ABSTRACT
In patients with tetralogy of Fallot (TOF) repair and a borderline pulmonary valve annulus (PVA) size, surgical repair often necessitates a transannular incision and subsequent placement of a patch with or without a monocusp or, alternatively, a right ventricle-to-pulmonary artery conduit. We discuss here a technique in which the pulmonary valve annulus can be safely preserved, with infrequent postoperative issues as well as the potential for less incidence of right ventricular outflow intervention in the long term.
Subject(s)
Cardiac Surgical Procedures/methods , Pulmonary Valve/diagnostic imaging , Tetralogy of Fallot/surgery , Ventricular Outflow Obstruction/prevention & control , Cardiac Valve Annuloplasty , Cardiopulmonary Bypass/methods , Follow-Up Studies , Heart Septal Defects, Ventricular/surgery , Humans , Polyethylene Terephthalates/therapeutic use , Pulmonary Artery/surgery , Pulmonary Valve/pathology , Risk Assessment , Sternotomy/methods , Tetralogy of Fallot/diagnostic imaging , Treatment Outcome , Ultrasonography, Doppler/methodsABSTRACT
Few data exist regarding the efficacy and safety of the Amplatzer ductal occluder (ADO) type 1 device in the Asian region. This retrospective study, conducted between August 2001 and April 2011, attempted device placement for 231 patients (165 females and 66 males) with a median age of 7.4 years (range, 3 months to 64 years) and an average weight of 19.4 kg (range, 4.1-81.0 kg). Among the patients in this study, 66 (28.6%) had pulmonary hypertension, ten (4.3%) had trisomy 21, and eight (3.5%) had other congenital cardiac anomalies. The mean narrowest patent ductus arteriosus (PDA) diameter was 4.2 mm (range, 1.3-10 mm), and the ampulla size was 9.6 mm (range, 4-20 mm). Successful implantation was achieved for 229 patients (99.1%). Complete angiographic occlusion was achieved for 201 patients (87.8%) at the end the procedure. Follow-up data were available for 129 patients (66%). At the follow-up assessment, complete echocardiographic occlusion was seen in 128 patients (99.2%) after 1 month and in 100% of the patients after 6 months. The significant morbidities involved one device embolization and one dislodgment, for which surgical retrieval was performed. No mortalities occurred during the study period, and no late clinical adverse events occurred during the follow-up period. Occlusion of the PDA using ADO is safe, effective, and applicable for a wide range of PDA sizes including large PDAs in small symptomatic infants and in adults. Good outcomes can be attributed to experience of the operators, proper patient selection, and appropriate device size selection.
Subject(s)
Ductus Arteriosus, Patent/therapy , Embolization, Therapeutic/instrumentation , Septal Occluder Device/trends , Adolescent , Adult , Child , Child, Preschool , Equipment Design , Female , Follow-Up Studies , Humans , Infant , Infant, Newborn , Male , Middle Aged , Philippines , Retrospective Studies , Septal Occluder Device/statistics & numerical data , Time Factors , Treatment Outcome , Young AdultABSTRACT
The first successful stage I palliation for hypoplastic left heart syndrome (HLHS) in a four-day-old female in the Philippines is reported, along with a discussion of the particular dynamics and challenges of performing this kind of surgery in a developing nation. Challenges met were not limited to the preoperative and perioperative period but involved the interstage period as well. In the face of such challenges, our experience, reported here, is the cause for cautious optimism.
