Primary central pulmonary artery plasty for right atrial isomerism with pulmonary coarctation

2021 ◽  
pp. 021849232110452
Author(s):  
Motonori Ishidou ◽  
Keiichi Hirose ◽  
Akio Ikai ◽  
Kisaburo Sakamoto
Keyword(s):  
Pulmonary Artery ◽  
Fontan Procedure ◽  
Pulmonary Arteries ◽  
Pulmonary Atresia ◽  
Right Atrial ◽  
Bidirectional Cavopulmonary Shunt ◽  
Significant Difference ◽  
Central Pulmonary Artery ◽  
Right Isomerism ◽  
Cavopulmonary Shunt

Objective Patients with unbalanced pulmonary artery growth resulting from pulmonary coarctation are considered unsuitable candidates for the Fontan procedure. Particularly, patients with right isomerism pose a challenge. We aimed to investigate the use of primary central pulmonary artery plasty at initial palliation in patients with right isomerism. Methods We recruited 34 right isomerism patients with pulmonary atresia and pulmonary coarctation who underwent modified Blalock-Taussig shunt with or without primary central pulmonary artery plasty between 1998 and 2014. We classified them into the primary central pulmonary artery plasty (group P) and no primary central pulmonary artery plasty (group N) groups. We retrospectively analyzed reintervention for pulmonary artery after initial palliation, difference in size between the left and right pulmonary arteries, overall survival, success of the Fontan procedure. Results The group P and group N included 25 and 9 patients, respectively. Five (20%) and six (67%) patients in group P and group N, respectively, required reintervention for pulmonary artery after initial palliation ( p = 0.017). No patient underwent reintervention for the pulmonary artery before bidirectional cavopulmonary shunt in group P. There was a significant difference in the bilateral pulmonary artery size balance between the groups before bidirectional cavopulmonary shunt ( p = 0.041). The two-lung Fontan procedure was successful in 14 (56%) and 1 (11%) patient in group P and group N. Conclusion Primary central pulmonary artery plasty may contribute toward improving the balance in the size of the PA and preclude the need for reintervention for PA.

Modified Fontan Procedure with the Simultaneous Bidirectional Cavopulmonary Shunt

1995 ◽  
Vol 3 (1) ◽  
pp. 29-34
Author(s):  
Kim Yong Jin ◽  
Jun Tae Gook ◽  
Lee Jeong Ryul ◽  
Rho Joon Ryang ◽  
Suh Kyung Phill
Keyword(s):  
Pericardial Effusion ◽  
Pulmonary Artery ◽  
Fontan Procedure ◽  
Vena Cava ◽  
Right Atrial ◽  
Postoperative Arrhythmia ◽  
Bidirectional Cavopulmonary Shunt ◽  
Group 2 ◽  
Cavopulmonary Shunt ◽  
Group 1

We reviewed our experience of 56 patients from 1989 to 1992 who underwent a modified Fontan procedure and a bidirectional cavopulmonary shunt simultaneously. There were 39 male and 17 female patients and their weight ranged from 6.54 to 29kg (mean weight 13.58 ± 3.96kg). Patient age ranged from 16 to 135 months (mean age 42.8 ± 3.7 months). Diagnoses included single ventricle in 29, tricuspid atresia in 11, double outlet of right ventricle in 10, hypoplastic left heart syndrome in 4, and pulmonary atresia with intact ventricular septum in 2 patients. The techniques of inferior vena cava to pulmonary artery (IVC-PA) connection were anastomosis of proximal superior vena cava (SVC) to pulmonary artery (PA) in 27 (group 1), direct atriopulmonary anastomosis with roof formation in 29 patients (group 2). There were significant differences in postoperative 1-hour right atrial (RA) pressure and period of chest tube drainage between group 1 and group 2. The early mortality was 12.5% (7/56), and 2 late deaths (4.1%) occurred with a mean follow-up period of 22.4 months. Risk factors for the late postoperative arrhythmia were immediate postoperative arrhythmia and prolonged pleuro-pericardial effusion. Direct connection of the remaining proximal SVC to PA with the bidirectional cavopulmonary shunt may have less pleuro-pericardial effusion and late arrhythmia than atriopulmonary anastomosis.

scholarly journals Using the autologous innominate vein as a substitute for pulmonary arteries in a patient with pulmonary atresia and absent pulmonary arteries

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ahmad Ali Amirghofran ◽  
Kamran Jamshidi ◽  
Mohammadreza Edraki ◽  
Hamid Amoozgar ◽  
Farah Peiravian ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Ductus Arteriosus ◽  
Pulmonary Arteries ◽  
Pulmonary Atresia ◽  
Innominate Vein ◽  
Free Graft ◽  
Case Presentation ◽  
Novel Technique ◽  
Central Pulmonary Artery

Abstract Background Repair of the absence of the whole or major parts of pulmonary arteries is a challenge, and the choice of conduit material to reconstruct the pulmonary arteries is under dispute. We used the autologous innominate vein to construct pulmonary arteries. Case presentation l We present a novel technique using the autologous innominate vein as a free graft in a 6-month-old infant with pulmonary atresia and absence of central pulmonary arteries. Double ductus arteriosus were the only source of perfusion of the lungs. The innominate vein was substituted for the central pulmonary artery between the two lung hila. Total repair by using Contegra graft was performed 9 months later. The patient has been followed for 5 years. Conclusions The autologous innominate vein could be used as inter-hilar pulmonary arteries with no calcification and fibrosis in 5-year follow-up.

Post-Fontan pulmonary artery growth in patients with a bidirectional cavopulmonary shunt with additional antegrade pulsatile blood flow

2020 ◽  
pp. 021849232098409
Author(s):  
Sunita J Ferns ◽  
Chawki El Zein ◽  
Sujata Subramanian ◽  
Tarek Husayni ◽  
Michel N Ilbawi
Keyword(s):  
Blood Flow ◽  
Pulmonary Artery ◽  
Pulmonary Blood Flow ◽  
Fontan Procedure ◽  
Glenn Shunt ◽  
Bidirectional Cavopulmonary Shunt ◽  
Group 2 ◽  
Cavopulmonary Shunt ◽  
Group 1

Background Patients with antegrade pulmonary blood flow after a bidirectional cavopulmonary shunt (Glenn) may have better pulmonary artery growth. This study evaluated pulmonary artery growth in patients with and without prior additional pulsatile antegrade flow in a Glenn shunt at midterm follow-up after a Fontan procedure. Methods We reviewed 212 patients who had single-ventricle palliation in a 10-year period;103 (33 in pulsatile group 1 and 70 in nonpulsatile group 2) were selected for analysis. Data on demographics, procedures, perioperative course, and midterm follow-up after the Fontan procedure were compared. Echocardiography data were collected. Pulmonary artery sizes measured at cardiac catheterization and follow-up echocardiograms were used to calculate the Nakata index. Results Perioperative details were comparable in both groups, mean pulmonary artery pressure and systemic oxygen saturations were higher in group 1 compared to group 2. Venovenous collaterals were increased in group 1. There was a significant difference in the pre-Fontan and follow-up Nakata index between groups. There was a significant increase in the Nakata index in group 1 between the pre-Glenn and pre-Fontan assessments as well as the Nakata index between the pre-Fontan and midterm follow-up. There was no significant change in the Nakata index in group 2 between assessments. Conclusions A pulsatile Glenn shunt is associated with better pulmonary artery growth which continues long after the additional pulsatile flow is eliminated. It is possible that the effects of anterograde pulmonary blood flow on pulmonary artery growth in early life continue long after the Fontan completion.

scholarly journals Pulmonary atresia with a ventricular septal defect and left pulmonary artery discontinuity: a case report 

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Hyun-Hwa Cha ◽  
Hae Min Kim ◽  
Won Joon Seong
Keyword(s):  
Pulmonary Artery ◽  
Subclavian Artery ◽  
Septal Defect ◽  
Left Subclavian Artery ◽  
Ductus Arteriosus ◽  
Main Pulmonary Artery ◽  
Pulmonary Arteries ◽  
Pulmonary Atresia ◽  
Left Pulmonary Artery ◽  
Right Pulmonary Artery

Abstract Background Unilateral pulmonary artery discontinuity is a rare malformation that is associated with other intracardiac abnormalities. Cases accompanied by other cardiac abnormalities are often missed on prenatal echocardiography. The prenatal diagnosis of isolated unilateral pulmonary artery discontinuity can also be delayed. However, undiagnosed this malformation would have an effect on further prognosis. We report our case of a prenatal diagnosis of pulmonary atresia with ventricular septal defect and left pulmonary artery discontinuity. Case presentation A 33-year-old Asian woman visited our institution at 24 weeks of gestation because of suspected fetal congenital heart disease. Fetal echocardiography revealed a small atretic main pulmonary artery giving rise to the right pulmonary artery without bifurcation and the left pulmonary artery arising from the ductus arteriosus originating from the left subclavian artery. The neonate was delivered by cesarean section at 376/7 weeks of gestation. Postnatal echocardiography and multidetector computed tomography showed a right aortic arch, with the small right pulmonary artery originating from the atretic main pulmonary artery and the left pulmonary artery originating from the left subclavian artery. Patency of the ductus arteriosus from the left subclavian artery was maintained with prostaglandin E1. Right ventricular outflow tract reconstruction and pulmonary angioplasty with Gore-Tex graft patch was performed 25th day after birth. Unfortunately, the neonate died because of right heart failure 8 days postoperation. Conclusion There is a possibility that both pulmonary arteries do not arise from the same great artery (main pulmonary artery or common arterial trunk). Therefore, clinicians should check the origin of both pulmonary arteries.

Single-Stage versus Two-Stage Modified Fontan Procedure

2007 ◽  
Vol 15 (4) ◽  
pp. 327-331 ◽  
Author(s):  
Sukasom Attanavanich ◽  
Alisa Limsuwan ◽  
Suthep Vanichkul ◽  
Panuwat Lertsithichai ◽  
Montein Ngodngamthaweesuk
Keyword(s):  
Pulmonary Artery ◽  
Fontan Procedure ◽  
Volume Overload ◽  
Single Stage ◽  
Two Stage ◽  
Bidirectional Glenn ◽  
Atrioventricular Valve Regurgitation ◽  
Bidirectional Glenn Shunt ◽  
Significant Difference ◽  
Before And After

We compared surgical outcomes of the single-stage and two-stage modified Fontan procedures to clarify clinical superiority. Of 28 children undergoing a modified Fontan procedure from October 1995 to October 2005, 15 had a 1-stage and 13 had a 2-stage operation. In the 2-stage group, pulmonary artery growth was evaluated before and after the first stage. Operative mortality was 26.6% in the 1-stage group and 0% in the 2-stage group. The benefits of a previous bidirectional Glenn shunt were decreased cyanosis and volume overload, but there was no significant difference in pulmonary artery growth reflected in pulmonary artery indices before and after the bidirectional Glenn procedure. Older children underwent a 2-stage modified Fontan procedure and had better outcomes in terms of lower mortality, improved oxygen saturation, decreased volume load, and less deterioration of atrioventricular valve regurgitation.

Non-confluent pulmonary arteries in a patient with pulmonary atresia and intact ventricular septum: ? a 5th aortic arch with a systemic-to-pulmonary arterial connection

2000 ◽  
Vol 10 (4) ◽  
pp. 419-422 ◽  
Author(s):  
Astolfo Serra ◽  
Francisco Chamie ◽  
R.M. Freedom
Keyword(s):  
Pulmonary Artery ◽  
Aortic Arch ◽  
Pulmonary Arteries ◽  
Pulmonary Atresia ◽  
Left Pulmonary Artery ◽  
Ventricular Septum ◽  
Intact Ventricular Septum ◽  
Right Pulmonary Artery ◽  
Pulmonary Arterial ◽  
The Right

AbstractMajor abnormalities of pulmonary circulation are uncommon in the patient with pulmonary atresia and intact ventricular septum. Non-confluent pulmonary arteries have only rarely been described in this setting. In this case report, we describe a patient in whom the pulmonary arteries are non-confluent, with the right pulmonary artery supplied through a right-sided arterial duct, and the left pulmonary artery most likely through a fifth aortic arch, thus providing a systemic-to-pulmonary arterial connection. We discuss the various forms of non-confluent pulmonary arteries in the setting of pulmonary atresia and intact ventricular septum.

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