Original article
Congenital heart surgery
Neonatal Pulmonary Artery Reconstruction During Shunting to Treat and Prevent Juxtaductal Coarctation

Presented at the Poster Session of the Fiftieth Annual Meeting of The Society of Thoracic Surgeons, Orlando, FL, Jan 25–29, 2014.
https://doi.org/10.1016/j.athoracsur.2014.09.034Get rights and content

Background

Coarctation of the pulmonary artery may lead to its early obstruction. We investigated the outcomes of a strategy of aggressive reconstruction of the pulmonary arteries in the neonatal period.

Methods

From 2000 to 2013 a total of 162 consecutive neonates (< 90 days) underwent systemic-to-pulmonary shunting. Twenty-eight of them underwent the following concomitant reconstruction of the central pulmonary arteries: end-to-end anastomosis (4), patch reconstruction of the pulmonary arteries (24) with 0.4 mm Gore-Tex (W. L. Gore & Associates, Newark, DE) patch (18), or autologous pericardium (6). Ten patients were directed to univentricular palliation and 18 to biventricular repair.

Results

There was 1 in-hospital death (4%) and 2 deaths after hospital discharge (inter-stage mortality, 7%). The follow-up of the 25 survivors was complete. After a mean of 3 ± 3 years, patients with single ventricle palliation reached the following stages: shunts (2); one and a half ventricle repair (1); bidirectional cavopulmonary shunt (4); and Fontan (2). Fourteen of the patients destined for biventricular physiology reached complete repair while 2 patients were still with shunts. There was no pulmonary artery occlusion. Focal narrowing or pulmonary artery hypoplasia was the main indication for 10 of the subsequent 36 reinterventions.

Conclusions

Neonatal pulmonary artery reconstruction effectively prevents pulmonary artery occlusion and warrants pulmonary artery growth in the majority of cases of juxtaductal pulmonary artery coarctation. A number of these patients needed enlargement of their central pulmonary arteries in subsequent procedures. Indications of this reconstruction at the time of systemic-to-pulmonary shunting remains to be specified.

Section snippets

Patients and Methods

The design of the study was approved by The Royal Children’s Hospital Research Ethics Committee and the need for individual consent was waived because of the retrospective nature of the project. All patients less than 90 days of age who had undergone a systemic-to-pulmonary artery shunt procedure with concomitant pulmonary artery reconstruction in The Royal Children’s Hospital were identified in the hospital database. All their hospital records were reviewed and their follow-up was obtained

Results

From February 2000 to August 2013, 162 consecutive patients aged less than 90 days had a systemic-to-pulmonary artery shunt procedure. Twenty-eight of these patients had concomitant pulmonary artery reconstruction at the time of the shunt procedure. Patient’s characteristics are given in Table 1. The median age at the time of the shunt procedure and pulmonary artery reconstruction was 11 days (6 to 36). The mean weight of the patients at the time of the initial surgery was 3.03 ± 0.55 kg. All

Comment

Juxtaductal coarctation of the pulmonary artery has been described since the 1950s and it has been described to be present in up to 40% of cyanotic neonates with right ventricular outflow tract obstruction [9]. The incidence of spontaneous development of critical stenosis or discontinuous pulmonary arteries in patients with pulmonary atresia with no evidence of preoperative stenosis may be as high as 29%, but the lack of a prospective series focused on this issue precludes us to confirm these

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