초록접수 현황
| 20F-149 | 구연 발표 |
Long term outcomes of non-functioning right ventricular exclusion in patients with pulmonary atresia and intact ventricular septum
Sang On Lee¹, Tae-Gook Jun¹, June Huh², Jinyoung Song², I-Seok Kang², Ji-Hyuk Yang¹
¹ Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
² Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Purpose : A portion of patients with pulmonary atresia and intact ventricular septum (PAIVS) need to go through univentricular repair. RV exclusion can be performed in these patients to prevent the exacerbation of RV to coronary connections and left ventricular (LV) dysfunction.
Methods : Between 1995 and 2017, 32 patients with PAIVS underwent univentricular repair. 23 patients underwent RV exclusion with systemic-to-pulmonary artery shunt (n=13) or cavo-pulmonary anastomosis (n=10) was performed in 23 patients. Median age at RV exclusion was 65 days (range, 5~420). Median z-value of the tricuspid valve in the exclusion group was -2.65 (range, -0.71~-6.62). The tricuspid valve was closed directly or using a patch. Thrombotic materials were inserted into the RV cavity in eighteen patients.
Results : Median follow-up was 107 months (range, 0~226). There was 3 mortalities, and other 20 patients all completed Fontan operation. Among survivals, postoperative echocardiography showed that LV end-diastolic diameter (23.1 mm vs. 25.68 mm, p=0.035), LV end-diastolic volume (18.69 mL: vs. 25.12 mL, p=0.023), and stroke volume (12.84 mL vs. 17.71 mL, p=0.015) increased significantly. In recent echocardiography, ejection fraction (70.16% vs. 70.79%, p=0.82) and fractional shortening (38.43% vs. 40.12%, p=0.472) showed no significant changes. None showed regional wall motion abnormalities in long term follow up echocardiography.
Conclusion : RV exclusion may have beneficial results on LV systolic function, by avoiding possible ischemia, and on LV diastolic function, by obliterating the non-functioning cavity and enhancing the geometry of the ventricular septum. Long term outcome also seems to be tolerable.
Methods : Between 1995 and 2017, 32 patients with PAIVS underwent univentricular repair. 23 patients underwent RV exclusion with systemic-to-pulmonary artery shunt (n=13) or cavo-pulmonary anastomosis (n=10) was performed in 23 patients. Median age at RV exclusion was 65 days (range, 5~420). Median z-value of the tricuspid valve in the exclusion group was -2.65 (range, -0.71~-6.62). The tricuspid valve was closed directly or using a patch. Thrombotic materials were inserted into the RV cavity in eighteen patients.
Results : Median follow-up was 107 months (range, 0~226). There was 3 mortalities, and other 20 patients all completed Fontan operation. Among survivals, postoperative echocardiography showed that LV end-diastolic diameter (23.1 mm vs. 25.68 mm, p=0.035), LV end-diastolic volume (18.69 mL: vs. 25.12 mL, p=0.023), and stroke volume (12.84 mL vs. 17.71 mL, p=0.015) increased significantly. In recent echocardiography, ejection fraction (70.16% vs. 70.79%, p=0.82) and fractional shortening (38.43% vs. 40.12%, p=0.472) showed no significant changes. None showed regional wall motion abnormalities in long term follow up echocardiography.
Conclusion : RV exclusion may have beneficial results on LV systolic function, by avoiding possible ischemia, and on LV diastolic function, by obliterating the non-functioning cavity and enhancing the geometry of the ventricular septum. Long term outcome also seems to be tolerable.
첨부파일 : PAIVS.pptx
책임저자: Ji-Hyuk Yang
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
발표자: Sang On Lee, E-mail : seanelgon@gmail.com