Otto Rahkonen1, Rajiv R Chaturvedi1, Lee Benson1, Osami Honjo2, Christopher A Caldarone2, Kyong-Jin Lee3. 1. Labatt Family Heart Centre, Division of Cardiology, The Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Canada. 2. Labatt Family Heart Centre, Division of Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Canada. 3. Labatt Family Heart Centre, Division of Cardiology, The Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Canada. Electronic address: kyong-jin.lee@sickkids.ca.
Abstract
OBJECTIVE: Pulmonary artery growth is an important determinant of outcome in single-ventricle strategies. Higher rates of pulmonary artery intervention have been reported with hybrid-based palliation when compared with Norwood palliation. METHODS: We performed a retrospective review of pulmonary artery growth and clinical outcomes in patients undergoing hybrid-based single-ventricle palliation. RESULTS: The stage I hybrid procedure was performed in 72 patients between 2004 and 2012, of whom 54 were on a Fontan palliative pathway. Thirty-four infants completed stage II, and 20 infants underwent the Fontan operation. The mean diameters of the right pulmonary artery (5.6 ± 1.9 mm) and left pulmonary artery (5.6 ± 2.1 mm) were similar before stage II. After stage II, the right and left pulmonary artery diameters were 8.5 ± 2.1 mm and 5.8 ± 1.3 mm, respectively (P < .001), and after the Fontan operation, these were 8.8 ± 2.0 mm and 6.4 ± 1.1 mm, respectively (P = .002). The mean right pulmonary artery z score was normal throughout, but the left pulmonary artery did not maintain a normal size. The cumulative pulmonary artery intervention rate was 50% at any time after stage II. Fifteen interventions (88%) were performed after stage II (35% during the same hospitalization, 71% <60 days). The most intervened site was the midsection of the left pulmonary artery (41%). Initial pulmonary artery intervention was balloon dilation in 59% of patients and stent implantation in 41% of patients. Half of patients with initial balloon dilation required reintervention. CONCLUSIONS: There is significant risk of left pulmonary artery compromise after the second stage of hybrid palliation associated with a high intervention rate.
OBJECTIVE:Pulmonary artery growth is an important determinant of outcome in single-ventricle strategies. Higher rates of pulmonary artery intervention have been reported with hybrid-based palliation when compared with Norwood palliation. METHODS: We performed a retrospective review of pulmonary artery growth and clinical outcomes in patients undergoing hybrid-based single-ventricle palliation. RESULTS: The stage I hybrid procedure was performed in 72 patients between 2004 and 2012, of whom 54 were on a Fontan palliative pathway. Thirty-four infants completed stage II, and 20 infants underwent the Fontan operation. The mean diameters of the right pulmonary artery (5.6 ± 1.9 mm) and left pulmonary artery (5.6 ± 2.1 mm) were similar before stage II. After stage II, the right and left pulmonary artery diameters were 8.5 ± 2.1 mm and 5.8 ± 1.3 mm, respectively (P < .001), and after the Fontan operation, these were 8.8 ± 2.0 mm and 6.4 ± 1.1 mm, respectively (P = .002). The mean right pulmonary artery z score was normal throughout, but the left pulmonary artery did not maintain a normal size. The cumulative pulmonary artery intervention rate was 50% at any time after stage II. Fifteen interventions (88%) were performed after stage II (35% during the same hospitalization, 71% <60 days). The most intervened site was the midsection of the left pulmonary artery (41%). Initial pulmonary artery intervention was balloon dilation in 59% of patients and stent implantation in 41% of patients. Half of patients with initial balloon dilation required reintervention. CONCLUSIONS: There is significant risk of left pulmonary artery compromise after the second stage of hybrid palliation associated with a high intervention rate.
Authors: Anouk S Moerdijk; Johannes M P J Breur; Mirella M C Molenschot; Gregor J Krings Journal: Pediatr Cardiol Date: 2022-01-16 Impact factor: 1.655