JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES) ›› 2015, Vol. 53 ›› Issue (11): 41-45.doi: 10.6040/j.issn.1671-7554.0.2015.404

• Clinical Medicine • Previous Articles     Next Articles

Initial palliative repair of pulmonary atresia with ventricular septal defect by rehabilitating right ventricle to pulmonary artery connection

FENG Zhiyu, GUO Rui, YANG Yanliang, LI Haiming, DONG Mingliang, XU Huihui, LIU Yimin, GUO Kai, WANG Guangzhen, WANG Hui   

  1. Department of Cardiac Surgery, Qilu Children s Hospital of Shandong University, Jinan 250022, Shandong, China
  • Received:2015-04-04 Online:2015-11-10 Published:2015-11-10

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Abstract: Objective To assess the efficacy and safety of right ventricle to pulmonary artery connection as an initial procedure in patients with pulmonary atresia and ventricular septal defect. Methods Clinical data of 8 patients (mean age 3.2±4.7 months, range 10 days-11 months) with pulmonary atresia, ventricular septal defect and pulmonary artery hypoplasia (McGoon ratio 0.94±0.27) treated during Nov. 2013 and Jan. 2015 were retrospectively reviewed. Connection of right ventricle to pulmonary artery was constructed to rehabilitate the anterior blood flow. All patients were carefully followed up with echocardiography at 3-month intervals after the procedure. When pulmonary artery achieved satisfactory growth and McGoon index was considered adequate ratio reached the criterion of curative resection, a complete repair was performed. Results No early deaths occurred. During the follow-up of 3 to 10 months (mean 8.5±3.1 months), significant pulmonary artery growth was obtained (McGoon ratio 1.21±0.35, P=0.01) in all patients. One case whose McGoon ratio reached 1.63 after 13 months received complete repair. Another case with severe cyanotic spells 12 months after the initial palliation whose McGoon ratio was 1.27 also underwent anatomic repair. Postoperative recovery was uneventfully with satisfactory haemodynamics. At the last visit, the cardiac function was grade Ⅰ in New York Heart Association. The other 6 patients were still awaiting complete repair with a satisfactory pulmonarytree growth at last evaluation. Conclusion Early rehabilitating anterior blood flow by connecting right ventricle and pulmonary artery yields a relatively low morbidity and mortality, with good functional results in patients with pulmonary atresia, ventricular septal defect and hypoplastic native pulmonary arteries. Ultimately, significant pulmonary artery growth can be obtained and this strategy allows complete repair in majority of patients.

Key words: Treatment outcome, Palliative care, Pulmonary atresia with ventricular septal defect, Cardiac surgical procedures, Right ventricle to pulmonary artery connection

CLC Number: 

  • R654
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