Right Ventricle-pulmonary Anastomosis for Right Ventricle Outflow Reconstruction in Patients with Pulmonary Atresia and Ventricular Septal Defect_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YANXin-jian ,  ZHUANGJian , CHENJi-mei , CENJian-zheng , DINGYi-qun , WENShu-sheng , XUGang , LIHe-zhi

Department of Pediatric Cardiovascular Surgery, Guangdong General Hospital, Guangdong Cardiovascular Institute, Guangzhou 510080, P. R. China;

Corresponding author：

ZHUANGJian, Email: zhuangjian5413@tom.com

Keywords：

Congenital heart disease; Right ventricle-Pulmonary artery anastomasis; Right ventricle outflow tract reconstruction; Right heart function

DOI：

10.7507/1007-4848.20140083

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Objective To investigate pulmonary artery growth, valvular regurgitation and right heart function after right ventricle-pulmonary artery (RV-PA) anastomosis for right ventricle outflow (RVOT) reconstruction in patients with different types of pulmonary atresia and ventricle septal defect (PA/VSD). Methods Clinical data of 31 PA/VSD patients who underwent right ventricle-pulmonary anastomosis for RVOT reconstruction from November 2002 to September 2012 in Guangdong General Hospital were retrospectively analyzed. There were 20 male and 11 female patients with their age ranging from 14 days to 14.50 years (47.90±53.84 months). Patients were followed up after discharge to evaluate the anastomasis, pulmonary artery growth, pulmonary artery and tricuspid regurgitation and their relationship with follow-up duration. Right ventricular strain and other echocardiography indexes were used to evaluate right heart function. Results Three patients died postoperatively. Twenty-seven patients (27/31, 87.1%)were followed up for 4-129 (35.97±28.24)months. There was no late death during follow-up. There was no anastomotic restenosis in patients who received radical surgery. Four patients who received palliative surgery had comparative anastomotic restenosis. The diameters of RV-PA anastomasis, left and right branches of the pulmonary artery during follow-up were significantly larger than early postoperative diameters (P < 0.05). Echocardiography showed that pulmonary artery and tricuspid regurgitation were aggravated, which was not correlated to follow-up duration. Overall right heart function was good during follow-up. Conclusions Clinical outcomes of RV-PA anastomosis for RVOT reconstruction in patients with PA/VSD are satisfactory. RV-PA anastomasis, left and right branches of the pulmonary artery can keep their growth and development. Mid-term and long-term right heart function is good.

Citation： YANXin-jian, ZHUANGJian, CHENJi-mei, CENJian-zheng, DINGYi-qun, WENShu-sheng, XUGang, LIHe-zhi. Right Ventricle-pulmonary Anastomosis for Right Ventricle Outflow Reconstruction in Patients with Pulmonary Atresia and Ventricular Septal Defect. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(3): 290-295. doi: 10.7507/1007-4848.20140083 Copy

1.	Cho JM, Puga FJ, Danielson GK, et al. Early and long-term results of the surgical treatment of tetralogy of Fallot with pulmonary atresia, with or without major aortopulmonary collateral arteries. J Thoracic Cardiovasc Surg, 2002, 124 (1):70-81.
2.	庄建, 张镜芳, 陈欣欣, 等.肺动脉右心室直接吻合纠治复杂先天性心脏病.中华胸心血管外科杂志, 2005, 21 (3):130-132.
3.	邓喜成, 李守军.肺动脉闭锁合并室间隔缺损的外科治疗策略.中国胸心血管外科临床杂志, 2010, 17 (1):50-54.
4.	Castaneda AR, Jonas RA, Mayer J, et al. Chief editor. Tetralogy of Fallot. In:Cardiac Surgery of the Neonate and Infant. Philadelphia, Pennsylvania:WB Saunders Company. 1994. 215-234.
5.	Amark MK. Independent factors associated with mortality, reinter-vention, and achievement of complete repair in children with pulmonary atresia with ventricular septal defect. J Am Coll Cardiol, 2006, 47 (7):1448-1456.
6.	Ross DN, Somervil LJ. Correction of pulmonary atresia with a homo-graft aortic valve. lancet, 1966, 2:1446.
7.	Sfyidis GP. The contegra^® valved heterograft conduit for right ventricular outflow tract Reconstruction:a reliable solution. Hellenic J Cardiol, 2011, 52 (6):501-508.
8.	Bando K, Danielson GK, Schaff HV, et al. Outcome of pulmonary and aortic Homografts for right ventricular outflow tract recontraction. J Thorac Cardiovasc Surg, 1995, 109 (3):509-518.
9.	Meyns B, Van Garsse L, Boshoff D, et al. The contegra conduit in the right ventricular outflow tract induces supravalvular stenosis. J Thorac Cardiovasc Surg, 2004, 128 (6):834-840.
10.	徐志伟, 陈道中, 易定华, 等.肺动脉带瓣管道重建右室流出道.中华胸心血管外科杂志, 2012, 28 (9):536-539.
11.	Mair DD, Puga FJ. Management of pulmonary atresia with ventri-cular septal defect. Curr Treat Options Cardiovasc Med, 2003, 5 (5):409-415.
12.	Rastelli GC, Ongley PA, Davis GD, et al. Surgical repair for pulm-onary valve atresia with coronary-pulmonary artery fistula:report of a case. Mayo Clin Proc, 1965, 40:521-527.
13.	祝忠群, 刘锦纷, 郑景浩, 等.肺动脉闭锁伴室间隔缺损的分期手术治疗.中华医学杂志, 2010, 90 (13):898-901.
14.	Lecompte Y, Jy N, leca F, et al. Reconstruction of the pulmonary outflow tract without prosthetic conduit. J Thorac Cardiovasc Surg, 1982, 84 (5):727-733.
15.	Ando M, Imai Y, Hoshino S, et al. Autologous Reconstruction of pulmonary trunk at reoperation after extracardiac conduit repair. Ann Thorac Surg, 1995, 59 (3):621-625.
16.	Isomatsu Y. Establishing right ventricle-pulmonary artery continuity by autologous tissue:an alternative approach for prosthetic conduit repair. Ann Thorac Surg, 2004, 78 (1):173-180.
17.	Chiu IS, Div M, Huang SC, et al. Surgical treatment of anomalies with discontinuity between the right ventricle and the pulmonary arteries without use of an extracardiac conduit. Ann Thorac Surg, 2009, 87 (4):1220-1225.
18.	Ong K. Right ventricle to pulmonary artery conduit reoperations in patients with tetralogy of fallot or pulmonary atresia associated with ventricular septal defect. Am J Cardiol, 2013, 111 (11):1638-1643.
19.	杨盛春, 陈欣欣, 孙善全, 等.复杂先天性心脏病右心室流出道重建困难的处理.中国胸心血管外科临床杂志, 2013, 20 (1):105-107.
20.	Jonsson H, Ivert T, Jonasson R, et al. Work capacity and central heodynamic:thirteen-six years after repair of tetralogy of Fallot. J Thorac Cardiovasc Surg, 1995, 110 (2):416-426.
21.	Kurotobi S. Determination of timing for reoperation in patients after right ventricular outflow Reconstruction. Am J Cardiol, 2005, 95 (11):1344-1350.
22.	Koestenberger M, Nagel B, Ravekes W, et al. Systolic right ventr-icular function in pediatric and adolescent patients with tetralogy of Fallot:echocardiography versus magnetic resonance imaging. J Am Soc Echocardiogr, 2011, 24 (1):45-52.
23.	Tanaka H, Nesser HJ, Buck T, et al. Dyssynchrony by speckletrac-king echocardiography and response to cardiac Resynchronization therapy:results of the Speckle Tracking and Resynchronization (STAR)study. Eur Heart J, 2010, 31 (14):1690-1700.
24.	Rudski GL. Guidelines for the echocardiographic assessment of the right heart in adults:a report rom the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr, 2010, 23 (7):685-713.
25.	Puranik R, Tsang V, Lurz P, et al. Long-term importance of right ventricular outflow tract patch function in patients with pulomanry regurgitation. J Thorac Cardiovasc Surg, 2012, 143 (5):1103-1107.
26.	Derby DC. Outcomes following non-valved autologous Reconstruc-tion of the right ventricular outflow tract in neonates and infants. Eur J Cardiothorac Surg, 2008, 34 (4):726-731.
27.	Schichter AJ, Kreutzer C, Mayorquim RC, et al. Five to fifteen year follow-up of fresh autologous pericardial valved conduits. J Thorac Cardiovasc Surg, 2000, 119 (5):869-879.
28.	Piazza L. Timing of pulmonary valve replacement after tetralogy of Fallot repair. Expert Rev Cardiovasc Ther, 2012, 10 (7):917-923.

1. Cho JM, Puga FJ, Danielson GK, et al. Early and long-term results of the surgical treatment of tetralogy of Fallot with pulmonary atresia, with or without major aortopulmonary collateral arteries. J Thoracic Cardiovasc Surg, 2002, 124 (1):70-81.
2. 庄建, 张镜芳, 陈欣欣, 等.肺动脉右心室直接吻合纠治复杂先天性心脏病.中华胸心血管外科杂志, 2005, 21 (3):130-132.
3. 邓喜成, 李守军.肺动脉闭锁合并室间隔缺损的外科治疗策略.中国胸心血管外科临床杂志, 2010, 17 (1):50-54.
4. Castaneda AR, Jonas RA, Mayer J, et al. Chief editor. Tetralogy of Fallot. In:Cardiac Surgery of the Neonate and Infant. Philadelphia, Pennsylvania:WB Saunders Company. 1994. 215-234.
5. Amark MK. Independent factors associated with mortality, reinter-vention, and achievement of complete repair in children with pulmonary atresia with ventricular septal defect. J Am Coll Cardiol, 2006, 47 (7):1448-1456.
6. Ross DN, Somervil LJ. Correction of pulmonary atresia with a homo-graft aortic valve. lancet, 1966, 2:1446.
7. Sfyidis GP. The contegra^® valved heterograft conduit for right ventricular outflow tract Reconstruction:a reliable solution. Hellenic J Cardiol, 2011, 52 (6):501-508.
8. Bando K, Danielson GK, Schaff HV, et al. Outcome of pulmonary and aortic Homografts for right ventricular outflow tract recontraction. J Thorac Cardiovasc Surg, 1995, 109 (3):509-518.
9. Meyns B, Van Garsse L, Boshoff D, et al. The contegra conduit in the right ventricular outflow tract induces supravalvular stenosis. J Thorac Cardiovasc Surg, 2004, 128 (6):834-840.
10. 徐志伟, 陈道中, 易定华, 等.肺动脉带瓣管道重建右室流出道.中华胸心血管外科杂志, 2012, 28 (9):536-539.
11. Mair DD, Puga FJ. Management of pulmonary atresia with ventri-cular septal defect. Curr Treat Options Cardiovasc Med, 2003, 5 (5):409-415.
12. Rastelli GC, Ongley PA, Davis GD, et al. Surgical repair for pulm-onary valve atresia with coronary-pulmonary artery fistula:report of a case. Mayo Clin Proc, 1965, 40:521-527.
13. 祝忠群, 刘锦纷, 郑景浩, 等.肺动脉闭锁伴室间隔缺损的分期手术治疗.中华医学杂志, 2010, 90 (13):898-901.
14. Lecompte Y, Jy N, leca F, et al. Reconstruction of the pulmonary outflow tract without prosthetic conduit. J Thorac Cardiovasc Surg, 1982, 84 (5):727-733.
15. Ando M, Imai Y, Hoshino S, et al. Autologous Reconstruction of pulmonary trunk at reoperation after extracardiac conduit repair. Ann Thorac Surg, 1995, 59 (3):621-625.
16. Isomatsu Y. Establishing right ventricle-pulmonary artery continuity by autologous tissue:an alternative approach for prosthetic conduit repair. Ann Thorac Surg, 2004, 78 (1):173-180.
17. Chiu IS, Div M, Huang SC, et al. Surgical treatment of anomalies with discontinuity between the right ventricle and the pulmonary arteries without use of an extracardiac conduit. Ann Thorac Surg, 2009, 87 (4):1220-1225.
18. Ong K. Right ventricle to pulmonary artery conduit reoperations in patients with tetralogy of fallot or pulmonary atresia associated with ventricular septal defect. Am J Cardiol, 2013, 111 (11):1638-1643.
19. 杨盛春, 陈欣欣, 孙善全, 等.复杂先天性心脏病右心室流出道重建困难的处理.中国胸心血管外科临床杂志, 2013, 20 (1):105-107.
20. Jonsson H, Ivert T, Jonasson R, et al. Work capacity and central heodynamic:thirteen-six years after repair of tetralogy of Fallot. J Thorac Cardiovasc Surg, 1995, 110 (2):416-426.
21. Kurotobi S. Determination of timing for reoperation in patients after right ventricular outflow Reconstruction. Am J Cardiol, 2005, 95 (11):1344-1350.
22. Koestenberger M, Nagel B, Ravekes W, et al. Systolic right ventr-icular function in pediatric and adolescent patients with tetralogy of Fallot:echocardiography versus magnetic resonance imaging. J Am Soc Echocardiogr, 2011, 24 (1):45-52.
23. Tanaka H, Nesser HJ, Buck T, et al. Dyssynchrony by speckletrac-king echocardiography and response to cardiac Resynchronization therapy:results of the Speckle Tracking and Resynchronization (STAR)study. Eur Heart J, 2010, 31 (14):1690-1700.
24. Rudski GL. Guidelines for the echocardiographic assessment of the right heart in adults:a report rom the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr, 2010, 23 (7):685-713.
25. Puranik R, Tsang V, Lurz P, et al. Long-term importance of right ventricular outflow tract patch function in patients with pulomanry regurgitation. J Thorac Cardiovasc Surg, 2012, 143 (5):1103-1107.
26. Derby DC. Outcomes following non-valved autologous Reconstruc-tion of the right ventricular outflow tract in neonates and infants. Eur J Cardiothorac Surg, 2008, 34 (4):726-731.
27. Schichter AJ, Kreutzer C, Mayorquim RC, et al. Five to fifteen year follow-up of fresh autologous pericardial valved conduits. J Thorac Cardiovasc Surg, 2000, 119 (5):869-879.
28. Piazza L. Timing of pulmonary valve replacement after tetralogy of Fallot repair. Expert Rev Cardiovasc Ther, 2012, 10 (7):917-923.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Right Ventricle-pulmonary Anastomosis for Right Ventricle Outflow Reconstruction in Patients with Pulmonary Atresia and Ventricular Septal Defect

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