초록접수 현황
| 19F-143 | 구연 발표 |
'Shunt-only' Strategy in Patients with Pulmonary Atresia or Stenosis and Juxtaductal Pulmonary Artery Stenosis
Eun Seok Choi, Won Young Lee, Bo Sang Kwon, Chun Soo Park, Tae-Jin Yun
Divisions of Pediatric Cardiac Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
Purpose : Neonates and infants who require a modified Blalock-Taussig (mBT) shunt can have juxtaductal (JD) pulmonary artery (PA) stenosis. We investigated that clinical outcome of mBT shunt using ‘shunt only’ strategy.
Methods : From 2009 to 2017, one hundred eleven patients who underwent mBT shunt without PA angioplasty with preoperative computed tomography angiography were enrolled for the study. We defined that JDPA stenosis is that ratio of the diameter of JDPA to hilar PA was smaller than 0.9. Medical records of patients were reviewed retrospectively.
Results : The median age and body weight at surgery were 16 days (11-22 days) and 3.3 kg (3.1–3.6 kg), respectively. There were 4 early deaths (3.6%), 9 interstage deaths (8.1%) and 5 patients (4.5%) were lost to follow-up during interstage period. JDPA stenosis was found in 54 patients (48.6%). Unplanned PA interventions including another mBT shunt at contralateral side PA in 6 and PA angioplasty in 1 were performed during interstage period in 7 patients (7/54: 13%) all of whom had JDPA stenosis. Mean PA diameter ratio (non-shunt side/shunt side) before next stage operation was 0.86 ± 0.27. Median z-score of diameter of non-shunt side PA before next stage operation was -0.03 (-0.64–1.37). Both univariate and multivariate analyses cannot identify a risk factor for significant hypoplasia of non-shunt side PA.
Conclusion : The non-shunt side PA is grown well after mBT shunt following ‘shunt-only’ strategy in selected patients with JDPA stenosis. Meticulous surveillance is mandatory because it is difficult to predict significant hypoplasia of non-shunt side PA in those patients.
Methods : From 2009 to 2017, one hundred eleven patients who underwent mBT shunt without PA angioplasty with preoperative computed tomography angiography were enrolled for the study. We defined that JDPA stenosis is that ratio of the diameter of JDPA to hilar PA was smaller than 0.9. Medical records of patients were reviewed retrospectively.
Results : The median age and body weight at surgery were 16 days (11-22 days) and 3.3 kg (3.1–3.6 kg), respectively. There were 4 early deaths (3.6%), 9 interstage deaths (8.1%) and 5 patients (4.5%) were lost to follow-up during interstage period. JDPA stenosis was found in 54 patients (48.6%). Unplanned PA interventions including another mBT shunt at contralateral side PA in 6 and PA angioplasty in 1 were performed during interstage period in 7 patients (7/54: 13%) all of whom had JDPA stenosis. Mean PA diameter ratio (non-shunt side/shunt side) before next stage operation was 0.86 ± 0.27. Median z-score of diameter of non-shunt side PA before next stage operation was -0.03 (-0.64–1.37). Both univariate and multivariate analyses cannot identify a risk factor for significant hypoplasia of non-shunt side PA.
Conclusion : The non-shunt side PA is grown well after mBT shunt following ‘shunt-only’ strategy in selected patients with JDPA stenosis. Meticulous surveillance is mandatory because it is difficult to predict significant hypoplasia of non-shunt side PA in those patients.
책임저자: Tae-Jin Yun
Divisions of Pediatric Cardiac Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
발표자: Eun Seok Choi, E-mail : gninihs@naver.com