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Published on: February 11, 2017
A Single-Center Clinical Analysis of 121 Pediatric Cases with Pulmonary Atresia and Ventricular Septal Defect
Fan Cao1, Wenhua Liu2, Rongjun Zou3
1Department of Cardiovascular Surgery, Women and Children's Medical Center Affiliated to Guangzhou Medical University, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
Insights
The pulmonary artery flow study (PAFS) effectively predicts outcomes for children with pulmonary atresia and ventricular septal defect (PA/VSD). A mean pulmonary artery pressure (mPAP) over 25 mmHg indicates higher risk and poorer survival rates.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Research
- Diagnostic Imaging in Pediatrics
Background:
- Pulmonary atresia and ventricular septal defect (PA/VSD) presents complex challenges in pediatric cardiac surgery.
- Accurate prognostic assessment is crucial for optimizing treatment strategies in these patients.
- The utility of pulmonary artery flow study (PAFS) for predicting outcomes in PA/VSD requires further investigation.
Purpose of the Study:
- To evaluate the prognostic value of the pulmonary artery flow study (PAFS) in children diagnosed with PA/VSD.
- To determine the correlation between PAFS parameters and surgical outcomes, including VSD closure success and patient survival.
- To identify specific thresholds within PAFS measurements that indicate higher risk.
Main Methods:
- Retrospective analysis of 121 pediatric patients with type B or C PA/VSD who underwent PAFS.
- Collection and statistical analysis of demographic, operative, and follow-up data.
- Utilized Spearman's correlation, ROC curves, and Kaplan-Meier survival analysis to assess prognostic significance.
Main Results:
- Mean pulmonary artery pressure (mPAP) showed a strong correlation with postoperative right ventricular systolic pressure/left ventricular systolic pressure (RVSP/LVSP) (P=.000).
- An mPAP cutoff of 24.5 mmHg accurately predicted VSD closure success (79.2% sensitivity, 91.2% specificity).
- Elevated mPAP and RVSP/LVSP were linked to prolonged ventilation and ICU stay; mPAP > 25 mmHg correlated with significantly poorer survival (P=.009).
Conclusions:
- The pulmonary artery flow study (PAFS) is a valuable tool for assessing prognosis in pediatric PA/VSD.
- PAFS reliably predicts successful VSD closure and influences postoperative outcomes.
- An mPAP threshold of 25 mmHg can identify high-risk PA/VSD patients needing intensive management.
Abstract:
BackgroundThis study analyzed the utility of the pulmonary artery flow study (PAFS) in prognostic assessment for children with pulmonary atresia and ventricular septal defect (PA/VSD).MethodsWe reviewed 121 patients with type B or C pulmonary atresia and ventricular septal defect (PA/VSD) who underwent the PAFS between August 2016 and August 2024. Demographic, operative, and follow-up data were collected. Statistical analyses included Spearman's correlation, ROC curves, and Kaplan-Meier survival analysis.ResultsThe cohort included 60 males and 61 females, with 97 type B and 24 type C cases. Mean age was 44 months and median weight was 12.8 kg. Mean pulmonary artery pressure (mPAP) strongly correlated with postoperative right ventricular systolic pressure/left ventricular systolic pressure (RVSP/LVSP) (P = 0.000). An mPAP cutoff of 24.5 mmHg predicted VSD closure with 79.2% sensitivity and 91.2% specificity. Mean pulmonary artery pressure and RVSP/LVSP were associated with prolonged ventilation and critical care unit stay. During follow-up, 15/121 children (12.4%) died, with significantly poorer survival in those with mPAP > 25 mmHg (P = 0.009).ConclusionsThe pulmonary artery flow study is a valuable predictor of successful VSD closure and postoperative outcomes. An mPAP threshold of 25 mmHg may help identify high-risk patients requiring more intensive management.
