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Article: Evolution of the management approach for pulmonary atresia with intact ventricular septum

TitleEvolution of the management approach for pulmonary atresia with intact ventricular septum
Authors
Issue Date2005
PublisherB M J Publishing Group. The Journal's web site is located at http://heart.bmjjournals.com/
Citation
Heart, 2005, v. 91 n. 5, p. 657-663 How to Cite?
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.
Persistent Identifierhttp://hdl.handle.net/10722/42172
ISSN
2014 Impact Factor: 5.595
2013 SCImago Journal Rankings: 2.793
PubMed Central ID
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorMi, YPen_HK
dc.contributor.authorChau, AKTen_HK
dc.contributor.authorChiu, CSWen_HK
dc.contributor.authorYung, TCen_HK
dc.contributor.authorLun, KSen_HK
dc.contributor.authorCheung, YFen_HK
dc.date.accessioned2007-01-08T02:30:54Z-
dc.date.available2007-01-08T02:30:54Z-
dc.date.issued2005en_HK
dc.identifier.citationHeart, 2005, v. 91 n. 5, p. 657-663en_HK
dc.identifier.issn1355-6037en_HK
dc.identifier.urihttp://hdl.handle.net/10722/42172-
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.en_HK
dc.format.extent194049 bytes-
dc.format.extent4482 bytes-
dc.format.mimetypeapplication/pdf-
dc.format.mimetypetext/plain-
dc.languageengen_HK
dc.publisherB M J Publishing Group. The Journal's web site is located at http://heart.bmjjournals.com/en_HK
dc.relation.ispartofHearten_HK
dc.rightsHeart. Copyright © B M J Publishing Group.en_HK
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.subject.meshBalloon dilatation - methods - mortalityen_HK
dc.subject.meshPulmonary atresia - therapyen_HK
dc.subject.meshLaser surgery - methods - mortalityen_HK
dc.subject.meshCardiac surgical procedures - methods - mortalityen_HK
dc.subject.meshRetrospective studiesen_HK
dc.titleEvolution of the management approach for pulmonary atresia with intact ventricular septumen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=1355-6037&volume=91&issue=5&spage=657&epage=663&date=2005&atitle=Evolution+of+the+management+approach+for+pulmonary+atresia+with+intact+ventricular+septumen_HK
dc.identifier.emailCheung, YF:xfcheung@hku.hken_HK
dc.identifier.authorityCheung, YF=rp00382en_HK
dc.description.naturepublished_or_final_versionen_HK
dc.identifier.doi10.1136/hrt.2004.033720en_HK
dc.identifier.pmid15831657en_HK
dc.identifier.pmcidPMC1768866-
dc.identifier.scopuseid_2-s2.0-17644424676en_HK
dc.identifier.hkuros98077-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-17644424676&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume91en_HK
dc.identifier.issue5en_HK
dc.identifier.spage657en_HK
dc.identifier.epage663en_HK
dc.identifier.isiWOS:000228388200020-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.scopusauthoridMi, YP=8363663200en_HK
dc.identifier.scopusauthoridChau, AKT=35787094400en_HK
dc.identifier.scopusauthoridChiu, CSW=8714554800en_HK
dc.identifier.scopusauthoridYung, TC=9132842300en_HK
dc.identifier.scopusauthoridLun, KS=8363663600en_HK
dc.identifier.scopusauthoridCheung, YF=7202111067en_HK

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