Effectiveness and Safety of Percutaneous Transcatheter Implantation of Pulmonary Arterial Stent in Congenital Heart Disease

BACKGROUND AND OBJECTIVES: Pulmonary arterial stenosis is a relatively common complication after corrective operation of congenital heart disease. Unilateral stenosis of pulmonary arteries could result in decrease perfusion of affected lung, pulmonary regurgitation, or elevation of right ventricular pressure. Eventually there are increasing risks of right ventricular failure, arrhythmia, or sudden death. However we have limited data of pulmonary arterial stent in paediatric population as the treatment of branch pulmonary stenosis. This study aimed at validating the effectiveness and investigating complications of pulmonary arterial stent implantation in a single institution during mid-term follow up period. SUBJECTS AND METHODS: A total of 42 patients (50 stents) were implanted for treating branch pulmonary arterial stenosis. We used cardiac catheterization for comparing diameter after stent implantation directly and lung perfusion scan indirectly. We also investigated any adverse effect relating the procedure. RESULTS: Percent stenosis of stenotic lesions were decreased from 54.1+/-10.7% to 22.8+/-12.5% (p<0.001) and degree of decrement in affected lung perfusion was declined from 22.7+/-8.0% to 10.3+/-9.0% (p<0.001) immediately and lasts during mid-term follow up period. Complication rate relating the procedure was 12% (6 out of 12) and there was no mortality case. CONCLUSION: This series showed immediate and short term effectiveness of pulmonary arterial stent in congenital heart defects. We concluded that percutaneous transcatheter implantation of pulmonary arterial stent was safe and effective during short and mid-term follow up period.

Left Ventricular Inflow Obstruction Caused by a Persistent Left Superior Vena Cava and a Dilated Coronary Sinus: A case report / 대한흉부외과학회지

Left ventricular inflow obstruction can be caused by a persistent left superior vena cava (SVC) and a dilated coronary sinus. A 31-day-old male infant with secondum atrial septal defect (ASD) and bilateral SVC underwent an operation for treating his uncontrollable congestive heart failure. The preoperative 2-dimensional echocardiography showed a normally sized mitral valve shrouded by a dilated coronary sinus. The operation consisted of pericardial patch closure of the ASD, coronary sinus unroofing and left SVC transfer to the right atrial auricle. The postoperative course was complicated by persistent chylothorax, which was controlled by thoracic duct ligation. He was discharged to home at the postoperative day 39. He has been followed up for 9 months and has displayed normal development.

Surgical Outcome of Tetralogy of Fallot in Adolt: Implication of Preoperative Cyanosis / 대한흉부외과학회지

BACKGROUND: We analysed differences in operative methods and postoperative outcome according to the severity of preoperative cyanosis in adult ToF (Tetralogy of Fallot) patients. MATERIAL AND METHOD: From August 1989 to June 2001, thirty three adult patients, 18 females and 15 males, underwent total correction for ToF. Their age ranged from 15 years to 54 years (median: 34). Patients were divided into 2 groups by preoperative SaO2 (arterial oxygen saturation): group I (n=cyanotic, SaO2 or =95%). Preoperative median hemoglobin level was higher in group I compared to group II (17.5 g/dl vs 15 g/dl). Postoperative follow-up duration ranged from 1 to 94 months (670 patient-month, median: 14 months), and 63 two-dimensional echocardiographic examinations were done during this period. RESULT: There were no early or late mortality. With regard to RVOT (right ventricular outflow tract) reconstruction, trans-annular patch and RV-PA extracardiac conduit were used in 7 and 3 patients respectively, and all of them belonged to group I. In group I, cardiopulmonary bypass time, aortic cross-clamping time, ICU day, hospital day were significantly longer than in group II, and postoperative inotropic support was significantly greater than in group II. There was no ventricular arrhythmia in both groups, and one patient in group I suffered from atrial arrhythmia, which was resolved spontaneously after tricuspid and pulmonary valve replacement. During follow-up periods, functional class, residual RVOT stenosis and pulmonary regurgitation, tricuspid regurgitation, occurrence of ventricular and atrial arrhythmias were comparable between two groups. CONCLUSION: In adult ToF patients with severe preoperative cyanosis, more aggressive RVOT reconstruction and careful postoperative care are mandatory. However intermediate-term outcome of this group of patients is comparable to the patients with minimal or no preoperative cyanosis.

Intermediate-term Result of Tricuspid Annuloplasty for Tricuspid Regurgitation Associated with Congenital Heart Disease in Adult / 대한흉부외과학회지

BACKGROUND: We assessed the intermediate-term result of tricuspid annuloplasty (TAP) for tricuspid valve regurgitation (TR) associated with congenital heart disease in adults. Risk factors for residual TR were also analysed. MATERIAL AND METHOD: From August 1989 to June 2001, seventy three adult patients, 51 females and 22 males, underwent TAP for TR associated with various congenital heart disease. Their age ranged from 16 years to 73 years (mean:43). Associated heart anomalies were atrial septal defect (55), ventricular septal defect (6), partial anomalous pulmonary venous return (4) and others (8). Preoperative and postoperative TR velocities were 3.25 m/sec and 2.56 m/sec respectively, and the types of TAP were De Vega in 43, Kay in 18 and Ring annuloplasty in 12. Postoperative follow-up duration was 2,347 patient-month (mean: 32.6 months), and 134 two-dimensional echocardiographic examinations were done during this period. Residual TR greater than III/IV was considered as TAP failure. RESULT: TAP failure was observed in 7 patients (9.6%), and one patient among them underwent tricuspid valve replacement. Risk factors for TAP failure were diagnosis other than atrial septal defect (p=0.001), preoperative (p=0.038) and postoperative (p=0.028) high TR velocity. There was no statistical significance in terms of TAP methods. CONCLUSION:Careful evaluation of valve morphology and aggressive surgical intervention are mandatory for the repair of TR with preoperative or residual RV pressure overload.

Redo Heart Transplantation after Previous Cardiac Operations / 대한이식학회지

PURPOSE: Heart transplantation on patients with previous cardiac operations has become more and more popular nowadays, and we assessed retrospectively the clinical features and surgical outcome of the patients who underwent redo heart transplantation after various cardiac operations. METHODS: From November 1992 to June 2002, one hundred and six patients received heart transplantation, and, among them, 12 patients (11.3%), 7 men and 5 women, had had previous cardiac operations (Group I). Their age ranged from 14 years to 61 years (median: 36). Previous cardiac procedures were mitral valve surgery in 3, coronary artery bypass in 3, total correction of tetralogy of Fallot in 2, tricuspid valve surgery in 2, Aortic valve surgery in 1 and placement of left ventricular assist device (LVAD) in 1. Interval between primary operation to cardiac transplantation ranged from 18 months to 142 months (median: 78 months) when we exclude one patient who underwent transplantation 1 month after LVAD placement. HLA cross matching was done in all patients to rule out the presence of preformed anti-HLA antibody in recipients' sera. Postoperative follow-up duration was 423 patient-months (median 36 months), and intra- operative findings and postoperative outcome were compared with those of 94 patients who received cardiac transplantation as a primary operation (Group II). RESULTS: There were no early and late mortality. Pre-bypass anesthetic time were longer in Group I (140 min) compared to Group II (100 min), and intra-operative events were more frequent in Group I (pre-bypass Hemodynamic instability in 5, Bleeding during reentry in 2, defibillation for ventricular fibrillation in 1, unplanned femoral cannulation in 1 and delayed sternal closure in 1. But there were no differences in bypass time, post-bypass anesthetic time, ventilatory support, ICU stay, hospital stay, inotropic support, chest tube drainage and transfusion amount between two groups. There was no space problem due to fibrotic and restrictive pericardial cavity in all but one patient, whose body weight was only 65% of donor body weight and pericardial cavity was relatively small. During the follow-up period, 3 patients (25%) experienced acute rejection necessitating steroid pulse therapy. CONCLUSION: Redo heart trasplantation is more complicated procedure compared to primary cardiac transplantation, but early and intermediate term result is comparable to the latter. Space problem may ensue if pericardial cavity is small and Donor-Recipient body weight mismatch is great.