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[Palliative surgery of congenital heart disease in early infancy]
1Second Department of Surgery, Yamagata University School of Medicine, Japan.
Insights
Palliative surgeries for congenital heart disease (CHD) in infants under 3 months, including pulmonary artery banding and Blalock-Taussig shunt, demonstrated effectiveness in improving pulmonary artery pressure and growth. These early interventions facilitate successful two-staged corrections.
Area of Science:
- Pediatric Cardiology
- Cardiothoracic Surgery
- Neonatal Medicine
Context:
- Congenital heart disease (CHD) is a significant cause of mortality in neonates.
- Palliative surgical interventions are crucial for managing complex CHD in early infancy.
- This study reviews palliative procedures performed between 1988 and 1993.
Purpose:
- To evaluate the efficacy and outcomes of various palliative surgical procedures in infants under 3 months with CHD.
- To assess the impact of these procedures on pulmonary artery pressure and pulmonary artery growth.
- To determine the role of early palliative surgery in facilitating subsequent corrective procedures.
Summary:
- A total of 38 infants with CHD underwent palliative surgery, including pulmonary artery banding (PAB), Blalock-Taussig shunt (BTS), Brock operation, Blalock-Hanlon operation (BH), and Norwood operation (NRD).
- Overall operative mortality was 23%, with variations among procedures (PAB: 14.3%, BTS: 8.3%, Brock: 33.3%, NRD: 100%).
- PAB significantly reduced pulmonary artery pressure post-operatively, while BTS led to significant pulmonary artery growth during follow-up. The Brock operation utilized balloon dilation for pulmonary valve stenosis.
Impact:
- Effective palliative strategies in early infancy are essential for successful staged correction of complex congenital heart disease.
- The findings support the use of early palliative interventions to improve hemodynamics and facilitate long-term management of CHD.
- This study highlights the importance of tailored palliative approaches based on specific CHD diagnoses.
Abstract:
A total of 38 patients aged under 3 months with congenital heart disease (CHD) underwent palliative surgery between April, 1988 and March, 1993. The mean age at operation was 28.0 (range 1 to 87) days. Palliative procedures were: pulmonary artery banding (PAB) in 14 patients (IAA complex: 4, CoA complex: 6, AVSD: 2, TA: 2), Blalock-Taussig shunt (BTS) in 12 (TOF: 2, TGA: 1, AVSD: 1, PA-IVS: 3, PA-VSD: 3, PA-SV: 1, PA-AVSD: 1), Brock operation in 6 (PPS: 2, PA-IVS: 3, PA-SV: 1), Blalock-Hanlon operation (BH) with PAB in 2 (MA-SV: 2) and Norwood operation (NRD) in 4 (HLHS: 4). PAB of IAA or CoA complex was performed just after the repair of IAA or CoA. Overall operative mortality was 23% (PAB: 14.3, BTS: 8.3, Brock: 33.3, NRD: 100%). One week after PAB, pulmonary artery pressure (PAP) decreased significantly compared to the intraoperative PAP value after PAB (43.1 +/- 16.2, 32.3 +/- 9.0 mmHg, p < 0.05, respectively). Pulmonary artery index (PAI), which is an index of pulmonary artery growth, after BTS increased significantly compared to the preoperative value (mean follow-up interval: 22.1 months) (379.5 +/- 101.4, 159.3 +/- 51.2, p < 0.001, respectively). During Brock operation, balloon catheter was used in order to dilate pulmonary valve. One year after Brock operation, mean pressure gradient through the pulmonary valve 22.6 mmHg. Two-staged corrections of CHD will be performed both safely and successfully by effective palliations at the first stages in early infancy.