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

Abstract

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)

Discrete subaortic stenosis in an adult patient

“…It is characterized by a membranous or fibromembranous tissue that partly or fully surrounds the subaortic region. This membranous shelf causing flow turbulence in the LVOT can result in progressive subaortic stenosis, concentric left ventricular hypertrophy, and secondary aortic regurgitation [1][2][3].…”

Impact of Pulmonary Flow Study Pressure on Outcomes After One-Stage Unifocalization

“…Mean PAP values of 30 mm Hg or less were selected for VSD closure at a reasonable postoperative right ventricular pressure [7]. Recently, Honjo and associates [8] demonstrated that the functional intraoperative flow study is highly correlated with postoperative hemodynamics, and more accurately predicts successful VSD closure than anatomic indices [9][10][11][12]. In addition, Zhu and colleagues [13] explored the flow study accuracy as a predictor of medium term survival after unifocalization, concluding that pressures of 25 mm Hg or greater are associated with an increased hazard of death (hazard ratio 9.8, 95% confidence interval: 1.14 to 83.30).…”

Comparison of 16-multidetector-row computed tomography and angiocardiography for evaluating the central pulmonary artery diameter and pulmonary artery index in children with congenital heart disease

“…ACG has been performed to evaluate the PA; and, indeed, a recent study still used ACG to measure PA size. 20 As we noted above, ACG is an invasive technique that cannot be used frequently, and 16-MDCT is less invasive. For follow-up of the PA size, we suggest use of MDCT as well as MRA.…”