Influence of age at time of surgery on pre-operative left ventricular mass and postoperative outcome of Fontan operation in children with tricuspid atresia and native pulmonary stenosis.
Purpose of this study was to examine the influence of early (less than two and half years) versus later (greater than four years) age at time of Fontan type palliation in tricuspid atresia with native pulmonary stenosis on outcome with special reference to left ventricular mass and function. Among the 21 patients with tricuspid atresia, twelve (group A) underwent a Fontan type palliation at a median age of one (.6 to 2.5) years and nine (group B) at a median age of 7.5 (4.8 to 28) years. Left ventricular mass was assessed by cross-sectional echocardiography in the apical two and four chamber view. Mass was calculated as difference between epicardial and endocardial volume x 1.05 (specific gravity of heart muscle). Mass divided by volume at end-diastole yielded the mass/volume index. There was a weak correlation between age and left ventricular mass with an r-value of 0.74. Ejection fraction was calculated from the endocardial volume measurements at end-diastole and end-systole. Patient data were compared to normal values previously established in 95 controls, who were age-matched for the patients. Immediately before surgery left ventricular mass was significantly higher in the nine patients, who underwent surgery at a later age. While postoperative stay in hospital and duration of treatment in the intensive care unit did not differ significantly between both groups, the incidence of pleural and pericardial effusions and the duration of insertion of drainage tubes for these effusions differed significantly with the group A patients (under two and half years of age) doing better.(ABSTRACT TRUNCATED AT 250 WORDS)
Vogel
M
M
Klinik für Herz- und Kreislaufkrankheiten im Kindesalter, Deutschen Herzzentrum, München.
Staller
W
W
Bühlmeyer
K
K
Sebening
F
F
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002306:Cardiac Volume / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography / Q000295:instrumentation; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery; D006330:Heart Defects, Congenital / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007223:Infant; D008297:Male; D010166:Palliative Care; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011651:Pulmonary Artery / Q000503:physiopathology / Q000601:surgery; D011666:Pulmonary Valve Stenosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D012815:Signal Processing, Computer-Assisted / Q000295:instrumentation; D015996:Survival Rate; D014261:Tricuspid Valve / Q000002:abnormalities*; D016277:Ventricular Function, Left / Q000502:physiology*; D016278:Ventricular Function, Right / Q000502:physiology