repair candidates and 10 Fontan candidates. To evaluate the pulmonary arterial development, the preoperative and postoperative pulmonary arterial index and minimum diameter of the pulmonary artery were compared.
Results:
No early or in-hospital deaths occurred, and there was no nonconfluent pulmonary artery development or segmental mal-development after a mean follow-up period of 14.9 months. Immediate pulmonary flow regulation was required in 2 patients because of excessive pulmonary flow. The mean pulmonary arterial index increased significantly from 103 mm2/m2 to 343 mm2/m2, and the mean minimum diameter of the pulmonary artery increased significantly from 2.02 mm to 4.45 mm. Four biventricular repair candidates completed definitive repair, and 2 required surgical reintervention in the pulmonary artery. Six Fontan candidates completed the Glenn procedure, and 1 completed the Fontan procedure. Three required surgical reintervention in the pulmonary artery. Two late deaths occurred after the Glenn procedure because of ventricular dysfunction and respiratory infection.
Conclusions:
Pulmonary arterial reconstruction in early infancy provides sufficient and balanced pulmonary arterial development for pulmonary atresia with pulmonary coarctation.
