Home > Riviste > The Journal of Cardiovascular Surgery > Fascicoli precedenti > The Journal of Cardiovascular Surgery 2000 February;41(1) > The Journal of Cardiovascular Surgery 2000 February;41(1):23-30

ULTIMO FASCICOLO
 

JOURNAL TOOLS

Opzioni di pubblicazione
eTOC
Per abbonarsi
Sottometti un articolo
Segnala alla tua biblioteca
 

ARTICLE TOOLS

Estratti
Permessi
Share

 

ORIGINAL ARTICLES  CARDIAC PAPERS 

The Journal of Cardiovascular Surgery 2000 February;41(1):23-30

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Outcome of patients with cyanotic congenital heart disease undergoing a second systemic-to-pulmonary artery shunt

Aeba R., Katogi T., Takeuchi S., Kawada S.

From the Division of Cardiovascular Surgery Keio University, Tokyo, Japan


PDF


Back­ground. Mul­tiple ­systemic-to-pul­mo­nary ­artery ­shunts ­often rep­re­sent a devi­a­tion ­from the ­initial man­age­ment ­strategy for cya­notic con­gen­ital ­heart dis­ease. ­This ­study ana­lysed the out­come in ­patients under­going a ­second ­shunt.
­Methods. ­Between 1965 and 1998, 80 ­patients ­required a ­second ­shunt. ­Patient age ­ranged ­from 11 ­days to 11.2 ­years at the ­initial ­shunt, and 4 ­months to 25.6 ­years at the ­second ­shunt. The ­interval ­between ­shunts ­ranged ­from 11 ­days to 19.6 ­years.
­Results. The ­patient sur­vival ­rates at 1, 6, 12, 60 and 120 ­months fol­lowing the ­second ­shunt ­were 95.0±2.4%, 92.5±3.0%, 87.4±3.7%. 82.4±4.5% and 74.8±5.8%, respec­tively. ­Although ­excess pul­mo­nary ­flow was not encoun­tered ­after the ­second ­shunt, ­mode and inci­dence of mor­bidity ­were oth­er­wise sim­ilar to the ­first one. ­Between 9 ­months and 7.5 ­years ­after the ­second ­shunt, 24 ­patients under­went suc­cessful defin­i­tive ­repair. Mul­ti­var­i­able anal­ysis iden­ti­fied pul­mo­nary ­atresia (p=0.027) and a ­short (<1 ­year) ­interval ­between the two ­shunts (p=0.034) as the inde­pen­dent ­risk fac­tors for ­long-­term ­shunt ­failure. ­Single ven­tricle phys­iology (p=0.002) and a cen­tral ­approach for the ­second ­shunt (p=0.016) ­were inde­pen­dent ­risk fac­tors for ­lack of appli­ca­tion, or ­failure of intra­car­diac defin­i­tive ­repair.
Con­clu­sions. A sig­nif­i­cant lim­i­ta­tion in lon­gevity and ­quality of ­life is ­common in ­patients ­requiring a ­second ­shunt, espe­cially ­those asso­ciated ­with pul­mo­nary ­atresia, the ­single ven­tricle phys­iology ­heart, or ungraft­ably hypo­plastic con­tra­lat­eral ­branch pul­mo­nary ­artery to the ­first ­shunt. ­Since ­excess pul­mo­nary ­blood ­flow ­leading to con­gen­ital ­heart ­failure and/or ven­tric­ular dia­stolic dys­func­tion is ­unlikely, all ­patients who pre­clude defin­i­tive ­repair due to ­decreased pul­mo­nary ­blood ­flow ­even ­after the ­first ­shunt ­should be ­shunted ­again.

inizio pagina