title: Pulmonary reperfusion injury after the unifocalization procedure for tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collateral arteries.
abstract: OBJECTIVE
  The aims of our study are to describe the incidence, clinical profile, and risk factors for pulmonary reperfusion injury after the unifocalization procedure for tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collateral arteries. We hypothesized the following: (1) Pulmonary reperfusion injury is more likely to occur after unifocalization procedures in which a septated circulation is not achieved, (2) pulmonary reperfusion injury is directly related to the severity of stenosis in major aortopulmonary collateral arteries, and (3) pulmonary reperfusion injury leads to longer intubation time and longer hospitalization.
  
  
  METHODS
  Consecutive patients with tetralogy of Fallot/pulmonary atresia/major aortopulmonary collateral arteries who underwent unifocalization procedures over a 5-year period were identified in our institutional database. Chest radiographs before the unifocalization procedure, from postoperative days 0 to 4, and from 2 weeks after the unifocalization procedure or at discharge were evaluated by a pediatric radiologist for localized pulmonary edema. Determination of stenosis severity was based on review of preoperative angiograms. Statistical analyses using multivariate repeated-measures analyses were performed with generalized estimating equations.
  
  
  RESULTS
  Pulmonary reperfusion injury was present after 42 of 65 (65%) unifocalization procedures. In 36 of 42 cases of reperfusion injury, unilateral injury was present. Risk factors for the development of reperfusion injury included bilateral unifocalization (P = .01) and degree of stenosis (P = .03). We did not identify an association between pulmonary reperfusion injury and time to tracheal extubation or hospital discharge.
  
  
  CONCLUSIONS
  Pulmonary reperfusion injury is common after the unifocalization procedure for tetralogy of Fallot/pulmonary atresia/major aortopulmonary collateral arteries. Severity of stenosis and bilateral unifocalization are associated with the development of reperfusion injury.
authors.affiliation: Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030, USA. samaskat@texaschildrenshospital.org
authors.forename: Shiraz A
authors.initials: SA
authors.lastname: Maskatia
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Feinstein
authors.forename: Beverley
authors.initials: B
authors.lastname: Newman
authors.forename: Frank L
authors.initials: FL
authors.lastname: Hanley
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Roth
mesh_terms: D000015:Abnormalities, Multiple / Q000601:surgery; D000293:Adolescent; D000328:Adult; D001013:Aorta, Thoracic / Q000002:abnormalities* / Q000000981:diagnostic imaging; D015415:Biomarkers / Q000097:blood; D013504:Cardiovascular Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003097:Collateral Circulation; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging; D018633:Pulmonary Atresia / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D013902:Radiography, Thoracic; D015427:Reperfusion Injury / Q000000981:diagnostic imaging / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013771:Tetralogy of Fallot / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*
chemical_list: D015415:Biomarkers