RESUMO
UNLABELLED: The aim of this study was to determine the results and mid-term outcome of a modified Senning technique using autologous tissue for total cavopulmonary connection. The study involved 31 children, 8 with tricuspid atresia and 23 with complex congenital heart disease. In this operation, a flap of autologous atrial free wall tissue was used to tunnel inferior vena caval blood to the pulmonary arteries. An additional Damus-Kay-Stansel operation was required in 9 patients with subaortic obstruction. RESULTS: the early mortality rate was 16% (5 out of 31 patients) and there were four late deaths. COMPLICATIONS: Pleural effusions were encountered in 17 patients, of whom 4 had a concomitant pericardial effusion. Diaphragmatic paralysis was diagnosed in five patients, one of whom underwent surgical plication. Median hospital stay was 26 days. The 1- to 5-year actuarial survival was 68.6%. Follow-up ranged from 10 months to 7.1 years, mean 3.2 years. A serious atrial arrhythmia was diagnosed in one patient and another one died, possibly from rhythm disorders. Exercise tolerance and quality of life has improved in all but one of the survivors. Although follow-up is short, we have thus far witnessed a low incidence of hemodynamic and rhythm disturbances with this modification of the cavopulmonary connection.
Assuntos
Artéria Pulmonar/cirurgia , Veia Cava Inferior/cirurgia , Análise Atuarial , Adolescente , Anastomose Cirúrgica , Arritmias Cardíacas/etiologia , Criança , Pré-Escolar , Feminino , Seguimentos , Técnica de Fontan/métodos , Átrios do Coração/cirurgia , Cardiopatias Congênitas/cirurgia , Humanos , Lactente , Tempo de Internação , Masculino , Derrame Pericárdico/etiologia , Derrame Pleural/etiologia , Complicações Pós-Operatórias , Paralisia Respiratória/etiologia , Retalhos Cirúrgicos , Taxa de Sobrevida , Valva Tricúspide/anormalidades , Valva Tricúspide/cirurgiaRESUMO
Twenty-six children who underwent an arterial switch operation for transposition of the great arteries were examined with MRI and Doppler ultrasound (US). The aim was to determine the capability of MRI for detecting a possible stenosis of the pulmonary arteries. In 10 children angiocardiography (ACG) was done after the MRI examination. Using ACG as the gold standard, MRI was sensitive in the detection of pulmonary artery stenosis. MRI was more precise in the localization of a stenosis than was Doppler US. Right ventricular hypertrophy was a sensitive indicator of pulmonary artery stenosis. These results suggest that MRI could serve as a screening examination for pulmonary artery stenosis after an arterial switch operation.
