Management of pulmonary atresia or critical pulmonary stenosis and intact ventricular septum with a small or hypoplastic right ventricle.
Twenty-one neonates and infants less than 3 months old undergoing cardiac surgery for an obstructed right ventricular outflow tract, intact ventricular septum and a small or hypoplastic right ventricle were retrospectively analyzed, in order to assess the effects of a change in management protocol. Seven of the 8 patients with critical pulmonary stenosis survived surgery using a transannular outflow patch, whereas only 1 of the 8 patients with pulmonary atresia survived the same operation. Two patients in the latter group died 2 and 3 months after surgery but with complications arising from surgery. Of 5 patients with pulmonary atresia who had a modified Blalock Taussig shunt, 3 patients survived the surgery and were discharged home. These results significantly indicate that there is an unacceptably high mortality for the relief of pulmonary atresia (with intact septum) using a transannular outflow patch, and a Blalock Taussig shunt is the preferred operation. The transannular outflow patch is a safe operation for neonates with critical pulmonary stenosis, irrespective of the size of the right ventricle.
de Moor
M M
MM
Department of Paediatrics (Cardiology Unit), University of Cape Town, Republic of South Africa.
Human
D G
DG
Reichart
B
B
D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures / Q000379:methods; D002932:Cineangiography; D006321:Heart / Q000000981:diagnostic imaging; D006346:Heart Septum / Q000473:pathology; D006352:Heart Ventricles / Q000002:abnormalities*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011664:Pulmonary Valve / Q000002:abnormalities*; D011666:Pulmonary Valve Stenosis / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D014261:Tricuspid Valve / Q000473:pathology; D014694:Ventricular Outflow Obstruction / Q000601:surgery