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Noninvasive imaging of intraarterial baffles in infants and children
A J Chin1, R L Larsen, M A Seliem
1Cardiac Non-Invasive Laboratories, Children's Hospital of Philadelphia, PA 19104.
Insights
The Aubert and Takeuchi procedures use intrapulmonary artery baffles to reroute blood to coronary arteries, avoiding transplantation. Ultrasound imaging revealed rare supravalvar narrowing as a potential complication.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Medical Imaging
Background:
- The Aubert and Takeuchi procedures are surgical techniques used in complex congenital heart disease.
- These procedures involve creating baffles within the pulmonary artery to redirect aortic blood to the coronary arteries, bypassing direct coronary artery transplantation.
- They are indicated in specific scenarios, such as anomalous coronary artery origins or complex coronary anatomy.
Purpose of the Study:
- To assess the long-term sequelae of intrapulmonary artery baffles used in the Aubert and Takeuchi procedures.
- To evaluate the safety and efficacy of these baffle techniques using ultrasound imaging.
Main Methods:
- Retrospective imaging study using ultrasound (echocardiography).
- Involved 15 patients (5 Aubert, 10 Takeuchi) with varying ages and follow-up durations.
- Assessment of baffle geometry, aorticopulmonary window, and potential complications like stenosis or shunting.
Main Results:
- Baffle geometry and aorticopulmonary windows were visualized in all 15 patients.
- No instances of aorticopulmonary window stenosis or peribaffle shunting were detected in any patient.
- Supravalvar narrowing of the pulmonary artery was observed in two Aubert patients and one Takeuchi patient, with reoperation performed in two cases.
Conclusions:
- Intrapulmonary artery baffles in Aubert and Takeuchi procedures are generally well-visualized and do not lead to significant stenosis or shunting.
- Supravalvar narrowing is a potential complication that may require reoperation.
- Ultrasound is effective in assessing the outcomes of these complex surgical repairs.
Abstract:
Baffles within the lumen of the pulmonary artery are created in (1) the Aubert procedure, a variation of the arterial switch favored by some surgeons when two major coronary ostia arise close to one another or when one coronary artery has an intramural course, and (2) the Takeuchi procedure, a technique applied to patients with anomalous origin of the left coronary from the pulmonary artery. In both operations, coronary artery transplantation is avoided; instead, an aorticopulmonary window is created and aortic blood is redirected by an intrapulmonary artery baffle into the coronary circulation. We imaged five patients with Aubert and 10 patients with Takeuchi procedures by use of ultrasound to assess the sequelae of such intraarterial baffles. All five Aubert patients were < 3 weeks old; the ages of the 10 Takeuchi patients ranged from 2 to 86 months. Two patients died early after surgery; the remaining 13 patients were observed for 3 to 83 months (median 46 months). In all 15 patients, the baffle geometry was visualized and the aorticopulmonary window was identified. In the six who had serial imaging, none developed aorticopulmonary window stenosis. In no patient was any peribaffle shunting detected. Supravalvar narrowing, caused by the baffle partially obstructing the neopulmonary artery, was observed in two of five Aubert patients; in only one of these has reoperation been performed. In one of the 10 Takeuchi patients supravalvar narrowing of the pulmonary artery (related to repair of coexistent tetralogy of Fallot) has developed and the patient has since undergone reoperation.