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Current results with construction and interruption of the Waterston anastomosis
Insights
The Waterston anastomosis offers a 90% survival rate in neonates, even those severely cyanotic. This procedure can be safely reversed for complete intracardiac repair with minimal complications.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease Management
- Neonatal Surgical Interventions
Background:
- The Waterston anastomosis is a palliative surgical procedure used in neonates with complex congenital heart disease.
- Its effectiveness and safety, particularly regarding reversibility for subsequent complete repair, require further evaluation.
Purpose of the Study:
- To assess the outcomes of the Waterston anastomosis in a cohort of infants and neonates.
- To evaluate the feasibility and complications associated with takedown of the Waterston anastomosis during complete intracardiac repair.
Main Methods:
- Retrospective review of 21 infants and neonates undergoing Waterston anastomosis between 1973 and 1977.
- Analysis of operative mortality, hospital survival, late deaths, and palliation success.
- Evaluation of 9 patients who underwent subsequent complete intracardiac repair after Waterston anastomosis, including assessment of right pulmonary artery angulation and reconstruction.
Main Results:
- Hospital survival was 90% (2 operative deaths) with 3 late deaths.
- Satisfactory palliation was achieved in all survivors except one requiring a Potts anastomosis.
- Complete intracardiac repair after Waterston anastomosis had no operative mortality, with only 2 patients experiencing slight persistent narrowing of the right pulmonary artery after patch reconstruction.
Conclusions:
- The Waterston anastomosis is associated with low operative mortality in severely cyanotic neonates.
- Takedown of the Waterston anastomosis for complete repair is feasible with minimal morbidity and no mortality, even with significant right pulmonary artery angulation.
Abstract:
The Waterston anastomosis was constructed in 21 infants and neonates between 1973 and 1977. Sixteen neonates were 1 week old or less and 8 were less than 24 hours old. There were 2 operative deaths, giving a hospital survival of 90%. There were 3 late deaths. All surviving infants received satisfactory palliation except 1 who required a Potts anastomosis one year later. During the same time interval, 9 other patients who had had a Waterston anastomosis underwent complete intracardiac repair. Seven of them had significant angulation of the right pulmonary artery necessitating patch reconstruction. All patients survived operation, and follow-up pulmonary angiograms demonstrated only a slight persistent narrowing of the right pulmonary artery in 2 patients. We conclude that the Waterston anastomosis can be constructed with a low operative mortality even in the severely cyanotic neonate and that it can be taken down at the time of complete repair with minimal morbidity and no mortality even if it has significantly angulated the right pulmonary artery.