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Late hemodynamic and angiographic findings after ascending aorta--pulmonary artery anastomosis
Insights
The Waterston anastomosis in 75 children, especially neonates, had a high mortality rate. Postoperative pulmonary artery abnormalities, including kinking and occlusion, were common, necessitating follow-up catheterization.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease Management
- Vascular Surgery
Background:
- The Waterston anastomosis is a palliative surgical procedure for certain congenital heart defects.
- Infants, particularly neonates, are at high risk for complications during cardiac surgery.
- Postoperative pulmonary artery complications can significantly impact patient outcomes.
Purpose of the Study:
- To evaluate the outcomes and complications of ascending aorta-pulmonary artery (Waterston) anastomosis in pediatric patients.
- To identify risk factors associated with operative mortality.
- To assess the incidence and nature of postoperative pulmonary artery abnormalities.
Main Methods:
- Retrospective review of 75 pediatric patients undergoing Waterston anastomosis.
- Analysis of preoperative clinical data, including age, cardiac condition, hypoxemia, and acidosis.
- Postoperative assessment including cardiac catheterization and angiography in a subset of patients.
Main Results:
- Overall mortality was 28% (21 operative, 8 late deaths).
- Operative deaths were associated with complex cardiac conditions and preoperative physiological derangements.
- 64% of catheterized patients had pulmonary artery abnormalities, most commonly kinking or narrowing; 5/33 had pulmonary artery occlusion.
- Pulmonary vascular disease was also observed.
Conclusions:
- Waterston anastomosis in infants, especially neonates, carries significant operative risk.
- Postoperative pulmonary artery structural abnormalities are frequent and can include kinking, narrowing, and occlusion.
- Routine postoperative catheterization 1 year after surgery is recommended to assess pulmonary vascular resistance and artery status.
Abstract:
Ascending aorta-pulmonary artery (Waterston) anastomosis was performed in 75 children, 51 of whom were younger than 1 month of age and 36 younger than 1 week of age at the time of operation. There were 21 operative and eight late deaths. Operative deaths occurred more frequently in infants with complex cardiac conditions and severe hypoxemia and acidosis preoperatively. The postoperative status of the pulmonary arteries or arterioles could not be correlate with the degree of cardiomegaly, the pulmonary vascular markings, or characteristics of the shunt murmur. Sixty-four percent of the patients catheterized had one or more postoperative structural abnormalities of the pulmonary arteries following the operation, most frequently kinking or narrowing of a pulmonary artery. Occlusion of a pulmonary artery occurred in five of 33 patients studied by angiography. Pulmonary vascular disease may also develop. Therefore, patients should be catheterized 1 year postoperatively to evaluate the level of pulmonary vascular resistance and the pulmonary arteries.