[Intermediate results of the integrated approach to pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries].
BACKGROUND
The aim of this study was to validate the preliminary surgical results of the integrated approach to pulmonary atresia, ventricular septal defect (VSD), and multiple aortopulmonary collateral arteries by retrospective analysis of our center experience.


METHODS
Between January 1994 and January 2003, 40 patients aged 22 days to 13 years underwent surgery for pulmonary atresia, VSD, and multiple aortopulmonary collaterals. Case selection was based on preoperative calculation of total neopulmonary arterial index (TNPAI), pulmonary arterial index (PAI), and pulmonary arteries-to-collateral arteries lung segment perfusion ratio (Spa:Sca). The decision for a possible VSD closure during one-stage procedures was based on an intraoperative pulmonary flow study. Twenty-seven patients with a TNPAI > or = 150 mm2/m2 underwent primary unifocalization, irrespective of PAI and Spa:Sca. Conversely, 13 patients with a TNPAI < 150 mm2/m2 and hypoplastic (PAI < 100 mm2/m2) dominant (Spa:Sca > 1) pulmonary arteries received a first-stage right ventricular outflow tract reconstruction, followed by unifocalization and repair (i.e., VSD closure) in 11 cases.


RESULTS
Among 38 patients who received total unifocalization, the overall repairability rate was 84% (first instance repairs: n = 29; delayed VSD closure: n = 3; 95% confidence interval 72-96%), with a survival rate at 7.8 years of 83%. Repaired survivors (n = 29) are asymptomatic (n = 25) or mildly symptomatic (n = 4) at a follow-up interval of 43 +/- 30 months, with a 0.48 +/- 0.2 mean hemodynamic right ventricular/left ventricular pressure ratio.


CONCLUSIONS
Increasing experience with the integrated approach to pulmonary atresia, VSD, and multiple aortopulmonaty collaterals has confirmed the preliminary results of our surgical series. The pulmonary flow study remains the most accurate intraoperative test for successful management of VSD during unifocalization procedures.
Carotti
Adriano
A
Dipartimento di Cardiochirurgia Pediatrica, Ospedale Pediatrico Bambino Gesù, Roma. carotti@opbg.net
Albanese
Sonia B
SB
Minniti
Giuseppe
G
Guccione
Paolo
P
Di Donato
Roberto M
RM
D000015:Abnormalities, Multiple / Q000235:genetics / Q000601:surgery*; D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D002872:Chromosome Deletion; D002892:Chromosomes, Human, Pair 22; D003097:Collateral Circulation; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000235:genetics / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007430:Intraoperative Care; D008297:Male; D010166:Palliative Care; D011651:Pulmonary Artery / Q000002:abnormalities / Q000601:surgery*; D018633:Pulmonary Atresia / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome