| Objective： To compare the differences of the effect and safeness in the common systemic-to-pulmonary artery shunts to rehabilitate the hypoplastic pulmonary arteries in patients with pulmonary atresia and ventricular septal defect.Methods:From December2009to August2012,47consecutive patients (mean age1.78±1.82years, range0.2-8.1years) diagnosed with pulmonary atresia, ventricular septal defect and pulmonary artery hypoplasia (Nakata index86.62±45.02mm2/m2; McGoon ratio1.03±0.40) were included in this retrospective study.28(59.6%) patients underwent the procedure of modified blalock-taussing shunt (BT shunt)and the left19paitents receiewed the central shunt, mainly based on the surgeon habits and preoperative pulmonary vascular development. The nakata index in the BT group was significantly smaller than that in the central pulmonary shunt group(P<0.01). Some patients received transcatheter occlusion of major aortopulmonary collaterals and/or pulmonary angioplasty. Mean follow-up was2.36±1.07years.Result:After the systemic-to-pulmonary artery shunts,two groups’pulmonary vascular had significant growth (Nakata index:207.94±101.47, McGoon ratio of1.55±0.44),but there was no difference between the two groups(P>0.05).The central shunt group had more prolonged mechanical ventilation time and ICU monitoring time than the BT shunt group(p<0.01).15(31.9%)patients underwent the anatomical repair after palliative surgery in an average of1.1years(0.6-1.6years).They were all in the BT shunt group. There were no early dearth and late dearth. All survivors who underwent anatomical repair were in New York Heart Association class Ⅰ-Ⅱ.Conclusion:Although the systemic-to-pulmonary artery shunts can effectively promote the hypoplastic pulmonary arteries growth in the PA-VSD patients, but ultimately only1/3of the patients can get biventricular repiar. The central shunt group had worse early and late results than the BT group,maybe for poorer preoperative pulmonary vascular development. Objective:To determine the effect and safeness of the right ventricle to pulmonary artery connection to rehabilitate the hypoplastic pulmonary arteries in patients with pulmonary atresia and ventricular septal defect.Methods:From December2009to August2012,45consecutive patients (mean age1.61±1.63years, range0.2-7.2years) diagnosed with pulmonary atresia, ventricular septal defect and pulmonary artery hypoplasia (Nakata index88.25±29.27mm2/m2; McGoon ratio0.94±0.14) were included in this retrospective study. All patients underwent the procedure of right ventricle to pulmonary artery connection, during which most of them received transcatheter occlusion of major aortopulmonary collaterals and/or pulmonary angioplasty. Mean follow-up was2.06±0.83years.Results:There were no early deaths, but one patient died of myocarditis. Significant pulmonary artery growth was obtained (Nakata index215.1±107.79mm2/m2, P<0.001; McGoon ratio1.6±0.5, P<0.001) in all of the47patients.Restenosis occurs in2patients’pulmonary arterial brach and1parient’s outflow tract of right ventricle.All of the restenosis were relieved though percutneous trnsluminl blloon dilttion.28patients (62.2%) whose pulmonary growth was considered adequate obtained a complete repair.There were1early dearth and no late dearth. All survivors who underwent anatomical repair were in New York Heart Association class Ⅰ-Ⅱ.The patients with right ventricle/left ventricle pressure ratio more than0.6after the anatomical repair had prolonged mechanical ventilation time and ICU monitoring time.Conclusions:Connection of the right ventricle to the pulmonary artery is safe and effective to promote the growth of the native pulmonary arteries in patients with pulmonary atresia, ventricular septal defect and hypoplastic native pulmonary arteries who ultimately have anatomical repair. The right ventricle/left ventricle pressure ratio is the important impact of early results Object: To compare the effect between the right ventricle to pulmonary artery connection and the systemic-to-pulmonary artery shunts in patients with pulmonary atresia and ventricular septal defect.Method:From December2009to August2012,92consecutive patients (mean age1.69±1.72years, range0.2-8.1years) diagnosed with pulmonary atresia, ventricular septal defect and pulmonary artery hypoplasia (Nakata index87.51±36.97mm2/m2; McGoon ratio0.97±0.28) were included in this retrospective study.45patients underwent the procedure of right ventricle to pulmonary artery connection and47underwent the systemic-to-pulmonary artery shunts,during which part of them received transcatheter occlusion of major aortopulmonary collaterals and/or pulmonary angioplasty. The mechanical ventilation time and ICU monitoring time,the pulmonary vascular growth and the anatomical repair rate were compared between the two groups.Results:All the patients’pulmonary vascular had significant growth(p<0.001),but there was no sinificant difference between the two groups.15(31.9%) patients in the BT group and28(62.2%) patients in the RVPA group ultimately had anatomical repair.3patients were awaiting for the anatomical repair.At the anatomical repair, the cyanosis in the RVPA group were improved more than the patients in the BT group. The RVPA group had less mechanical ventilation time and ICU monitoring time than the BT group,but there was no statistical difference.Conclusion:The right ventricle to pulmonary artery connection has higher rate of staging anatomical repiar in patients with pulmonary atresia and ventricular septal defect and maybe help the patients reconver after the anatomical repair. Objective:This study retrospectively analysised the clinical data of patients with pulmonary atresia with ventricular septal defect who underwent the staging right ventricle to pulmonary artery connection and anatomical repair to find the evaluation index for the postoperative pulmonary vascular development.Methods:From December2009to July2013,28consecutive patients diagnosed with pulmonary atresia, ventricular septal defect and pulmonary artery hypoplasia (Nakata index89.39±17.91mm2/m2; McGoon ratio0.96±0.11) were included in this retrospective study. All of them underwent the staging right ventricle to pulmonary artery connection and anatomical repair. They were divided into two groups according to the right ventricle/left ventricle pressure ratio(one was more than0.6, the other was less than0.6) to compare the difference of Preoperative and postoperative Nakata index,Mcgoon ratio,Oxygen saturation and hemoglobin concentration.Results:After the right ventricle to pulmonary artery connection,alll the28patients receiewed the anatomical with the rising of nakata index and Mcgoon ratio (nakata index:264.25±85.84mm2/m2(P<0.001),Mcgoon ratio2.0±0.36(P<0.001)).10patients’postoperative right ventricle/left ventricle pressure ratio were more than0.6(Group A),the left18patents were less than0.6(Group B).In the grop A,there was1early death for pulmonary infection and right heart dysfunction,and another need ECMO assitance for acute respiratory distress syndrome and ultimately discharged. Group A had significantly prolonged mechanical ventilation time and ICU monitoring time than Group B(p<0.01).There was no statistical difference between the two groups in the preoperative Nakata index and Mcgoon ratio.SpO2and HB were significanly improved after the anatomical repair(p<0.01).Conclusions:The right ventricle/left ventricle pressure ratio was independent risk factor for patients with pulmonary atresia with ventricular septal defect who underwent the staging right ventricle to pulmonary artery connection and anatomical repair.There was limitation for Nakata index and Mcgoon ratio to evaluate the development of pulmonary vascular after the palliative right ventricle to pulmonary connection.The improvement of preoperative SPO2and decline of preoperative HB can reflect the development of pulmonary vascular after the right ventricle to pulmonary artery connection. |
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