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[Systemic-pulmonary fistula. Percentage of children attaining corrective surgery]
Insights
Systemic pulmonary fistulae (SPF) in children offers a chance for corrective surgery but carries high risks. Newborns and those with complex conditions face poorer outcomes, highlighting the need for careful consideration.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Thoracic Surgery
Context:
- Systemic pulmonary fistulae (SPF) are complex congenital heart defects.
- Limited data exists on the long-term outcomes of SPF management.
- Surgical palliation is often necessary for these conditions.
Purpose:
- To review the long-term results of systemic pulmonary fistulae (SPF) in pediatric patients.
- To evaluate the efficacy and outcomes of SPF as a palliative or definitive surgical approach.
- To identify factors influencing survival and the success of corrective surgery post-SPF.
Summary:
- A review of 91 children undergoing SPF between 1978-1980 with a minimum 53-month follow-up.
- 88% survived the immediate postoperative period, 71% survived long-term, but only 53% achieved corrective surgery.
- Outcomes were significantly worse for newborns (50% mortality) and those with complex pathologies compared to older children (19% mortality).
- Specific conditions like Tetralogy of Fallot (72%) and TGA with pulmonary stenosis (58%) had higher rates of corrective surgery.
Impact:
- SPF can be a crucial step towards total correction for complex congenital heart disease.
- High mortality and morbidity rates associated with SPF necessitate careful patient selection.
- Age (newborns) and complex pathology are identified as significant negative prognostic factors for long-term results.
Abstract:
Because of the lack of information on definitive long term results of the systemic pulmonary fistulae (SPF) we decided to review our experience. From 1978/1980, SPF was carried out on 91 children with a minimal follow-up period of 53 months, 80 (88%) survive the immediate postoperative period, 65 (71%) the late period, although only 48 (53%) reached corrective surgery. 14 (50%) of the 28 newborn children died and only 9 (32%) had corrective surgery. 12 (19%) of the 63 children of two months or older died and 39 (62 por 100) had definitive surgery. 72% with Fallot syndrome, 58% with TGA and pulmonary stenosis and less than 40% of other pathologies also reached definitive corrective surgery. Frequently the SPF is the only alternative to achieve total correction although there may be a high mortality and morbidity rate. The age (newborn children) and the complex pathology are unfavourable in the end results.