ZHANG Shuai 1,2 , MA Jianrui 1,2 , YAN Xinjian 1,2 , QIU Hailong 1,2 , XIE Wen 1,2 , REN Qiushi 1,2 , YU Juemin 1,2 , CHEN Tianyu 1,2 , ZHANG Yong 1,2 , LI Xiaohua 1,2 , LIU Furong 1,2 , WEN Shusheng 1,2 , ZHUANG Jian 1,2 , GAO Qiang 1,2 , CEN Jianzheng 1,2
  • 1. Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, P. R. China;
  • 2. Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, 510080, P. R. China;
GAO Qiang, Email: jamesofnebulae@163.com; CEN Jianzheng, Email: gaoqiang_89@163.com
Pulmonary atresia; ventricular septal defect; congenital heart disease; right ventricular-pulmonary artery connection; patch expansion; pericardial tube
10.7507/1007-4848.202303044
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Objective To compare the benefits and drawbacks of primary patch expansion and pericardial tube right ventricular-pulmonary artery connection in patients diagnosed with pulmonary atresia with ventricular septal defect (PA/VSD). Methods A retrospective study was conducted on the patients who were diagnosed with pulmonary atresia with ventricular septal defect (PA/VSD) and underwent primary right ventricular-pulmonary artery connection surgery at our center between January 2010 and December 2020. The patients were categorized into two groups based on the type of right ventricular-pulmonary artery connection: the whole pericardial tube right ventricular-pulmonary artery connection group (pericardial tube group), and the patch expansion right ventricular-pulmonary artery connection group (patch expansion group). The patients' general clinical data and cardiopulmonary bypass data were documented, and the cardiac CT data obtained before and after the surgery were compared with the clinical and imaging data. Results Finally 51 patients were collected, including 31 males and 20 females, with a median age of 12.57 (4.57, 49.67) months. There were 19 patients in the pericardial tube group, with a median age of 17.17 (7.33, 49.67) months, and 32 patients in the patch expansion group with a median age of 8.58 (3.57, 52.72) months. In both groups, the diameter, McGoon index, and Nakata index were significantly increased after treatment (P<0.001). However, the pericardial tube group required a longer occlusion time (P<0.001). The rate of reoperation was high, with 72.5% of patients requiring further surgery. Specifically, 26 (81.3%) patients in the patch expansion group and 12 (63.2%) patients in the pericardial tube group finally completed radical resection. There was no statistical difference observed in the long-term cure rate or mortality between the two groups. Conclusion  In patients with PA/VSD, the use of patch expansion or pericardial tube right ventricular-pulmonary artery connection as the initial palliative treatment strategy can promote the development of pulmonary vessels and provide a favorable basis for subsequent radical operations. However, compared to pericardial tube, patch expanded right ventricular-pulmonary artery connection is a simpler procedure to perform and retains some of the intrinsic pulmonary artery development potential, thus making it a preferred procedure.