title: Management and outcomes of heterotaxy syndrome associated with pulmonary atresia or pulmonary stenosis.
abstract: BACKGROUND
  Historic outcomes of patients with heterotaxy and pulmonary atresia or pulmonary stenosis (PA/PS) have been poor and in the current era are incompletely described. We reviewed our management of these patients and associated risk factors for death.
  
  
  METHODS
  We retrospectively reviewed the records of all patients with heterotaxy and PA/PS treated in our institution from January 1, 2002, to August 31, 2012. Death data were also confirmed with the Social Security Death Index. The log-rank test was done to assess six risk factors for death.
  
  
  RESULTS
  We identified 42 patients with heterotaxy and PA/PS. Median age at the first operation was 6.5 days, and median follow-up was 3.5 years. Death data were complete for all patients. Overall mortality was 19% (8 of 42). The 30-day, 1-year, and 5-year mortality estimation was 4.76%, 12.3%, and 19.1% respectively, as determined by the Kaplan-Meier method. The log-rank test showed total anomalous pulmonary venous return (TAPVR) (p<0.05) and obstructed TAPVR requiring an operation at less than 30 days (p=0.001) were significant risk factors for death.
  
  
  CONCLUSIONS
  In the current era, surgical treatment of heterotaxy and PA/PS can result in good outcomes. Associated TAPVR and obstructed TAPVR requiring neonatal correction were noted to be risk factors for death.
authors.affiliation: Division of Pediatric Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: vinod.sebastian@utsouthwestern.edu.
authors.forename: Vinod A
authors.initials: VA
authors.lastname: Sebastian
authors.affiliation: Division of Pediatric Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Javier
authors.initials: J
authors.lastname: Brenes
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Raghav
authors.initials: R
authors.lastname: Murthy
authors.affiliation: Division of Pediatric Cardiology, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas.
authors.forename: Surendranath
authors.initials: S
authors.lastname: Veeram Reddy
authors.affiliation: Division of Pediatric Cardiology, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas.
authors.forename: V Vivian
authors.initials: VV
authors.lastname: Dimas
authors.affiliation: Division of Pediatric Cardiology, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas.
authors.forename: Alan
authors.initials: A
authors.lastname: Nugent
authors.affiliation: Division of Pediatric Cardiology, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zellers
authors.affiliation: Research Department, Children's Medical Center Dallas, Dallas, Texas.
authors.forename: Rong
authors.initials: R
authors.lastname: Huang
authors.affiliation: Division of Pediatric Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Kristine J
authors.initials: KJ
authors.lastname: Guleserian
authors.affiliation: Division of Pediatric Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Forbess
mesh_terms: D000015:Abnormalities, Multiple; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures / Q000379:methods*; D004452:Echocardiography; D005500:Follow-Up Studies; D059446:Heterotaxy Syndrome / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D018633:Pulmonary Atresia / Q000175:diagnosis / Q000601:surgery*; D011667:Pulmonary Veins / Q000002:abnormalities*; D011668:Pulmonary Veno-Occlusive Disease / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome