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Article: Evolution of the management approach for pulmonary atresia with intact ventricular septum
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TitleEvolution of the management approach for pulmonary atresia with intact ventricular septum
 
AuthorsMi, YP2
Chau, AKT
Chiu, CSW3
Yung, TC
Lun, KS
Cheung, YF1
 
Issue Date2005
 
PublisherB M J Publishing Group. The Journal's web site is located at http://heart.bmjjournals.com/
 
CitationHeart, 2005, v. 91 n. 5, p. 657-663 [How to Cite?]
DOI: http://dx.doi.org/10.1136/hrt.2004.033720
 
AbstractObjective: To review the evolution of the management approach for pulmonary atresia with intact ventricular septum (PAIVS) in the past two decades and to assess its impact on patient outcomes. Design and patients: Retrospective review of the management and outcomes of 94 patients (55 male patients) with PAIVS diagnosed between July 1980 and August 2003. Settings: Tertiary paediatric cardiac centre. Results: Seven patients died before interventions. Of the remaining 87 patients who underwent intervention at a median age of 9 days (from 1 day to 2 years), 12 had right ventricular outflow tract reconstruction (RVOTR), 42 had closed pulmonary valvotomy (CPV), and 15 had laser assisted valvotomy with balloon valvoplasty. A systemic-pulmonary shunt was inserted in 18 patients, six of whom had subsequent RVOTR (n = 4) or laser assisted valvotomy (n = 2). Since 1990, catheter intervention accounted for 38% (17 of 45) of the right ventricular outflow procedures. The mean (SEM) freedom from reintervention was 93 (7)%, 71 (12)%, and 57 (13)% after RVOTR, 75 (7)%, 40 (8)%, and 14 (6)% after CPV, and 54 (13)%, 24 (12)%, and 16 (10)% after laser assisted valvotomy at one month, six months, and one year, respectively (RVOTR versus CPV, p < 0.001; RVOTR versus laser assisted valvotomy, p = 0.001). Low cardiac output syndrome was significantly less common after catheter intervention than after RVOTR (0% v 44%, p = 0.003) or CPV (0% v 29%, p = 0.01). The overall mean (SEM) survival was 77 (5)% and 70 (5)% at one and five years, respectively, and the overall mortality was 33% (29 of 87). There were no significant differences in survival between the three groups. Conclusions: Multiple interventions are often required in the treatment algorithm of PAIVS. The shift towards increased use of the transcatheter approach has reduced the occurrence of postprocedural low cardiac output syndrome.
 
ISSN1355-6037
2013 Impact Factor: 6.023
2013 SCImago Journal Rankings: 2.793
 
DOIhttp://dx.doi.org/10.1136/hrt.2004.033720
 
PubMed Central IDPMC1768866
 
ISI Accession Number IDWOS:000228388200020
 
ReferencesReferences in Scopus
 
DC FieldValue
dc.contributor.authorMi, YP
 
dc.contributor.authorChau, AKT
 
dc.contributor.authorChiu, CSW
 
dc.contributor.authorYung, TC
 
dc.contributor.authorLun, KS
 
dc.contributor.authorCheung, YF
 
dc.date.accessioned2007-01-08T02:30:54Z
 
dc.date.available2007-01-08T02:30:54Z
 
dc.date.issued2005
 
dc.description.abstractObjective: To review the evolution of the management approach for pulmonary atresia with intact ventricular septum (PAIVS) in the past two decades and to assess its impact on patient outcomes. Design and patients: Retrospective review of the management and outcomes of 94 patients (55 male patients) with PAIVS diagnosed between July 1980 and August 2003. Settings: Tertiary paediatric cardiac centre. Results: Seven patients died before interventions. Of the remaining 87 patients who underwent intervention at a median age of 9 days (from 1 day to 2 years), 12 had right ventricular outflow tract reconstruction (RVOTR), 42 had closed pulmonary valvotomy (CPV), and 15 had laser assisted valvotomy with balloon valvoplasty. A systemic-pulmonary shunt was inserted in 18 patients, six of whom had subsequent RVOTR (n = 4) or laser assisted valvotomy (n = 2). Since 1990, catheter intervention accounted for 38% (17 of 45) of the right ventricular outflow procedures. The mean (SEM) freedom from reintervention was 93 (7)%, 71 (12)%, and 57 (13)% after RVOTR, 75 (7)%, 40 (8)%, and 14 (6)% after CPV, and 54 (13)%, 24 (12)%, and 16 (10)% after laser assisted valvotomy at one month, six months, and one year, respectively (RVOTR versus CPV, p < 0.001; RVOTR versus laser assisted valvotomy, p = 0.001). Low cardiac output syndrome was significantly less common after catheter intervention than after RVOTR (0% v 44%, p = 0.003) or CPV (0% v 29%, p = 0.01). The overall mean (SEM) survival was 77 (5)% and 70 (5)% at one and five years, respectively, and the overall mortality was 33% (29 of 87). There were no significant differences in survival between the three groups. Conclusions: Multiple interventions are often required in the treatment algorithm of PAIVS. The shift towards increased use of the transcatheter approach has reduced the occurrence of postprocedural low cardiac output syndrome.
 
dc.description.naturepublished_or_final_version
 
dc.format.extent194049 bytes
 
dc.format.extent4482 bytes
 
dc.format.mimetypeapplication/pdf
 
dc.format.mimetypetext/plain
 
dc.identifier.citationHeart, 2005, v. 91 n. 5, p. 657-663 [How to Cite?]
DOI: http://dx.doi.org/10.1136/hrt.2004.033720
 
dc.identifier.doihttp://dx.doi.org/10.1136/hrt.2004.033720
 
dc.identifier.epage663
 
dc.identifier.hkuros98077
 
dc.identifier.isiWOS:000228388200020
 
dc.identifier.issn1355-6037
2013 Impact Factor: 6.023
2013 SCImago Journal Rankings: 2.793
 
dc.identifier.issue5
 
dc.identifier.openurl
 
dc.identifier.pmcidPMC1768866
 
dc.identifier.pmid15831657
 
dc.identifier.scopuseid_2-s2.0-17644424676
 
dc.identifier.spage657
 
dc.identifier.urihttp://hdl.handle.net/10722/42172
 
dc.identifier.volume91
 
dc.languageeng
 
dc.publisherB M J Publishing Group. The Journal's web site is located at http://heart.bmjjournals.com/
 
dc.publisher.placeUnited Kingdom
 
dc.relation.ispartofHeart
 
dc.relation.referencesReferences in Scopus
 
dc.rightsHeart. Copyright © B M J Publishing Group.
 
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License
 
dc.subject.meshBalloon dilatation - methods - mortality
 
dc.subject.meshPulmonary atresia - therapy
 
dc.subject.meshLaser surgery - methods - mortality
 
dc.subject.meshCardiac surgical procedures - methods - mortality
 
dc.subject.meshRetrospective studies
 
dc.titleEvolution of the management approach for pulmonary atresia with intact ventricular septum
 
dc.typeArticle
 
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Author Affiliations
  1. The University of Hong Kong
  2. Fudan University
  3. Grantham Hospital Hong Kong