Comparison of palliative and radical surgeries in treatment of typeⅠ pulmonary atresia with ventricular septum defect_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

TENG Yun , ZHUANG Jian , CHEN Jimei ,  CEN Jianzheng , XU Gang , WEN Shusheng

Department of Pediatric Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, P.R.China;

Corresponding?author：

CEN Jianzheng, Email: jamesofsolar@hotmail.com

Keywords：

Pulmonary atresia; staged surgery; radical surgery

DOI：

10.7507/1007-4848.201605042

Video：

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Objective To investigate and compare the different surgical strategies for typeⅠpulmonary atresia with ventricular septum defect (PA/VSD) and the outcomes of postoperative prognosis in early stage. Methods We retrospectively analyzed the clinical data of 61 typeⅠPA/VSD patients (40 males, 21 females) with a median age of 249 days (range, 13 days-19 years) in Guangdong Cardiovascular Institute from January 2005 to December 2014 . Among them, 42 patients (27 males, 15 females) with a median age of 11.11 months, ranging from 0.80–211.70 months received radical surgery as a radical surgery group. And 19 patients (13 males, 6 females) with a median age of 2.96 months, ranging from 0.47–161.83 months underwent palliative surgery as a palliative surgery group. We compared the two surgeries and their early outcomes. Results The mean postoperative oxygen saturation was 88.08%±9.64%, which showed significant improvement compared with preoperative oxygen saturation of 74.08%±12.99% (P＜0.05). Patients in the palliative surgery group had a lower body temperature during cardiopulmonary bypass and more respiratory complications than those in the radical surgery group (24.69 °C±3.11 °C vs. 27.18 °C±2.10 °C). Conclusion Both radical and palliative surgeries are good for the increase of pulmonary blood volume and the development of pulmonary vessels. Surgeons must pay more attention to choosing radical surgery for the babies, which is only considerd for those with well developed pulmonary arteries.

Citation： TENGYun, ZHUANGJian, CHENJimei, CENJianzheng, XUGang, WENShusheng. Comparison of palliative and radical surgeries in treatment of typeⅠ pulmonary atresia with ventricular septum defect. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(1): 48-51. doi: 10.7507/1007-4848.201605042 Copy

1.	?Tchervenkov CI, Roy N. Congenital Heart Surgery Nomenclature and Database Project: pulmonary atresia-ventricular septal defect. Ann Thorac Surg, 2000, 69(3): e97-e105.
2.	Furutake T, Koizumi J, Iwase T, et al. Artery fistula causing aortic regurgitation in pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries. Ann Thorac Surg, 2015, 99(5): e121-e123.
3.	Carrillo SA, Mainwaring RD, Patrick WL, et al. Surgical repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals with absent intrapericardial pulmonary arteries. Ann Thorac Surg, 2015, 100(2): e606-e614.
4.	Trezzi M, Carotti A. The role of intrapericardial pulmonary arteries in patients with PA/VSD/MAPCAs. Ann Thorac Surg, 2016, 101(4): e1634-e1635.
5.	Rajeshkannan R, Moorthy S, Sreekumar KP, et al. Role of 64-MDCT in evaluation of pulmonary atresia with ventricular septal defect. AJR Am J Roentgenol, 2010, 194(1): e110-e118.
6.	Liu J, Li H, Liu Z, et al. Complete preoperative evaluation of pulmonary atresia with ventricular septal defect with multi-detector computed tomography. PLoS One, 2016, 11(1): e146380.
7.	葉贊凱, 范祥明, 李志強, 等. 肺動脈閉鎖合并室間隔缺損患兒的肺循環血供和治療策略. 中國醫藥, 2014, 9(5): e636-e640.
8.	Grosse-Wortmann L, Yoo S, van Arsdell G, et al. Preoperative total pulmonary blood flow predicts right ventricular pressure in patients early after complete repair of tetralogy of Fallot and pulmonary atresia with major aortopulmonary collateral arteries. J Thorac Cardiovasc Surg, 2013, 146(5): e1185-e1190.
9.	Gomez O, Soveral I, Bennasar M, et al. Accuracy of fetal echocardiography in the differential diagnosis between truncus arteriosus and pulmonary atresia with ventricular septal defect. Fetal Diagn Ther, 2016, 39(2): e90-e99.
10.	Perri G, Albanese SB, Carotti A. Airway complications after single-stage unifocalization for pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries. J Card Surg, 2015, 30(5): 453-458.
11.	Zheng S, Yang K, Li K, et al. Establishment of right ventricle-pulmonary artery continuity as the first-stage palliation in older infants with pulmonary atresia with ventricular septal defect may be preferable to use of an arterial shunt. Interact Cardiovascular Thorac Surg, 2014, 19(1): e88-e94.
12.	Zhang Y, Hua Z, Yang K, et al. Outcomes of the rehabilitative procedure for patients with pulmonary atresia, ventricular septal defect and hypoplastic pulmonary arteries beyond the infant period. Eur J Cardiothorac Surg, 2014, 46(2): e297-e303.
13.	Gerelli S, van Steenberghe M, Murtuza B, et al. Neonatal right ventricle to pulmonary connection as a palliative procedure for pulmonary atresia with ventricular septal defect or severe tetralogy of Fallot. Eur J Cardiothorac Surg, 2014, 45(2): e278-e288.
14.	Watanabe N, Mainwaring RD, Reddy VM, et al. Early complete repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals. Ann Thorac Surg, 2014, 97(3): e909-e915.
15.	張浩, 王德, 花中東, 等. 姑息性右心室肺動脈連接術在肺動脈閉鎖合并室間隔缺損治療中的應用. 中國胸心血管外科臨床雜志, 2013, 20(2): e135-e138.
16.	Mcmahon CJ, Franklin O, Walsh KP. Stenting of central aortopulmonary shunt in a child with pulmonary atresia, ventricular septal defect, and severely hypoplastic pulmonary arteries. J Invasive Cardiol, 2013, 25(12): e216-e218.
17.	Sadiq A, Rajanbabu BB. Tetralogy with pulmonary atresia and leaking left pulmonary artery aneurysm. Ann Thorac Surg, 2014, 97(3): e87.
18.	Ong K, Boone R, Gao M, et al. Right ventricle to pulmonary artery conduit reoperations in patients with tetralogy of Fallot or pulmonary atresia associated with ventricular septal defect. Am J Cardiol, 2013, 111(11): e1638-e1643.
19.	閆新建, 莊建, 陳寄梅, 等. 肺動脈閉鎖合并室間隔缺損行肺動脈下拉重建右心室流出道. 中國胸心血管外科臨床雜志, 2014, 21(3): e290-e295.
20.	鄭景浩, 徐志偉, 劉錦紛, 等. 自體組織重建小兒永存動脈干的右心室流出道. 中華胸心血管外科雜志, 2015, 31(1): e10-e12.

1. ?Tchervenkov CI, Roy N. Congenital Heart Surgery Nomenclature and Database Project: pulmonary atresia-ventricular septal defect. Ann Thorac Surg, 2000, 69(3): e97-e105.
2. Furutake T, Koizumi J, Iwase T, et al. Artery fistula causing aortic regurgitation in pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries. Ann Thorac Surg, 2015, 99(5): e121-e123.
3. Carrillo SA, Mainwaring RD, Patrick WL, et al. Surgical repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals with absent intrapericardial pulmonary arteries. Ann Thorac Surg, 2015, 100(2): e606-e614.
4. Trezzi M, Carotti A. The role of intrapericardial pulmonary arteries in patients with PA/VSD/MAPCAs. Ann Thorac Surg, 2016, 101(4): e1634-e1635.
5. Rajeshkannan R, Moorthy S, Sreekumar KP, et al. Role of 64-MDCT in evaluation of pulmonary atresia with ventricular septal defect. AJR Am J Roentgenol, 2010, 194(1): e110-e118.
6. Liu J, Li H, Liu Z, et al. Complete preoperative evaluation of pulmonary atresia with ventricular septal defect with multi-detector computed tomography. PLoS One, 2016, 11(1): e146380.
7. 葉贊凱, 范祥明, 李志強, 等. 肺動脈閉鎖合并室間隔缺損患兒的肺循環血供和治療策略. 中國醫藥, 2014, 9(5): e636-e640.
8. Grosse-Wortmann L, Yoo S, van Arsdell G, et al. Preoperative total pulmonary blood flow predicts right ventricular pressure in patients early after complete repair of tetralogy of Fallot and pulmonary atresia with major aortopulmonary collateral arteries. J Thorac Cardiovasc Surg, 2013, 146(5): e1185-e1190.
9. Gomez O, Soveral I, Bennasar M, et al. Accuracy of fetal echocardiography in the differential diagnosis between truncus arteriosus and pulmonary atresia with ventricular septal defect. Fetal Diagn Ther, 2016, 39(2): e90-e99.
10. Perri G, Albanese SB, Carotti A. Airway complications after single-stage unifocalization for pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries. J Card Surg, 2015, 30(5): 453-458.
11. Zheng S, Yang K, Li K, et al. Establishment of right ventricle-pulmonary artery continuity as the first-stage palliation in older infants with pulmonary atresia with ventricular septal defect may be preferable to use of an arterial shunt. Interact Cardiovascular Thorac Surg, 2014, 19(1): e88-e94.
12. Zhang Y, Hua Z, Yang K, et al. Outcomes of the rehabilitative procedure for patients with pulmonary atresia, ventricular septal defect and hypoplastic pulmonary arteries beyond the infant period. Eur J Cardiothorac Surg, 2014, 46(2): e297-e303.
13. Gerelli S, van Steenberghe M, Murtuza B, et al. Neonatal right ventricle to pulmonary connection as a palliative procedure for pulmonary atresia with ventricular septal defect or severe tetralogy of Fallot. Eur J Cardiothorac Surg, 2014, 45(2): e278-e288.
14. Watanabe N, Mainwaring RD, Reddy VM, et al. Early complete repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals. Ann Thorac Surg, 2014, 97(3): e909-e915.
15. 張浩, 王德, 花中東, 等. 姑息性右心室肺動脈連接術在肺動脈閉鎖合并室間隔缺損治療中的應用. 中國胸心血管外科臨床雜志, 2013, 20(2): e135-e138.
16. Mcmahon CJ, Franklin O, Walsh KP. Stenting of central aortopulmonary shunt in a child with pulmonary atresia, ventricular septal defect, and severely hypoplastic pulmonary arteries. J Invasive Cardiol, 2013, 25(12): e216-e218.
17. Sadiq A, Rajanbabu BB. Tetralogy with pulmonary atresia and leaking left pulmonary artery aneurysm. Ann Thorac Surg, 2014, 97(3): e87.
18. Ong K, Boone R, Gao M, et al. Right ventricle to pulmonary artery conduit reoperations in patients with tetralogy of Fallot or pulmonary atresia associated with ventricular septal defect. Am J Cardiol, 2013, 111(11): e1638-e1643.
19. 閆新建, 莊建, 陳寄梅, 等. 肺動脈閉鎖合并室間隔缺損行肺動脈下拉重建右心室流出道. 中國胸心血管外科臨床雜志, 2014, 21(3): e290-e295.
20. 鄭景浩, 徐志偉, 劉錦紛, 等. 自體組織重建小兒永存動脈干的右心室流出道. 中華胸心血管外科雜志, 2015, 31(1): e10-e12.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Comparison of palliative and radical surgeries in treatment of typeⅠ pulmonary atresia with ventricular septum defect

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