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
2011 Impact Factor: 4.223
2011 SCImago Journal Rankings: 0.348
DOIhttp://dx.doi.org/10.1136/hrt.2004.033720
ISI Accession Number IDWOS:000228388200020
PubMed Central IDPMC1768866
ReferencesReferences in Scopus
DC Field
Value
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
2011 Impact Factor: 4.223
2011 SCImago Journal Rankings: 0.348
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
Author Affiliations
  1. The University of Hong Kong
  2. Fudan University
  3. Grantham Hospital Hong Kong