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Pulmonary circulation after biventricular repair in patients with major systemic-to-pulmonary collateral arteries
H Uemura1, T Yagihara, T Ishizaka
1Department of Cardiovascular Surgery, National Cardiovascular Center, Suita, Osaka, Japan.
Insights
Effective unifocalization and earlier repair are crucial for improving pulmonary circulation in patients with major systemic-to-pulmonary collateral arteries. Factors like age and collateral flow significantly impact postoperative pulmonary resistance.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Thoracic Surgery
Background:
- Major systemic-to-pulmonary collateral arteries present complex challenges in congenital heart disease.
- Unifocalization and biventricular repair are critical surgical interventions for these patients.
Purpose of the Study:
- To identify factors influencing postoperative pulmonary circulation after biventricular repair in patients with major systemic-to-pulmonary collateral arteries.
- To analyze the relationship between surgical techniques and patient outcomes.
Main Methods:
- A cohort of 48 patients underwent biventricular repair post-unifocalization.
- Surgical approaches included collateral artery ligation, pulmonary artery plasty, and reconstruction with heterologous pericardial tubes.
- Pulmonary vascular segments unifocalized ranged from 9-18, with residual collateral flow measured.
Main Results:
- Postoperative pulmonary resistance was statistically correlated with age at repair (r=0.77), number of unifocalized segments (r=-0.41), and percent collateral flow (r=0.48).
- Higher pulmonary resistance was observed with the use of heterologous pericardial tubes.
- Mortality was higher in patients with fewer unifocalized segments and those with CATCH 22 syndrome.
Conclusions:
- Effective unifocalization is essential for establishing adequate pulmonary circulation.
- Earlier definitive repair is recommended to optimize outcomes.
- Careful consideration of surgical techniques and patient factors is vital for managing pulmonary circulation post-repair.
Objective:
To determine factors affecting postoperative pulmonary circulation in patients with major systemic-to-pulmonary collateral arteries.
Methods:
A total of 48 patients underwent biventricular repair subsequent to unifocalization at ages in the range 1-34 years. The preparative procedures consisted of ligation of the collateral arteries in 6, plasty to the pulmonary arteries using no artificial materials in 12 and extensive reconstruction using heterologous pericardial tubes in 30. The number of the pulmonary vascular segments unifocalized was 9-18 (16 +/- 3). The amount of flow draining via residual minute systemic-to-pulmonary collaterals measured at the time of repair was 4-58% (24 +/- 16%) of the total perfusion by the cardiopulmonary bypass machine.
Results:
This value was 40 +/- 16% in 5 patients dying in the short term after repair. The number of segments was nine or ten after unifocalization in 2 of these. Another 4 patients died in the longer term, 3 of these with CATCH 22 syndrome dying because of pulmonary hypertension. Postoperative catheterization demonstrated mean pulmonary arterial pressures in the range 8-40 (21 +/- 9) mmHg and pulmonary resistance in the range 1.7-10 (5.0 +/- 2.1) units/m2. Pulmonary resistance was correlated statistically to age at repair (r = 0.77), the number of pulmonary vascular segments (r = -0.41) and to percent collateral flow (r = 0.48). The use of a heterologous pericardial tube for unifocalization was also related probably to higher pulmonary resistance.
Conclusion:
It is essential to accomplish effective unifocalizations followed by earlier definitive repair so as to establish better pulmonary circulation.