Absence of Pulmonary Artery Growth After Fontan Operation and Its Possible Impact on Late Outcome Stanislav Ovroutski, MD, Peter Ewert, MD, PhD, Vladimir.

Slides:

Advertisements

Similar presentations

Heart Transplant vs Left Ventricular Assist Device in Heart Transplant-Eligible Patients Matthew L. Williams, MD, Jaimin R. Trivedi, MD, MPH, Kelly C.

Advertisements

Mauer Biscotti, MD, Matthew Bacchetta, MD

Bloodless Surgery of Acute Type A Aortic Dissection in a Jehovah’s Witness Patient Miralem Pasic, MD, PhD, Wolfgang Ruisz, MD, Andreas Koster, MD, PhD,

Intraoperative Pulmonary Artery Stenting: An Alternative Technique for the Management of Pulmonary Artery Stenosis Fotios A. Mitropoulos, MD, PhD, Hillel.

Coronary Artery Bypass for Heart Failure in Ischemic Cardiomyopathy: 17-Year Follow- Up Marco Pocar, MD, PhD, Andrea Moneta, MD, Adalberto Grossi, MD,

Noninvasive Screening for Pulmonary Hypertension by Exercise Testing in Congenital Heart Disease Jan Müller, PhD, Pinar Bambul Heck, MD, Peter Ewert,

Jason F. Goldberg, MD, Travis P

Michael Kalina, DO, Frederick Giberson, MD

Robert L. Smith, MD, Morley A. Herbert, PhD, Todd M

Can Fontan Conversion for Patients Without Late Fontan Complications be Justified? Akihiko Higashida, MD, Takaya Hoashi, MD, PhD, Koji Kagisaki, MD, Masatoshi.

Trevor Williams, MD, MPH, Brian C

Coronary Artery Revascularization (CARE) Registry: An Observational Study of On- Pump and Off-Pump Coronary Artery Revascularization George Palmer, MD,

A Rare Case of Partial Anomalous Pulmonary Venous Return to Azygos Vein Without Direct Connection to Great Cardiac Vessels Jae Gun Kwak, MD, Soo-Jin.

Resmi KrishnankuttyRema, MS, Lakshmi P

Atrial Fibrillation After Coronary Artery Bypass Grafting Surgery: Development of a Predictive Risk Algorithm Mitchell J. Magee, MD, Morley A. Herbert,

An Analysis of Left Ventricular Retraining in Patients With Dextro- and Levo- Transposition of the Great Arteries Richard D. Mainwaring, MD, William L.

Single Ostium of the Right and Left Coronary Artery From the Right Pulmonary Artery Katarzyna Januszewska, MD, PhD, Hans-Gerd Kehl, MD, PhD, Edward Malec,

Michael L. Bailey, MBBS, Sven M. Richter, MD, Daniel V

Mark D. Iannettoni, MD, William R. Lynch, MD, Kalpaj R

Surgical Resection of a Giant Coronary Aneurysm

Late Presentation of a Right Bochdalek Hernia With Intrathoracic Liver, Gallbladder, Intestines and Omentum With Right Lower Lobe Hypoplasia Mohammad.

Trevor Williams, MD, MPH, Brian C

Mariano E. Brizzio, MD, Alex Zapolanski, MD, Richard E

Analysis of the Risk Factors for Early Failure After Extracardiac Fontan Operation Stanislav Ovroutski, MD, Christian Sohn, MD, Payman Barikbin, MD, Oliver.

Maria Restrepo, BS, Elaine Tang, BEng, Christopher M

Fontan Pathway Growth: A Quantitative Evaluation of Lateral Tunnel and Extracardiac Cavopulmonary Connections Using Serial Cardiac Magnetic Resonance

Stent Implantation Into Vertical Arterial Duct in Adult Patient With Cyanotic Congenital Heart Disease Kenji Suda, MD, Masahiko Matsumura, MD, Masahiko.

Anomalous Origin of Left Pulmonary Artery From Left Subclavian Artery

Melbourne Shunt Promotes Growth of Diminutive Central Pulmonary Arteries in Patients With Pulmonary Atresia, Ventricular Septal Defect, and Systemic-to-Pulmonary.

Coronary Artery Fistulae Involving Both Right and Left Coronary Arteries Ahmet Bolukcu, MD, Ahmet Can Topcu, MD, Yavuz Sensoz, MD, Ilyas Kayacioglu, MD

Kazunori Yoshida, MD, Satoshi Tobe, MD, Masahito Kawata, MD

Muhammad Aanish Raees, MBBS, Driss Mazhar, DFGSM, Jason T

Outcome of Surgical Correction of Congenital Supravalvular Aortic Stenosis With Two- and Three-Sinus Reconstruction Techniques Peter Kramer, MD, Daniel.

Coronary Sinus Orifice Atresia After the Fontan Completion: Unique Repair Technique Shinya Yokoyama, MD, PhD, Takeo Yonekura, MD, PhD, Noboru Nishiwaki,

Clinical Outcomes, Program Evolution, and Pulmonary Artery Growth in Single Ventricle Palliation Using Hybrid and Norwood Palliative Strategies Osami.

Oliver Miera, MD, Evgenij V

Severe Two-Vessel Ostial Stenosis of the Main Coronary Arteries in a Patient With Transposition of the Great Arteries After an Arterial Switch Operation

Red Blood Cell Transfusion Is Associated With Troponin Release After Elective Off- Pump Coronary Artery Bypass Surgery Fausto Biancari, MD, PhD, Eeva-Maija.

Thrombosis of intracardiac or extracardiac conduits after modified Fontan operation in patients with azygous continuation of the inferior vena cava Igor.

Rheumatoid Pleural Effusion in the Absence of Arthritic Disease

The Unifocal Bilateral Bidirectional Cavopulmonary Anastomosis

Postoperative Outcomes of Children With Tetralogy of Fallot, Pulmonary Atresia, and Major Aortopulmonary Collaterals Undergoing Reconstruction of Occluded.

Brian M. Cardis, MD, Derek A. Fyfe, MD, PhD, William T. Mahle, MD

The Common Trunk of the Left Pulmonary Vein Injured Incidentally During Lung Cancer Surgery Toru Nakamura, MD, Masaaki Koide, MD, Hidenori Nakamura,

Amiodarone as a First-Line Therapy for Postoperative Junctional Ectopic Tachycardia Lubica Kovacikova, MD, PhD, Nina Hakacova, MD, Dusan Dobos, MD, Peter.

Natural History of Exercise Capacity After the Fontan Operation: A Longitudinal Study Alessandro Giardini, MD, Alfred Hager, MD, Carlo Pace Napoleone,

Two Pumps for Single Ventricle: Mechanical Support for Establishment of Biventricular Circulation Stanislav Ovroutski, MD, PhD, Oliver Miera, MD, Thomas.

Side-to-Side Aorto-GoreTex Central Shunt Warrants Central Shunt Patency and Pulmonary Arteries Growth Luca Barozzi, MD, Christian P. Brizard, MD, John.

Tracheal Reconstruction in the Pediatric Population: How I Teach It

Contraceptive Implant Embolism Into the Pulmonary Artery: Thoracoscopic Retrieval Pascal A. Thomas, MD, PhD, Donatella Di Stefano, MD, Cécile Couteau,

Christopher E. Mascio, MD, Christopher L. Johnsrude, MD, Edward S

Invited Commentary The Annals of Thoracic Surgery

Hypoplastic Left Heart Syndrome With Anomalous Origin of the Right Coronary Artery Julie Cleuziou, MD, Felix Haas, MD, Christian Schreiber, MD, Hans-Jörg.

Fontan completion in patient with pulmonary artery sling associated with hypoplastic left heart syndrome Yasuhiro Kotani, MD, PhD, Kozo Ishino, MD, PhD,

Uncontrolled Antegrade Pulmonary Blood Flow and Delayed Fontan Completion After the Bidirectional Glenn Procedure: Real-World Outcomes in China Tao Zhang,

Christopher M. Haggerty, PhD, Kevin K

Håvard Nordgaard, MD, Nicola Vitale, MD, PhD, Rune Haaverstad, MD, PhD

Nicole M. Cresalia, MD, Aimee K. Armstrong, MD, Jennifer C

Temporary Fenestration Using Venoatrial Extracorporeal Membrane Oxygenation After the Fontan Operation Yun Hee Chang, MD, Hyungtae Kim, MD, Si Chan Sung,

The Annals of Thoracic Surgery

Mark I. Block, MD The Annals of Thoracic Surgery

Late Consequences of a Much Earlier Decision

The Impact of New Technology on Cardiothoracic Surgical Practice

Bloodless Surgery of Acute Type A Aortic Dissection in a Jehovah’s Witness Patient Miralem Pasic, MD, PhD, Wolfgang Ruisz, MD, Andreas Koster, MD, PhD,

Slide Tracheoplasty in Infants and Children: Risk Factors for Prolonged Postoperative Ventilatory Support Peter B. Manning, MD, Michael J. Rutter, MD,

Hilum-to-Hilum Gore-Tex Tube Replacement of Central Pulmonary Arteries

Ascending Aortic Extension for Enlargement of the Aortopulmonary Space in Children with Pulmonary Artery Stenosis Craig J. Baker, MD, Winfield J. Wells,

Surgical Reconstruction of Peripheral Pulmonary Arteries: Strategies, Outcomes, and New Classification Abdulaziz Al-Khaldi, MD, MS, Omar Tamimi, MD

Michelle C. Wallace, MD, James Jaggers, MD, Jennifer S

Repair of Left Ventricular Inflow Tract Lesions in Shone's Anomaly: Valve Growth and Long-Term Outcome Eva Maria B. Delmo Walter, MD, PhD, Richard Van.

Presentation transcript:

Absence of Pulmonary Artery Growth After Fontan Operation and Its Possible Impact on Late Outcome Stanislav Ovroutski, MD, Peter Ewert, MD, PhD, Vladimir Alexi-Meskishvili, MD, PhD, Katinka Hölscher, Oliver Miera, MD, Björn Peters, MD, Roland Hetzer, MD, PhD, Felix Berger, MD, PhD The Annals of Thoracic Surgery Volume 87, Issue 3, Pages 826-831 (March 2009) DOI: 10.1016/j.athoracsur.2008.10.075 Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Angiogram of the cavopulmonary anastomosis and pulmonary arteries before Fontan operation. The vessel diameter and the body surface area (BSA) are shown. Stenosis of the central part of left pulmonary artery (LPA) is visible. The peripheral pulmonary vessels are well developed. The pulmonary artery index (Nakata index; [π × (RPA2 + LPA2)/4]/BSA mm2/m2) is 158 mm2m2; the total lower lobe index ([π × (RLLA2 + LLLA2)/4]/BSA mm2/m2) is 145 mm2/m2. (B) The same patient 9 years after Fontan operation with additional enlargement of the central left pulmonary artery. Heart catheterization was performed because of the first episode of protein-losing enteropathy. No local stenosis of the pulmonary arteries with very low pulmonary indices (pulmonary artery [Nakata] index = 81 mm2/m2; total lower lobe index = 89 mm2/m2) were found. (LLLA = left lower lobe artery; RLLA = right lower lobe artery; RPA = right pulmonary artery.) The Annals of Thoracic Surgery 2009 87, 826-831DOI: (10.1016/j.athoracsur.2008.10.075) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Changes in Nakata index (pulmonary artery index [PAI]) and lower lobe index (LLI) of the pulmonary arteries during follow-up. Box-plot diagram demonstrates a significant decrease in the pulmonary artery index as well as the lower lobe index according to the stable somatic development of the children and nondevelopment of the pulmonary arteries. The Annals of Thoracic Surgery 2009 87, 826-831DOI: (10.1016/j.athoracsur.2008.10.075) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Scatter-diagram shows significant decrease in the pulmonary artery index (PAI; Nakata index) of the central pulmonary arteries according to the duration of the follow-up. The lowest pulmonary artery index is to be noted in the patients with longest follow-up. The Annals of Thoracic Surgery 2009 87, 826-831DOI: (10.1016/j.athoracsur.2008.10.075) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Correlation between low pulmonary artery index (PAI) and Fontan outcome. Block diagram shows significant differences in the long-term postoperative outcome between patients with low pulmonary artery index (<150 mm2/m2) and those with pulmonary artery index greater than 150 mm2/m2. In patients with pulmonary artery index less than 150 mm2/m2 at the end of the follow-up, unfavorable outcome was observed more frequently than in those with pulmonary artery index greater than 150 mm2/m2. The Annals of Thoracic Surgery 2009 87, 826-831DOI: (10.1016/j.athoracsur.2008.10.075) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Changes in the pulmonary artery pressure (PAP) during the follow up. Black triangles indicate patients with low pulmonary artery index (PAI < 150 mm2/m2). (OP = operation.) The Annals of Thoracic Surgery 2009 87, 826-831DOI: (10.1016/j.athoracsur.2008.10.075) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions