ABSTRACT
Anomalous left coronary artery from the pulmonary artery (ALCAPA) is an uncommon life-threatening congenital heart defect that occurs mostly as an isolated lesion. It is very rarely associated with other cardiac abnormalities. In this report, we present a case of an infant who successfully underwent complete surgical repair of a rare triad of congenital heart defects, including ALCAPA, ventricular septal defect (VSD), and double aortic arch (DAA). To the best of our knowledge, this is only the second case of ALCAPA diagnosis associated with VSD and DAA that has been described in the literature.
ABSTRACT
OBJECTIVES: Surgical repair of complex congenital heart defects with hypoplasia or atresia of the right ventricular outflow tract (RVOT) may require pulmonary valve implantation or replacement during the primary repair or reoperation. The purpose of this study is to evaluate the outcomes of cryopreserved homografts, bovine jugular vein conduits and decellularized Matrix P Plus N conduits in patients undergoing RVOT reconstruction at a single centre. METHODS: Retrospective, single-centre review of 173 patients with 199 conduits undergoing right ventricle-to-pulmonary artery reconstruction with valved conduit from 2002 to 2022. RESULTS: A total of 199 conduits were implanted in 173 patients (62.8% male), with a mean age of 8.97 ± 8.5 years. The following 3 types of conduits were used: homografts 129 (64.8%), bovine jugular vein conduits 45 (22.7%) and Matrix P Plus N 25 (12.5%). During the mean follow-up duration of 8.6 ± 5.8 years, there were 20 deaths, 35 conduit reoperations and 44 catheter reinterventions. Overall survival, reoperation-free and catheter reintervention-free survival at 20 years were 83%, 67.8% and 65.6%, respectively. Multivariable Cox analysis identified younger patient age, smaller conduit size, low patient weight and primary diagnosis of common arterial trunk as risk factors for reoperation and catheter reintervention. CONCLUSIONS: Long-term outcomes of reconstruction of the RVOT using homografts, bovine jugular vein and Matrix P Plus N conduits were acceptable. The reoperation rate for conduit dysfunction did not differ significantly among groups. Over time, the need for conduit replacement was higher in smaller conduits and in patients with common arterial trunk diagnosis.
ABSTRACT
OBJECTIVES: The purpose of this study is to evaluate our initial experience with aortic valve repair using polytetraflouroethylene (PTFE) leaflet extensions in congenital valvular disease. METHODS: From October 2008 through February 2011, 13 patients underwent aortic valvuloplasty by PTFE leaflet extensions. All valves were repaired in a tri-leaflet configuration using PTFE leaflet extensions. The median age at operation was 14 years (1.8-19.7 years) and the median weight was 58 kg (9.5-86 kg). Previous interventions included balloon valvuloplasty in two patients, aortic valvuloplasty in one and coarctation repair in one patient. Eight (73%) patients had combined aortic stenosis and insufficiency, three (23%) had isolated insufficiency and two (15%) had stenosis only. In 10 (77%) patients, a bicuspid aortic valve was present. RESULTS: The follow-up ranged from 2 to 30 months (mean follow-up 14.8 ± 9 months). At the latest echocardiography follow-up, six patients had none or trace aortic insufficiency, six patients had a mild aortic insufficiency and one patient had a mild-to-moderate insufficiency. The mean aortic insufficiency degree decreased from 1.8 ± 1.2 preoperatively to 0.8 ± 0.6 at the follow-up (P < 0.01). The mean gradient across the aortic valve decreased from 56 ± 40 mmHg preoperatively to 12 ± 13 mmHg at the follow-up (P < 0.0008). All patients are alive. There were no reoperations. The median hospital stay was 9 days (4-21 days). CONCLUSIONS: The use of PTFE leaflet extensions is an effective technique for aortic valve reconstruction in congenital valvular disease. Long-term follow-up is necessary to assess the durability of this type of repair.
