Pediatric cardiology
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Pediatric cardiology · Apr 2013
Intact right ventricle-pulmonary artery shunt after stage 2 palliation in hypoplastic left heart syndrome improves pulmonary artery growth.
For patients with hypoplastic left heart syndrome who have undergone the Norwood procedure with a right ventricle-pulmonary artery (RV-PA) shunt, the shunt can either be removed or left intact at the time of the stage 2 procedure. This study aimed to determine the effects of an intact shunt on pulmonary artery growth and clinical outcomes after the stage 2 procedure. A retrospective review of patients who underwent Norwood with an RV-PA shunt from 2005 to 2010 was performed. ⋯ Before Fontan, the group 2 patients had higher superior vena cava (SVC) pressures and more venovenous collaterals closed. There was increased pulmonary artery growth between the pre-stage 2 and pre-Fontan catheterizations in group 2 using both the Nakata Index (+148.5 vs -52.4 mm(2)/m(2); p = 0.01) and the McGoon Ratio (+0.36 vs +0.01; p = 0.01). These findings indicate that patients with an intact RV-PA shunt after stage 2 have greater pulmonary artery growth than patients with the shunt removed, with no increased risk of complications.
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Pediatric cardiology · Apr 2013
Coronary implantation using the autologous flap extension technique in complicated arterial switch operations.
The arterial switch operation (ASO) remains a challenging procedure, especially in cases with a complicated coronary anatomy. In recent years, the autologous flap extension technique has been used for coronary implantation in complicated ASOs. Operative techniques and indications are discussed in this report. ⋯ No ischemic electrocardiographic changes occurred. One patient underwent reoperation for supravalvular pulmonary stenosis 2 years later. The autologous flap extension technique for coronary implantation in complicated ASOs can decrease hospital mortality due to abnormal coronary arteries, especially for patients undergoing two-stage ASOs or patients whose main trunk of the right coronary artery or dilated right ventricular conus branch originates from the left- or right-facing sinus and follows an abnormal course of anterior looping to the aorta.