Pediatric cardiology
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Pediatric cardiology · Jul 1998
ReviewTetralogy of Fallot with major aortopulmonary collaterals: early total repair.
Tetralogy of Fallot with pulmonary atresia and major aortopulmonary collaterals is a complex lesion distinguished by marked heterogeneity of pulmonary blood supply. Over the past two decades, investigators have developed various approaches to the management of this anomaly generally based on the concept of staged unifocalization of pulmonary blood supply. ⋯ We aim to repair these patients early in infancy, with an emphasis on native tissue-tissue reconstruction, in order to optimize prospects for survival with a good functional outcome in as many patients as possible. In this review, we present our philosophy and our experience with unifocalization and repair in 72 patients.
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Extracardiac valved conduits were introduced in 1966. Currently, both aortic and pulmonary homografts, preserved in antibiotic/nutrient solution or cryopreserved, are used. Conduits are implanted between the right ventricle and pulmonary artery, left ventricle and pulmonary artery, right atrium and right ventricle, and left atrium to left ventricle. ⋯ Obstructed conduits are either replaced or outflow tract patch is used after removal of the conduit with or without pulmonary valve implantation. Current mortality of conduit insertion is low (5-6%). The risk of conduit replacement has also decreased in recent years to 2-3.5%
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Pediatric cardiology · Jul 1998
Comparative StudyUtility of intraoperative transesophageal echocardiography in the assessment of residual cardiac defects.
To investigate the accuracy of immediate postbypass transesophageal echocardiography in the assessment of residual cardiac defects, we compared intraoperative transesophageal echocardiograms with intra/postoperative data in 86 patients, aged 4 days to 30.7 years (median = 1.4 years), at risk for a total of 174 postoperative lesions: right (n = 55) or left (n = 26) ventricular outflow tract obstruction, ventricular septal defect (n = 65), aortic (n = 12) or mitral regurgitation (n = 8), or mitral stenosis (n = 8). Accuracy of intraoperative transesophageal echocardiography was evaluated based on comparison with (1) immediate post-bypass left (n = 4) or right (n = 9) ventricular outflow tract pressure gradients by pullback in the operating room, (2) direct surgical inspection of residual ventricular septal defects (n = 3), (3) pulmonary artery oxygen saturation (n = 49), (4) right ventricular outflow tract pullback gradient (n = 24), and (5) transthoracic echocardiogram (n = 51) performed within 40 days of surgery. The results indicate that intraoperative transesophageal echocardiography agreed with intra/postoperative data in 87% of patients at risk for right ventricular outflow tract obstruction, 96% at risk for left ventricular outflow tract obstruction, 97% at risk for ventricular septal defect, and 100% at risk for aortic regurgitation, mitral regurgitation, or mitral stenosis. ⋯ Of these, intraoperative transesophageal echocardiography confirmed and quantified suspected residual lesions in 7 and identified unsuspected lesions in 4 cases. Immediate postbypass transesophageal echocardiography proved reliable for assessing residual ventricular septal defect, mitral stenosis, and mitral or aortic regurgitation. Although accurate for assessment of the left and right ventricular outflow tracts in most patients, transesophageal echocardiography may not reliably reflect the severity of obstruction in all cases.