Subject(s)
Pulmonary Veins/abnormalities , Pulmonary Veins/surgery , Anastomosis, Surgical/methods , Angiography , Cardiac Catheterization , Echocardiography, Doppler, Color , Heart Atria/physiopathology , Hemodynamics , Humans , Infant , Infant, Newborn , Ligation , Pulmonary Circulation , Pulmonary Veins/diagnostic imaging , Pulmonary Veins/physiopathology , Pulmonary Wedge Pressure , Suture Techniques , Time Factors , Treatment Outcome , Vascular PatencyABSTRACT
From March 1988 through June 1995, 80 patients underwent repair for right ventricle (RV) to pulmonary artery (PA) discontinuity. Of these, 30 patients received homograft conduits, while the remaining 50 underwent repair without the use of a homograft. Handmade pericardial valved vascutek conduits (n = 18), non-valved vascutek tubes (n = 13) and non-conduit procedures like the rev operation (n = 12) and extended pericardial gusset (n = 5) were mainly used. The indications for repair for RV-PA discontinuity included ventricular septal defect with pulmonary atresia (VSD PA) (n = 36), truncus arteriosus (n = 18), ventricular septal defect with pulmonary and major aorto-pulmonary collaterals (VSD PA MAPCA) with staged repair (n = 5), congenitally corrected transposition of the great arteries with ventricular septal defect and pulmonic stenosis (CCTGA VSD PS) (n = 5) and double outlet left ventricle with ventricular septal defect and pulmonic stenosis (DOLV VSD PS) (n = 5). The choice of the procedure was governed by various factors, including type of cardiac defect, pulmonary artery pressure and morphology, previous operation, socio-economic constraints and availability of appropriate sized homografts. Non-circuit operations may prevent future reoperations in these patients.
Subject(s)
Heart Defects, Congenital/surgery , Heart Ventricles/surgery , Pulmonary Artery/surgery , Adolescent , Adult , Angiography , Cardiac Output , Child , Child, Preschool , Echocardiography, Doppler, Color , Female , Follow-Up Studies , Heart Defects, Congenital/diagnosis , Heart Defects, Congenital/physiopathology , Heart Ventricles/abnormalities , Humans , Infant , Male , Pulmonary Artery/abnormalities , Pulmonary Wedge Pressure , Retrospective Studies , Treatment OutcomeABSTRACT
Aortic valve replacement with a pulmonary autograft was performed in 24 patients between October 1993 and October 1994, at the All India Institute of Medical Sciences, New Delhi. There were 20 (83.3%) males and 4 (16.7%) females. Their ages ranged from 10 to 56 years (mean, 21.46 +/- 11.45 years). Associated procedures included 10 mitral valve procedures (4 open commissurotomies, 5 mitral valve repairs, and 1 homograft mitral valve replacement) and 1 tricuspid valve repair. There were 4 (16.7%) early deaths, 3 of which were due to bleeding or its sequelae and 1 due to septicemia. There were no late deaths. Follow-up ranged from 1 to 13 months (mean, 198.3 +/- 111.1 days). Nineteen (95%) patients are in New York Heart Association functional class I, and 1 patient (5%) is in class II, due to poor left ventricular function. Only 1 patient showed grade 2/4 aortic regurgitation on follow-up examinations, and none has shown progression of aortic regurgitation. Our early results with the pulmonary autograft are encouraging; however, long-term evaluation is needed.
