Woo Sung Jang1, Woong-Han Kim2, Sungkyu Cho3. 1. Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Republic of Korea. 2. Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: woonghan@snu.ac.kr. 3. Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Republic of Korea.
Abstract
BACKGROUND: Left pulmonary artery (LPA) stenosis with acute angulation is a common cause of reoperation after tetralogy of Fallot repair. We therefore investigated surgical outcomes of acute-angle correction angioplasty. METHODS: Between 2005 and 2012, 53 patients underwent operation for LPA stenosis as a concurrent procedure. We divided the patients into two groups according to the LPA ostium angulation: group I (acute angle, acute-angle correction angioplasty, n = 29) and group II (obtuse angle, conventional patch angioplasty, n = 24), encompassing subgroup type I (focal stenosis) and type II (diffuse stenosis). The changes in the z score of LPA and lung perfusion rates were monitored using computed tomography and lung perfusion scans. RESULTS: The z scores of LPA ostium and hilum were improved at 4.9 mean years of follow-up in group I (p = 0.002, p = 0.041). At the most recent follow-up, there were no differences in the LPA z score (p = 0.177; n = 16 in group I; n = 13 in group II) or left lung perfusion rates (group I: 39.5% ± 9.6%, n = 26; group II: 36.8% ± 11.2%, n = 18, p = 0.418) between the two groups. In group I, the ostial z scores and lung perfusion rates in patients with type II (-4.1 ± 3.1, 25.4%) were lower than patients with type I (-1.6 ± 2.5, 41.0%) at the most recent follow-up (p = 0.069, p = 0.001, respectively). The reoperation or reintervention rate was higher in patients with type II than in patients with type I in group I (p = 0.022). CONCLUSIONS: Acute-angle correction angioplasty was associated with similar LPA ostium z scores and left lung perfusion rates in the two groups. Diffuse LPA stenosis compromised left lung perfusion and increased reoperation or reintervention rate.
BACKGROUND:Left pulmonary artery (LPA) stenosis with acute angulation is a common cause of reoperation after tetralogy of Fallot repair. We therefore investigated surgical outcomes of acute-angle correction angioplasty. METHODS: Between 2005 and 2012, 53 patients underwent operation for LPA stenosis as a concurrent procedure. We divided the patients into two groups according to the LPA ostium angulation: group I (acute angle, acute-angle correction angioplasty, n = 29) and group II (obtuse angle, conventional patch angioplasty, n = 24), encompassing subgroup type I (focal stenosis) and type II (diffuse stenosis). The changes in the z score of LPA and lung perfusion rates were monitored using computed tomography and lung perfusion scans. RESULTS: The z scores of LPA ostium and hilum were improved at 4.9 mean years of follow-up in group I (p = 0.002, p = 0.041). At the most recent follow-up, there were no differences in the LPA z score (p = 0.177; n = 16 in group I; n = 13 in group II) or left lung perfusion rates (group I: 39.5% ± 9.6%, n = 26; group II: 36.8% ± 11.2%, n = 18, p = 0.418) between the two groups. In group I, the ostial z scores and lung perfusion rates in patients with type II (-4.1 ± 3.1, 25.4%) were lower than patients with type I (-1.6 ± 2.5, 41.0%) at the most recent follow-up (p = 0.069, p = 0.001, respectively). The reoperation or reintervention rate was higher in patients with type II than in patients with type I in group I (p = 0.022). CONCLUSIONS: Acute-angle correction angioplasty was associated with similar LPA ostium z scores and left lung perfusion rates in the two groups. Diffuse LPA stenosis compromised left lung perfusion and increased reoperation or reintervention rate.