Neonatal or infantile palliation for Tetralogy of Fallot with or without pulmonary atresia: Modified Blalock–Taussig shunt versus restrictive right ventricle to pulmonary artery connection. A 20-year experience

AbstractBackground:Pulmonary atresia with ventricular septal defect and severe tetralogy of Fallot require a palliative procedure for pulmonary artery rehabilitation. For first-stage palliation, two main surgical options are still debated: right ventricle to pulmonary artery connection and modified Blalock–Taussig shunt. We compared the clinical outcomes of the two procedures.Methods:From 1995 to 2018, 88 patients needed palliation (pulmonary atresia with ventricular septal defect n = 47; tetralogy of Fallot n = 41). Among these patients, 70 modified Blalock–Taussig shunt and 18 transannular path augmentation were performed before 6 months of age. Using a 1:1 propensity score match analysis, 20 patients were included in the analysis. The primary outcome was in-hospital mortality and pulmonary artery growth.Results:After matching, the pre-operative Nakata was smaller in transannular path augmentation 54 ± 24 mm2/m2 than modified Blalock–Taussig shunt 109 ± 31 mm2/m2 (p < 0.001). The age and weight were similar (p = 0.31 and p = 0.9, respectively). There was no difference in in-hospital mortality (p = 0.3). The Nakata index before biventricular repair and delta Nakata were smaller in modified Blalock–Taussig shunt group (206 ± 80 mm2/m2, 75 ± 103 mm2/m2) than transannular path augmentation (365 ± 170 mm2/m2, 214 ± 165 mm2/m2; p = 0.03; p < 0.001). Median time to biventricular repair was similar (p = 0.46). The rate of interstage reintervention was similar (p = 0.63).Conclusions:The transannular path augmentation is better for the rehabilitation of the native pulmonary artery. Despite a smaller pulmonary artery, right ventricle to pulmonary artery connection is equivalent to modified Blalock–Taussig shunt for rate of biventricular repair and time to biventricular repair.

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Right Ventricle to Pulmonary Artery Conduit Reoperations in Patients With Tetralogy of Fallot or Pulmonary Atresia Associated With Ventricular Septal Defect

The American Journal of Cardiology ◽

10.1016/j.amjcard.2013.01.337 ◽

2013 ◽

Vol 111 (11) ◽

pp. 1638-1643 ◽

Cited By ~ 23

Author(s):

Kevin Ong ◽

Robert Boone ◽

Min Gao ◽

Ron Carere ◽

John Webb ◽

...

Keyword(s):

Ventricular Septal Defect ◽

Pulmonary Artery ◽

Right Ventricle ◽

Tetralogy Of Fallot ◽

Septal Defect ◽

Pulmonary Atresia ◽

Artery Conduit

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OUTCOMES OF PALLIATIVE RIGHT VENTRICLE TO PULMONARY ARTERY CONNECTION FOR TETRALOGY OF FALLOT WITH PULMONARY ATRESIA AND MAPCAS

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2021.07.070 ◽

2021 ◽

Vol 37 (10) ◽

pp. S32

Author(s):

P Filippa ◽

P Bernier ◽

K Khalil ◽

M Haidar ◽

N Poirier

Keyword(s):

Pulmonary Artery ◽

Right Ventricle ◽

Tetralogy Of Fallot ◽

Pulmonary Atresia

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Coronary-pulmonary artery fistula in tetralogy of Fallot with pulmonary atresia

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492313505101 ◽

2013 ◽

Vol 22 (8) ◽

pp. 1003-1009 ◽

Cited By ~ 3

Author(s):

Sachin Talwar ◽

Robert H Anderson ◽

Vikas Kumar Keshri ◽

Shiv Kumar Choudhary ◽

Gurpreet Singh Gulati ◽

...

Keyword(s):

Pulmonary Artery ◽

Tetralogy Of Fallot ◽

Pulmonary Atresia ◽

Pulmonary Artery Fistula

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Stenting of the right ventricular outflow tract after thrombosis of the modified Blalock-Taussig shunt in a 8 month old infant with tetralogy of Fallot and right pulmonary artery agenesis

Almanac of Clinical Medicine ◽

10.18786/2072-0505-2017-45-3-254-257 ◽

2017 ◽

Vol 45 (3) ◽

pp. 254-257

Author(s):

I. A. Soynov ◽

A. V. Gorbatykh ◽

N. R. Nichay ◽

A. Yu. Omel'chenko ◽

A. V. Leykekhman ◽

...

Keyword(s):

Pulmonary Artery ◽

Right Ventricular ◽

Tetralogy Of Fallot ◽

Right Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Outflow Tract ◽

Right Pulmonary Artery ◽

The Right ◽

Pulmonary Artery Agenesis ◽

Blalock Taussig Shunt

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Surgical management of symptomatic neonates with Ebstein’s anomaly: choice of operation

Cardiology in the Young ◽

10.1017/s1047951114001747 ◽

2014 ◽

Vol 25 (6) ◽

pp. 1119-1123 ◽

Cited By ~ 9

Author(s):

Christopher J. Knott-Craig ◽

Thittamaranahalli Kariyappa S. Kumar ◽

Alejandro R. Arevalo ◽

Vijaya M. Joshi

Keyword(s):

Pulmonary Artery ◽

Right Ventricle ◽

Surgical Management ◽

Single Ventricle ◽

Pulmonary Atresia ◽

Early Mortality ◽

Ebstein’S Anomaly ◽

Ebstein's Anomaly ◽

Single Ventricle Palliation ◽

Artery Conduit

AbstractObjective:Symptomatic neonates with Ebstein’s anomaly pose significant challenge. Within this cohort, neonates with associated anatomical pulmonary atresia have higher mortality. We review our experience with this difficult subset.Methods:A total of 32 consecutive symptomatic neonates with Ebstein’s anomaly underwent surgical intervention between 1994 and 2013. Of them, 20 neonates (62%, 20/32) had associated pulmonary atresia. Patients’ weights ranged from 1.9 to 3.4 kg. All patients without pulmonary atresia had two-ventricle repair. Of the 20 neonates, 16 (80%, 16/20) with Ebstein’s anomaly and pulmonary atresia had two-ventricle repair and 4 had single-ventricle palliation, of which 2 underwent Starnes’ palliation and 2 Blalock–Taussig shunts. Six recent patients with Ebstein’s anomaly and pulmonary atresia had right ventricle to pulmonary artery valved conduit as part of their two-ventricle repair.Results:Overall early mortality was 28% (9/32). For those without pulmonary atresia, mortality was 8.3% (1/12). For the entire cohort of neonates with Ebstein’s anomaly and pulmonary atresia, mortality was 40% (8/20; p=0.05). Mortality for neonates with Ebstein’s anomaly and pulmonary atresia having two-ventricle repair was 44% (7/16). Mortality for neonates with Ebstein’s anomaly and pulmonary atresia having two-ventricle repair utilising right ventricle to pulmonary artery conduit was 16% (1/6). For those having one-ventricle repair, the mortality was 25% (1/4).Conclusions:Surgical management of neonates with Ebstein’s anomaly remains challenging. For neonates with Ebstein’s anomaly and anatomical pulmonary atresia, single-ventricle palliation is associated with lower early mortality compared with two-ventricle repair. This outcome advantage is negated by inclusion of right ventricle to pulmonary artery conduit as part of the two-ventricle repair.

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