Treatment of right ventricle to coronary artery connections in infants with pulmonary atresia and intact ventricular septum

Foker, John E., Setty, Shaun P., Berry, James, Jain, Prachi, Catton, Kirsti, Gittenberger-De-Groot, Adriana C. and Pyles, Lee A. (2008). Treatment of right ventricle to coronary artery connections in infants with pulmonary atresia and intact ventricular septum. In: 33rd Annual Meeting of the Western Thoracic Surgical Association, Santa Ana Pueblo, NM, United States, (749-756). 27-30 June 2007. doi:10.1016/j.jtcvs.2008.03.067


Author Foker, John E.
Setty, Shaun P.
Berry, James
Jain, Prachi
Catton, Kirsti
Gittenberger-De-Groot, Adriana C.
Pyles, Lee A.
Title of paper Treatment of right ventricle to coronary artery connections in infants with pulmonary atresia and intact ventricular septum
Conference name 33rd Annual Meeting of the Western Thoracic Surgical Association
Conference location Santa Ana Pueblo, NM, United States
Conference dates 27-30 June 2007
Journal name Journal of Thoracic and Cardiovascular Surgery   Check publisher's open access policy
Place of Publication Philadelphia, PA, United States
Publisher Mosby
Publication Year 2008
Sub-type Fully published paper
DOI 10.1016/j.jtcvs.2008.03.067
ISSN 0022-5223
1097-685X
1085-8687
Volume 136
Issue 3
Start page 749
End page 756
Total pages 8
Language eng
Formatted Abstract/Summary
Objective

At the severe end of the spectrum of infants with pulmonary atresia and intact ventricular septum, the likelihood of significant right ventricle to coronary artery connections increases. Our purpose is to present the first series of right ventricle to coronary artery connections ligated off bypass before right ventricular decompression and to evaluate the consequences of this approach.
Methods

From 1988 to 2007, 19 patients with pulmonary atresia and intact ventricular septum had a total of 69 right ventricle to coronary artery connections identified preoperatively, and 10 more were located intraoperatively. Of these, 71 were judged large enough to warrant off-pump direct ligation. Preoperative diagnosis was by transthoracic echocardiography and angiography. Transesophageal and surface echocardiography were used for intraoperative location. Direct visualization and echocardiographic assessment for regional wall motion abnormalities determined the effects of ligation. Right ventricular decompression was done in all patients.
Results

After ligation, coronary flow converted from moderately or largely retrograde to antegrade pefusion. Ligation produced no visual myocardial consequences or immediate local wall motion abnormalities. For 3 patients, however, apical-septal wall motion abnormalities appeared from 2 hours to 3 days postoperatively. Serial studies were done to assess the later effects in the 16 of 19 30-day survivors. No evidence for myocardial injury was found, and all continued on a 2-ventricle repair course.
Conclusion

The location and ligation of right ventricle to coronary artery connections can be reliably accomplished off bypass. Coronary flow became antegrade, improving myocardial oxygenation. No myocardial damage was observed. Inapparent right ventricle to coronary artery connections occasionally enlarge secondarily after right ventricular decompression, making early follow-up evaluation necessary after ligation. Despite the initial presence of significant right ventricle to coronary artery connections, 2-ventricle repairs are possible with long-term benefits.
Keyword Management
Circulation
Performance
Mortality
Repair
Q-Index Code E1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Conference Paper
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