초록접수 현황
| 15F-217 | 구연 발표 |
Right Ventricle-to-pulmonary Artery Shunt in Pulmonary Atresia with Ventricular Septal Defect ; a Word of Caution
Kwang Ho Choi, M.D.¹, Hyungtae Kim, M.D.¹, Hyoung Doo Lee, M.D.², Gil Ho Ban, M.D.², Geena Kim, M.D.², Si Chan Sung, M.D.¹
Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea¹, Department of Pediatrics, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea²
Background : Management of pulmonary atresia with ventricular septal defect (PA/VSD) depends on anatomy or surgical strategy of each institution. Traditional palliation of PA/VSD is systemic-pulmonary artery shunt. We have adopted right ventricle-to-pulmonary artery (RV-PA) shunt since 2011 to reduce interstage mortality of systemic-pulmonary artery shunt and to gain minimal right ventricular incision as possible. This study presents our experience of RV-PA shunt as initial palliative surgery for the PA/VSD.
Methods : From August 2011 to August 2015, 13 patients had underwent RV-PA shunt as palliative surgery. The mean follow-up duration was 19.2±12.4 months. The mean age of the operation was 17.9±2.1 days and the mean body weight of patients was 2.9±0.6 Kg. Five mm Gore-tex graft was used in 10 patients.
Results : There was no early mortality but there were two interstage mortalities at 34, 47 days postoperatively. One patient died of non-cardiac cause; aspiration, but the other patient died as pseudoaneurysm rupture. Three patients (23.1%) required catheter intervention for the left pulmonary artery stenosis which was related to ductus arteriosus, and two patients (15.4%) required re-operation due to shunt inflow stenosis and pseudoaneurysm impending rupture. Two patients (15.4%) showed pseudoaneurysm. Two patients (15.4%) was required the ECMO support postoperatively; one patient had weaning failure from CPB and the other had bleeding from suture line of right ventricular incision. Eight patients (61.5%) underwent total correction 12.9 months after palliative surgery, two patients are waiting for total correction, and one patient was lost follow-up.
Conclusion : RV-PA shunt can be an option for initial palliative surgery of PA/VSD. But there are some significant problems such as pseudoaneurysm, shunt inflow stenosis and ECMO requirement. Our study showed that cautions should be taken to perform the RV-PA shunt for the pailliative surgery of PA/VSD.
Methods : From August 2011 to August 2015, 13 patients had underwent RV-PA shunt as palliative surgery. The mean follow-up duration was 19.2±12.4 months. The mean age of the operation was 17.9±2.1 days and the mean body weight of patients was 2.9±0.6 Kg. Five mm Gore-tex graft was used in 10 patients.
Results : There was no early mortality but there were two interstage mortalities at 34, 47 days postoperatively. One patient died of non-cardiac cause; aspiration, but the other patient died as pseudoaneurysm rupture. Three patients (23.1%) required catheter intervention for the left pulmonary artery stenosis which was related to ductus arteriosus, and two patients (15.4%) required re-operation due to shunt inflow stenosis and pseudoaneurysm impending rupture. Two patients (15.4%) showed pseudoaneurysm. Two patients (15.4%) was required the ECMO support postoperatively; one patient had weaning failure from CPB and the other had bleeding from suture line of right ventricular incision. Eight patients (61.5%) underwent total correction 12.9 months after palliative surgery, two patients are waiting for total correction, and one patient was lost follow-up.
Conclusion : RV-PA shunt can be an option for initial palliative surgery of PA/VSD. But there are some significant problems such as pseudoaneurysm, shunt inflow stenosis and ECMO requirement. Our study showed that cautions should be taken to perform the RV-PA shunt for the pailliative surgery of PA/VSD.
책임저자: Si Chan Sung
Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
연락처 : Kwang Ho Choi, Tel: 055-360-2127 , E-mail : dream0312@dreamwiz.com
