Development of pulmonary arteries after central aortopulmonary shunt in newborns

Potapov, Evgenij; Alexi-Meskishvili, Vladimir; Dähnert, Ingo; Ivanitskaia, Ekaterina A.; Lange, Peter; Hetzer, Roland

doi:10.1016/s0003-4975(00)02442-5

Cited by 24 publications

(25 citation statements)

References 14 publications

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“…2 However, strategies involving firststage PA angioplasty for CoPA and an SP shunt show satisfactory early postoperative results 7 and increased Nakata indexes on bilateral sides. 7,8 Furthermore, our present results suggest that stable postoperative hemodynamics that arise through less invasive minimized CPB improve the results of first-stage palliation to reconstruct PA continuity and a SP shunt.…”

Section: Discussionsupporting

confidence: 54%

First-stage angioplasty for a single ventricle with pulmonary artery coarctation

Takabayashi

Shimpo

Yokoyama

et al. 2006

Jpn J Thorac Cardiovasc Surg

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We report first-stage palliation consisting of pulmonary artery angioplasty and a systemic-to-pulmonary shunt using a minimized cardiopulmonary bypass technique performed with modified ultrafiltration for two patients with a single ventricle, pulmonary atresia, patent ductus arteriosus, and pulmonary coarctation during early infancy. Postoperative early extubation (15 and 18 h) and bilateral pulmonary artery growth before the second stage (Nakata indexes, in mm2/m2: right 94, left 53; and right 209, left 70) were experienced. Less-invasive pulmonary artery continuity reconstruction at an early stage is advantageous for low-weight patients with a single ventricle and pulmonary coarctation.

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Section: Discussionsupporting

confidence: 54%

First-stage angioplasty for a single ventricle with pulmonary artery coarctation

Takabayashi

Shimpo

Yokoyama

et al. 2006

Jpn J Thorac Cardiovasc Surg

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“…The modified Blalock-Taussig shunt (MBTS) is currently widely used; shunt flow can be regulated in accord with the size of the systemic artery [3]. However, the incidence of iatrogenic pulmonary artery deformation subsequent to MBTS has been reported to be between 35% and 65% [4]. In particular, the placement of the MBTS in young patients suffering from pulmonary coarctation can result in the exacerbation of unequal flow between the right and left pulmonary arteries; in addition, it increases the risks of kinking, stenosis and deformation as well as the possibility of complete occlusion of the shunts at the distal anastomosis as the child grows.…”

Section: Introductionmentioning

confidence: 99%

Surgical strategy for pulmonary coarctation in the univentricular heart

Kim

Lim

et al. 2006

European Journal of Cardio-Thoracic Surgery

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“…[8][9][10] In patients with ToF, the feasibility of complete operative repair is largely dependent on the underlying distribution and size of the pulmonary arteries. 11,12) The pulmonary segmental arteries and preacinar structure of the bronchi, which is called the bronchopulmonary segment, are the basic topographical units of the lung. Although there is still disagreement with respect to whether the number of normal pulmonary segments is 20, it is widely accepted that the total number of bronchopulmonary segments is 20 in healthy individuals.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10][11][12] An important physiologic component of a favorable outcome is the postrepair peak right ventricular pressure, which may depend greatly upon the pulmonary arterial and aorta-pulmonary collateral morphology, as well as the type of repair performed. [4][5][6][7][8] In the present study, low and moderate risk patients were included while high risk patients with a PSAR < 0.50 were excluded.…”

Section: Discussionmentioning

confidence: 99%

“…The morphology and physiology of the pulmonary arteries are 2 main factors used to determine these ratios and indexes because the distribution, size of the pulmonary arteries, and efficiency of the pulmonary circulation are critical factors for successful surgery. 4,5,8,11,12) The McGoon ratio, which is the combined branch pulmonary arterial diameters divided by the descending aorta diameter, and the Nakata index, which is the combined cross-sectional area of the branch pulmonary arteries per square meter, are used to determine if the branch pulmonary arteries are large enough to permit corrective surgery. 12,17) Like the Mcgoon and Nakata indexes, smaller PSAR values are related to poor postsurgical outcomes, although in some cases PSAR and the PA index may not always be correlated (Figure 2).…”

Section: )mentioning

confidence: 99%

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Pulmonary Segmental Artery Ratio An Alternative to the Pulmonary Artery Index in Patients With Tetralogy of Fallot

et al. 2006

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SUMMARYThe objective of this study was to determine a reliable, alternative ratio to the pulmonary artery (PA) index, which will help to estimate the adequacy of postoperative pulmonary blood flow in patients with tetralogy of Fallot.We propose the pulmonary segmental artery ratio (PSAR), which is an angiographic measure for the quantitative standardization of the total number of pulmonary segmental arteries in a patient. The expected value of the PSAR is 1 and it is constant after the 16 th week of intrauterine life. Retrospective analysis of the PSAR and PA index calculations in patients with tetralogy of Fallot was conducted. Sixty-one patients were assigned to a moderate or low risk group according to their PSAR; the low risk group included 31 patients whose PSAR was between 0.75-1 (group 1) while the moderate risk group included 30 patients whose PSAR was between 0.50-0.75 (group 2). High risk patients whose PSAR was less than 0.50 were excluded from the study. Postoperative peak right ventricular pressure, the pulmonary artery to systemic pressure ratio, and peripheral arterial oxygen saturation preoperatively after cardiopulmonary bypass were analyzed separately in groups 1 and 2. Postoperative peak right ventricular pressure was lower in group 1 than group 2, while the pulmonary artery to systemic pressure ratio and peripheral arterial oxygen saturation were higher in group 1 than group 2 (P < 0.01).Based on the present findings, it is concluded that PSAR is not as reliable as the Nakata index. However, in cases in which the PSAR and PA index are not correlated, PSAR may be helpful for determining the adequacy of postoperative pulmonary blood flow and postoperative outcomes of patients with hypoplastic pulmonary arteries. (Int Heart J 2006; 47: 67-75)

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Development of pulmonary arteries after central aortopulmonary shunt in newborns

Cited by 24 publications

References 14 publications

First-stage angioplasty for a single ventricle with pulmonary artery coarctation

First-stage angioplasty for a single ventricle with pulmonary artery coarctation

Surgical strategy for pulmonary coarctation in the univentricular heart

Pulmonary Segmental Artery Ratio An Alternative to the Pulmonary Artery Index in Patients With Tetralogy of Fallot

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