초록접수 현황
| 16F-244 | 구연 발표 |
More Flow Control and Less Complication : An Internal Pulmonary Artery Banding Technique
Eung Re Kim, Ji Hyun Bang, Jae Gun Kwak, Woong-Han Kim
Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
Background : Although pulmonary artery banding (PAB) is an important option for treating various congenital cardiac anomalies, complications such as volatile banding diameter, migration of banding, and branch pulmonary artery stenosis are well known. In this study, we evaluate the efficacy and safety of internal PAB technique.
Methods : All infants who received internal PAB at our institution from 2003 to 2015 were retrospectively reviewed. Internal, instead of external, PAB was performed if the patient had cardiac or aortic anomaly requiring cardiopulmonary bypass at the time of initial surgery. Through a transverse incision of the main pulmonary artery, a doughnut-shaped Gore-Tex membrane with was placed and sutured perpendicularly inside the vessel lumen to block the blood flow. The diameter of the hole was between 3 to 4 mm depending on the patient’s body weight. Perioperative course and follow-up data including echocardiogram were collected and analyzed.
Results : Internal PAB technique was utilized in 28 patients at the median age of 13 days (range 1 to 89 days) with a mean weight of 3.44 ± 0.58 kg. Mean pressure gradient across the banding site was 3.69 ± 0.57 m/s at the time of discharge. There was 1 early, cardiac related mortality and 2 late, non-cardiac related mortalities. 25 patients (89.3%) underwent second-stage operation. Single-ventricle repair was performed in 13 patients (52%), with 7 patients reaching Fontan status. One-and-a-half ventricle and bi-ventricle repair were done in 1 (4%) and 11 patients (44%). Overall survival of the second-stage operation was 88.0% during a mean follow-up period of 5 ± 3.13 years. There were no cases of distal migration or distortion of the pulmonary valve. Stenosis of pulmonary artery bifurcation was present in 1 patient.
Conclusion : Internal PAB technique can be a safe and effective treatment option with reduced complication and good control of pulmonary blood flow.
Methods : All infants who received internal PAB at our institution from 2003 to 2015 were retrospectively reviewed. Internal, instead of external, PAB was performed if the patient had cardiac or aortic anomaly requiring cardiopulmonary bypass at the time of initial surgery. Through a transverse incision of the main pulmonary artery, a doughnut-shaped Gore-Tex membrane with was placed and sutured perpendicularly inside the vessel lumen to block the blood flow. The diameter of the hole was between 3 to 4 mm depending on the patient’s body weight. Perioperative course and follow-up data including echocardiogram were collected and analyzed.
Results : Internal PAB technique was utilized in 28 patients at the median age of 13 days (range 1 to 89 days) with a mean weight of 3.44 ± 0.58 kg. Mean pressure gradient across the banding site was 3.69 ± 0.57 m/s at the time of discharge. There was 1 early, cardiac related mortality and 2 late, non-cardiac related mortalities. 25 patients (89.3%) underwent second-stage operation. Single-ventricle repair was performed in 13 patients (52%), with 7 patients reaching Fontan status. One-and-a-half ventricle and bi-ventricle repair were done in 1 (4%) and 11 patients (44%). Overall survival of the second-stage operation was 88.0% during a mean follow-up period of 5 ± 3.13 years. There were no cases of distal migration or distortion of the pulmonary valve. Stenosis of pulmonary artery bifurcation was present in 1 patient.
Conclusion : Internal PAB technique can be a safe and effective treatment option with reduced complication and good control of pulmonary blood flow.
책임저자: Woong-Han Kim
Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
발표자: Eung Re Kim, E-mail : xion119@naver.com