title: Histomorphometric analysis of intrapulmonary vessels in patients undergoing bidirectional Glenn shunt and total cavopulmonary connection.
abstract: OBJECTIVE
  The purposes of this study were to elucidate the histomorphometry of the intrapulmonary arteries in patients undergoing univentricular type of repairs and to identify the histomorphometric characteristics, if any, that may predispose patients to postoperative Fontan failure.
  
  
  METHODS
  Operatively resected wedges of lung tissue from 44 patients undergoing univentricular type of repairs (aged 17 months to 34 years; mean, 83.52 ± 75.90 months) was subjected to histomorphometric analysis.
  
  
  RESULTS
  Despite pulmonary arterioplasty, a low Nakata index was associated with 9.61 (95% confidence interval: 1.01-91.5; P = .003) times increased risk of death after the operation. A statistically significant difference in the mean indexed diameter of the intra-acinar pulmonary arteries (P = .03) was observed between patients undergoing superior and total cavopulmonary connections. Overall, there were 8 (8.2%), 4 (9.1%), 13 (29.5%), and 29 (65.9%) instances of intrapulmonary arterial intimal lesions, thrombosis, smooth muscle extension, and interstitial fibrosis, respectively. Among patients undergoing total cavopulmonary connection, only low Nakata index was significantly associated with the presence of severe intimal lesions, abnormal smooth muscle extension, intra-acinar pulmonary arterial thrombus, and smaller intra-acinar pulmonary arteries.
  
  
  CONCLUSIONS
  A low Nakata index is significantly associated with the presence of severe intimal lesions, thrombus, abnormal smooth muscle extension, a lower mean indexed area of the intrapulmonary arteries, and poor postoperative outcome. However, none of the histomorphometrically derived parameters could conclusively predict the outcome after univentricular repair.
authors.affiliation: Cardiothoracic Sciences Centre, AIIMS, New Delhi, India. ujjwalchow@rediffmail.com
authors.forename: Ujjwal K
authors.initials: UK
authors.lastname: Chowdhury
authors.forename: Raghu M
authors.initials: RM
authors.lastname: Govindappa
authors.forename: Prasenjit
authors.initials: P
authors.lastname: Das
authors.forename: Ruma
authors.initials: R
authors.lastname: Ray
authors.forename: Mani
authors.initials: M
authors.lastname: Kalaivani
authors.forename: Srikrishna M
authors.initials: SM
authors.lastname: Reddy
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D018729:Fontan Procedure / Q000401:mortality; D006330:Heart Defects, Congenital / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities* / Q000601:surgery*; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D010784:Photomicrography; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000473:pathology*; D012307:Risk Factors; D016896:Treatment Outcome