Strategy of surgical management for pulmonary atresia with intact ventricular septum and mid-term follow-up
- VernacularTitle:室间隔完整型肺动脉闭锁的外科治疗策略及中期随访分析
- Author:
Xiaomin HE
1
,
2
;
Jinghao ZHENG
1
,
2
;
Kai LUO
1
,
2
;
Xinwei DU
1
,
2
;
Qi SUN
1
,
2
;
Zhongqun ZHU
1
,
2
;
Zhiwei XU
1
,
2
;
Jinfen LIU
1
,
2
Author Information
1. Department of Cardiothoracic Surgery, Shanghai Children'
2. s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, P.R.China
- Publication Type:Journal Article
- Keywords:
Pulmonary atresia with intact ventricular septum;
initial surgery;
Hybrid therapy;
one and half ventricular repair;
single ventricle operation
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2020;27(05):503-509
- CountryChina
- Language:Chinese
-
Abstract:
To evaluate the surgical strategy and follow-up for pulmonary atresia with intact ventricular septum (PA/IVS) in our heart center. Methods From January 2008 to December 2018, 151 patients with PA/IVS were divided into two groups: a one-stage surgery group (26 patients), including 17 males and 9 females at an average age of 14.7±13.2 months, and a staged surgery group (125 patients) including 72 males and 53 females at an average age of 6.4±6.3 months. The clinical effectiveness of the two groups were analyzed. Results All patients were followed up for 1-11 years. Eighteen patients died and 19 patients were lost to follow-up. The 1-year, 5-year and 10-year survival rate was 90.2%, 87.0%, and 85.2%, respectively. Two patients died in the one-stage surgery group. Twelve patients died after initial surgery, and 4 patients died after final operation in the staged surgery group. The Z value of tricuspid valve (P=0.013) and severe right ventricular dysplasia (P=0.025) were the risk factors of postoperative death in the patients with PA/IVS. Furthermore, 58 patients completed final operation, and the total number of the final operation (including one-stage radical surgery) accounted for 55.6% (84/151). Five patients accepted the re-operation intervention in the medium-term follow-up. The rest of the patients recovered well. Only 2 patients were classified as grade Ⅲ in cardiac function, and the rest patients were classified as gradeⅠ-Ⅱ. Conclusion According to the degree of right ventricular hypoplasia, the age at operation and the presence or absence of coronary artery malformation, the individualized surgical strategy could significantly improve the success rate of PA/IVS, and early completion of right ventricular decompression operation is conducive to improve the chance for biventricular repair.
