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2. Bilateral remote ischemic conditioning in children: A two-center, double-blind, randomized controlled trial in young children undergoing cardiac surgery

Author

Carver, Edmund D., Cranston, Alistair J., Harban, Fraser, Rolo, Vasco Laginha, Marcus, Ritchie, Moriarty, Anthony, Reddy, Raju, Ritchie-McLean, Susanna N., Stokes, Monica A., Thillaivasan, Ayngara, Bhatia, Nandlal, Bodlani, Carol, Lim, Wendy, Mellor, Joe, Scheffczik, Jutta, Drury, Nigel E., van Doorn, Carin, Woolley, Rebecca L., Amos-Hirst, Rebecca J., Bi, Rehana, Spencer, Collette M., Morris, Kevin P., Montgomerie, James, Stickley, John, Crucean, Adrian, Gill, Alicia, Hill, Matt, Weber, Ralf J.M., Najdekr, Lukas, Jankevics, Andris, Southam, Andrew D., Lloyd, Gavin R., Jaber, Osama, Kassai, Imre, Pelella, Giuseppe, Khan, Natasha E., Botha, Phil, Barron, David J., Madhani, Melanie, Dunn, Warwick B., Ives, Natalie J., Kirchhof, Paulus, and Jones, Timothy J.

Published
2024
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5. Bilateral remote ischemic conditioning in children: A two-center, double-blind, randomized controlled trial in young children undergoing cardiac surgery

Author

Drury, Nigel E., primary, van Doorn, Carin, additional, Woolley, Rebecca L., additional, Amos-Hirst, Rebecca J., additional, Bi, Rehana, additional, Spencer, Collette M., additional, Morris, Kevin P., additional, Montgomerie, James, additional, Stickley, John, additional, Crucean, Adrian, additional, Gill, Alicia, additional, Hill, Matt, additional, Weber, Ralf J.M., additional, Najdekr, Lukas, additional, Jankevics, Andris, additional, Southam, Andrew D., additional, Lloyd, Gavin R., additional, Jaber, Osama, additional, Kassai, Imre, additional, Pelella, Giuseppe, additional, Khan, Natasha E., additional, Botha, Phil, additional, Barron, David J., additional, Madhani, Melanie, additional, Dunn, Warwick B., additional, Ives, Natalie J., additional, Kirchhof, Paulus, additional, Jones, Timothy J., additional, Carver, Edmund D., additional, Cranston, Alistair J., additional, Harban, Fraser, additional, Rolo, Vasco Laginha, additional, Marcus, Ritchie, additional, Moriarty, Anthony, additional, Reddy, Raju, additional, Ritchie-McLean, Susanna N., additional, Stokes, Monica A., additional, Thillaivasan, Ayngara, additional, Bhatia, Nandlal, additional, Bodlani, Carol, additional, Lim, Wendy, additional, Mellor, Joe, additional, and Scheffczik, Jutta, additional

Published
2024
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9. Revisiting the anatomy of the right ventricle in the light of knowledge of its development.

Author

Crucean, Adrian, Spicer, Diane E., Tretter, Justin T., Mohun, Timothy J., and Anderson, Robert H.

Subjects
*HEART septum, *ANATOMY, *HUMAN embryos, *TRICUSPID valve, *HEART
Abstract

Controversies continue regarding several aspects of the anatomy of the morphologically right ventricle. There is disagreement as to whether the ventricle should be assessed in bipartite or tripartite fashion, and the number of leaflets to be found in the tricuspid valve. In particular, there is no agreement as to whether a muscular outlet septum is present in the normally constructed heart, nor how many septal components are to be found during normal development. Resolving these issues is of potential significance to those investigating and treating children with congenitally malformed hearts. With all these issues in mind, we have revisited our own experience in investigating the development and morphology of the normal right ventricle. To assess development, we have examined a large number of datasets, prepared by both standard and episcopic microscopy, from human and murine embryos. In terms of gross anatomy, we have compared dissections of normal autopsied hearts with virtual dissections of datasets prepared using computed tomography. Our developmental and postnatal studies, taken together, confirm that the ventricle is best assessed in tripartite fashion, with the three parts representing its inlet, apical trabecular, and outlet components. The ventricular septum, however, has only muscular and membranous components. The muscular part incorporates a small component derived from the muscularised fused proximal outflow cushions, but this part cannot be distinguished from the much larger part that is incorporated within the free‐standing muscular infundibular sleeve. We confirm that the tricuspid valve itself has three components, which are located inferiorly, septally, and antero‐superiorly. [ABSTRACT FROM AUTHOR]

Published
2024
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11. Expert Consensus Statement: Anatomy, Imaging, and Nomenclature of Congenital Aortic Root Malformations

Author

Tretter, Justin T., primary, Spicer, Diane E., additional, Franklin, Rodney C. G., additional, Béland, Marie J., additional, Aiello, Vera D., additional, Cook, Andrew C., additional, Crucean, Adrian, additional, Loomba, Rohit S., additional, Yoo, Shi-Joon, additional, Quintessenza, James A., additional, Tchervenkov, Christo I., additional, Jacobs, Jeffrey P., additional, Najm, Hani K., additional, and Anderson, Robert H., additional

Published
2023
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12. The Bilateral Remote Ischaemic Conditioning in Children (BRICC) trial: a two-centre, double-blind, randomised controlled trial in young children undergoing cardiac surgery

Author

Drury, Nigel E, primary, van Doorn, Carin, additional, Woolley, Rebecca L, additional, Amos-Hirst, Rebecca J, additional, Bi, Rehana, additional, Spencer, Collette M, additional, Morris, Kevin P, additional, Montgomerie, James, additional, Stickley, John, additional, Crucean, Adrian, additional, Gill, Alicia, additional, Hill, Matt, additional, Weber, Ralf JM, additional, Najdekr, Lukas, additional, Jankevics, Andris, additional, Southam, Andrew D, additional, Lloyd, Gavin R, additional, Jaber, Osama, additional, Kassai, Imre, additional, Pelella, Guiseppe, additional, Khan, Natasha E, additional, Botha, Phil, additional, Barron, David J, additional, Madhani, Melanie, additional, Dunn, Warwick B, additional, Ives, Natalie J, additional, Kirchhof, Paulus, additional, and Jones, Timothy J, additional

Published
2023
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18. Nomenclature for Pediatric and Congenital Cardiac Care: Unification of Clinical and Administrative Nomenclature – The 2021 International Paediatric and Congenital Cardiac Code (IPCCC) and the Eleventh Revision of the International Classification of Diseases (ICD-11)

Author

Jacobs, Jeffrey P., primary, Franklin, Rodney C. G., additional, Béland, Marie J., additional, Spicer, Diane E., additional, Colan, Steven D., additional, Walters, Henry L., additional, Bailliard, Frédérique, additional, Houyel, Lucile, additional, St. Louis, James D., additional, Lopez, Leo, additional, Aiello, Vera D., additional, Gaynor, J. William, additional, Krogmann, Otto N., additional, Kurosawa, Hiromi, additional, Maruszewski, Bohdan J., additional, Stellin, Giovanni, additional, Weinberg, Paul Morris, additional, Jacobs, Marshall Lewis, additional, Boris, Jeffrey R., additional, Cohen, Meryl S., additional, Everett, Allen D., additional, Giroud, Jorge M., additional, Guleserian, Kristine J., additional, Hughes, Marina L., additional, Juraszek, Amy L., additional, Seslar, Stephen P., additional, Shepard, Charles W., additional, Srivastava, Shubhika, additional, Cook, Andrew C., additional, Crucean, Adrian, additional, Hernandez, Lazaro E., additional, Loomba, Rohit S., additional, Rogers, Lindsay S., additional, Sanders, Stephen P., additional, Savla, Jill J., additional, Tierney, Elif Seda Selamet, additional, Tretter, Justin T., additional, Wang, Lianyi, additional, Elliott, Martin J., additional, Mavroudis, Constantine, additional, and Tchervenkov, Christo I., additional

Published
2021
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19. Supplemental Material, sj-pdf-1-pch-10.1177_21501351211032919 - Nomenclature for Pediatric and Congenital Cardiac Care: Unification of Clinical and Administrative Nomenclature – The 2021 International Paediatric and Congenital Cardiac Code (IPCCC) and the Eleventh Revision of the International Classification of Diseases (ICD-11)

Author

Jacobs, Jeffrey P., Franklin, Rodney C. G., Béland, Marie J., Spicer, Diane E., Colan, Steven D., Walters, Henry L., Bailliard, Frédérique, Houyel, Lucile, St. Louis, James D., Lopez, Leo, Aiello, Vera D., Gaynor, J. William, Krogmann, Otto N., Kurosawa, Hiromi, Maruszewski, Bohdan J., Stellin, Giovanni, Weinberg, Paul Morris, Jacobs, Marshall Lewis, Boris, Jeffrey R., Cohen, Meryl S., Everett, Allen D., Giroud, Jorge M., Guleserian, Kristine J., Hughes, Marina L., Juraszek, Amy L., Seslar, Stephen P., Shepard, Charles W., Srivastava, Shubhika, Cook, Andrew C., Crucean, Adrian, Hernandez, Lazaro E., Loomba, Rohit S., Rogers, Lindsay S., Sanders, Stephen P., Savla, Jill J., Tierney, Elif Seda Selamet, Tretter, Justin T., Wang, Lianyi, Elliott, Martin J., Mavroudis, Constantine, and Tchervenkov, Christo I.

Subjects
FOS: Clinical medicine, Cardiology, 110323 Surgery, 111403 Paediatrics
Abstract

Supplemental Material, sj-pdf-1-pch-10.1177_21501351211032919 for Nomenclature for Pediatric and Congenital Cardiac Care: Unification of Clinical and Administrative Nomenclature – The 2021 International Paediatric and Congenital Cardiac Code (IPCCC) and the Eleventh Revision of the International Classification of Diseases (ICD-11) by Jeffrey P. Jacobs, Rodney C. G. Franklin, Marie J. Béland, Diane E. Spicer, Steven D. Colan, Henry L. Walters, Frédérique Bailliard, Lucile Houyel, James D. St. Louis, Leo Lopez, Vera D. Aiello, J. William Gaynor, Otto N. Krogmann, Hiromi Kurosawa, Bohdan J. Maruszewski, Giovanni Stellin, Paul Morris Weinberg, Marshall Lewis Jacobs, Jeffrey R. Boris, Meryl S. Cohen, Allen D. Everett, Jorge M. Giroud, Kristine J. Guleserian, Marina L. Hughes, Amy L. Juraszek, Stephen P. Seslar, Charles W. Shepard, Shubhika Srivastava, Andrew C. Cook, Adrian Crucean, Lazaro E. Hernandez, Rohit S. Loomba, Lindsay S. Rogers, Stephen P. Sanders, Jill J. Savla, Elif Seda Selamet Tierney, Justin T. Tretter, Lianyi Wang, Martin J. Elliott, Constantine Mavroudis and Christo I. Tchervenkov in World Journal for Pediatric and Congenital Heart Surgery

Published
2021
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32. Classification of Ventricular Septal Defects for the Eleventh Iteration of the International Classification of Diseases—Striving for Consensus: A Report From the International Society for Nomenclature of Paediatric and Congenital Heart Disease

Author

Lopez, Leo, primary, Houyel, Lucile, additional, Colan, Steven D., additional, Anderson, Robert H., additional, Béland, Marie J., additional, Aiello, Vera D., additional, Bailliard, Frederique, additional, Cohen, Meryl S., additional, Jacobs, Jeffrey P., additional, Kurosawa, Hiromi, additional, Sanders, Stephen P., additional, Walters, Henry L., additional, Weinberg, Paul M., additional, Boris, Jeffrey R., additional, Cook, Andrew C., additional, Crucean, Adrian, additional, Everett, Allen D., additional, Gaynor, J. William, additional, Giroud, Jorge, additional, Guleserian, Kristine J., additional, Hughes, Marina L., additional, Juraszek, Amy L., additional, Krogmann, Otto N., additional, Maruszewski, Bohdan J., additional, St. Louis, James D., additional, Seslar, Stephen P., additional, Spicer, Diane E., additional, Srivastava, Shubhika, additional, Stellin, Giovanni, additional, Tchervenkov, Christo I., additional, Wang, Lianyi, additional, and Franklin, Rodney C.G., additional

Published
2018
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33. Defining transposition: What have we learnt?

Author

Roderick, Max, Maria, Nikita, Crucean, Adrian, Stickley, John, Barron, David, and Anderson, Robert

Subjects
HEART ventricle abnormalities, CORONARY artery abnormalities, HEART atrium, TRANSPOSITION of great vessels
Abstract

Understanding transposition is important for all who hope to effectively treat patients with the condition. The variants of the condition are frequently debated in the literature. We describe an unusual variant of transposition, in which despite the arterial roots being supported by morphologically inappropriate ventricles, the roots themselves were normally related, with the intrapericardial arterial trunks spiraling as they extended into the mediastinum. The specimen was identified following the re-categorization of our archive, and we subsequently conducted a detailed analysis of the underlying morphology. Using the principles of sequential segmental analysis, we compared the morphology with standard examples previously described. We show how it was the recognition of such hearts that promoted that concept that the combination of connections across the atrioventricular and ventriculo-arterial junctions was the essence of transposition. In the most common variant, the arrangements are concordant at the atrioventricular junctions, but discordant at the ventriculo-arterial junctions. We suggest that the overall arrangement of discordant ventriculo-arterial connections is best described simply as "transposition." When the discordant ventriculo-arterial connections are combined with similarly discordant connections at the atrioventricular junctions, the transposition is congenitally corrected. We point out that the use of "d" and "l" as prefixes does not distinguish between transposition and its congenitally corrected variant. For those using segmental notations, the correct description for the rare variant found in the setting of a posteriorly located aortic root with the usual atrial arrangement is transposition (S, D, NR). [ABSTRACT FROM AUTHOR]

Published
2021
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34. Nomenclature for Pediatric and Congenital Cardiac Care: Unification of Clinical and Administrative Nomenclature – The 2021 International Paediatric and Congenital Cardiac Code (IPCCC) and the Eleventh Revision of the International Classification of Diseases (ICD-11)

Author

Jacobs, Jeffrey P., Franklin, Rodney C. G., Béland, Marie J., Spicer, Diane E., Colan, Steven D., Walters, Henry L., Bailliard, Frédérique, Houyel, Lucile, St. Louis, James D., Lopez, Leo, Aiello, Vera D., Gaynor, J. William, Krogmann, Otto N., Kurosawa, Hiromi, Maruszewski, Bohdan J., Stellin, Giovanni, Weinberg, Paul Morris, Jacobs, Marshall Lewis, Boris, Jeffrey R., Cohen, Meryl S., Everett, Allen D., Giroud, Jorge M., Guleserian, Kristine J., Hughes, Marina L., Juraszek, Amy L., Seslar, Stephen P., Shepard, Charles W., Srivastava, Shubhika, Cook, Andrew C., Crucean, Adrian, Hernandez, Lazaro E., Loomba, Rohit S., Rogers, Lindsay S., Sanders, Stephen P., Savla, Jill J., Tierney, Elif Seda Selamet, Tretter, Justin T., Wang, Lianyi, Elliott, Martin J., Mavroudis, Constantine, and Tchervenkov, Christo I.

Abstract

AbstractSubstantial progress has been made in the standardization of nomenclature for paediatric and congenital cardiac care. In 1936, Maude Abbott published her Atlas of Congenital Cardiac Disease, which was the first formal attempt to classify congenital heart disease. The International Paediatric and Congenital Cardiac Code(IPCCC) is now utilized worldwide and has most recently become the paediatric and congenital cardiac component of the Eleventh Revision of the International Classification of Diseases(ICD-11). The most recent publication of the IPCCCwas in 2017. This manuscript provides an updated 2021 version of the IPCCC.The International Society for Nomenclature of Paediatric and Congenital Heart Disease(ISNPCHD), in collaboration with the World Health Organization (WHO), developed the paediatric and congenital cardiac nomenclature that is now within the eleventh version of the International Classification of Diseases (ICD-11). This unification of IPCCCand ICD-11 is the IPCCC ICD-11 Nomenclatureand is the first time that the clinical nomenclature for paediatric and congenital cardiac care and the administrative nomenclature for paediatric and congenital cardiac care are harmonized. The resultant congenital cardiac component of ICD-11 was increased from 29 congenital cardiac codes in ICD-9 and 73 congenital cardiac codes in ICD-10 to 318 codes submitted by ISNPCHDthrough 2018 for incorporation into ICD-11. After these 318 terms were incorporated into ICD-11 in 2018, the WHOICD-11 team added an additional 49 terms, some of which are acceptable legacy terms from ICD-10, while others provide greater granularity than the ISNPCHDthought was originally acceptable. Thus, the total number of paediatric and congenital cardiac terms in ICD-11 is 367. In this manuscript, we describe and review the terminology, hierarchy, and definitions of the IPCCC ICD-11 Nomenclature. This article, therefore, presents a global system of nomenclature for paediatric and congenital cardiac care that unifies clinical and administrative nomenclature.The members of ISNPCHDrealize that the nomenclature published in this manuscript will continue to evolve. The version of the IPCCCthat was published in 2017 has evolved and changed, and it is now replaced by this 2021 version. In the future, ISNPCHDwill again publish updated versions of IPCCC, as IPCCCcontinues to evolve.

Published
2021
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36. Contributors

Author

Afifi, Ahmed, Aiello, Vera D., Allen, Kiona, Alsaied, Tarek, Anderson, Jeffrey, Anderson, Robert H., Apitz, Christian, Asija, Ritu, Backer, Carl L., Baker, Annette, Bamforth, Simon D., de Faria, Guilherme Baptista, Barron, David J., Bates, Katherine E., Benson, Lee N., Berger, John Torrey, III, Berger, Stuart, Block, Joseph R., Brawn, William J., Brizard, Christian P., Bronicki, Ronald A., Brothers, Julie, Brown, David W., Brown, Nigel A., Bruneau, Benoit G., Bryant, Roosevelt, III, Bryant-Stephens, Tyra, Burn, John, Bryant, Roosevelt G., III, Calcagni, Giulio, Caldarone, Christopher, Camarda, Joseph A., Cameron, Duke E., Chaouki, Ahmad Sami, Cheung, Yiu-Fai, Christov, Georgi, Chung, Michael, Cohen, Mitchell I., Colman, Jack M., Crucean, Adrian, Daubeney, Piers E.F., Davis, Sarah Prochaska, Dayton, Jeffrey D., Dearani, Joseph, Dees, Lynn, Digilio, M. Cristina, Dionne, Audrey, Dipchand, Anne I., Dixon, Garth, d'Udekem, Yves, Ebels, Tjark, ElGuindy, Ahmed M., Elias, Barbara A., English, Robert, Etheridge, Susan P., Fisk, Anna, Flores, Saul, Fraser, Charles D., III, Freud, Lindsay R., Gentles, Thomas L., Jaeggi, Edgar, Gardiner, Helena M., Ghanayem, Nancy S., Giesinger, Regan E., Ginde, Salil, Goldberg, David J., Goldstein, Bryan H., Goldstein, Stuart L., Gowda, Srinath T., Green, Amanda S., Grogan, Kelly L., Grosse, Scott D., Gruber, Peter, Gupta, Saurabh K., Haller, Christoph, Hanley, Frank L., Harris, Matthew, Hayman, Laura, Hilton-Kamm, Debra, Hlavacek, Anthony M., Ho, Deborah Y., Hoffman, George M., Holzer, Ralf J., Hornberger, Lisa K., Hraska, Viktor, Hugo-Hamman, Christopher, Iyer, Krishna, Iyer, Parvathi, Jacobs, Marshall, James, Jeanne, Jefferies, John Lynn, Johnson, Joyce Tawfik, Jokhadar, Maan, Justino, Henri, Kasparian, Nadine A., Khoury, Michael, Kirk, Richard, Kirsch, Roxanne, Koffarnus, Mara, Kostolny, Martin, Kropf, Paulette Andrea, Kumar, Krishna, Kyle, William B., Lannon, Carole, Licht, Daniel J., Lihn, Stacey, Loepke, Andreas W., Loomba, Rohit S., Ma, Michael, Madrigal, Vanessa, Marcondes, Luciana, Marino, Bradley S., Marino, Bruno, Marshall, Audrey C., McBride, Michael G., McBrien, Angela, McCrindle, Brian W., McElhinney, Doff B., McNamara, Patrick J., Mertens, Luc L., Milano, Elena G., Miller, Kelley D., Mohun, Timothy J., Mokshagundam, Deepa, Moore, Ryan A., Morales, David L.S., Morgan, Conall T., Moon, Thomas, Moons, Philip, Mori, Shumpei, Mota, Cleonice, Muñiz, Juan-Carlos G., Mussatto, Kathleen, Naim, Maryam Y., Newburger, Jane W., Newkirk, Betsy, O'Leary, Patrick W., Olen, Melissa, Opotowsky, Alexander R., Oster, Matthew E., Paridon, Stephen M., Pasquali, Sara K., Penny, Daniel J., Perak, Amanda M., Perlow, Gabriel, Petit, Christopher J., Phillips, Alistair, Pinto, Nelangi M., Poh, Chin Leng, Presnell, Laura, Quail, Michael A., Qureshi, Athar M., Raczka, Lauren E., Reagor, James A., Rebolledo, Michael, Redington, Andrew N., Reid, Christopher, Remenyi, Bo, Rhodes, John F., Rice, Kathryn, Riggs, Kyle W., Riley, Christine M., Robbins, Jeffrey, Rossano, Joseph W., Rudd, Nancy A., Ryan, Thomas D., Rychik, Jack, Sable, Craig, Salvin, Joshua W., Satou, Gary, Savoca, Melanie Lyn, Saxena, Anita, Schmelzer, Anne C., Schmidt, Julie, Schumacher, Kurt R., Seed, Mike, Sermer, Mathew, Shaddy, Robert E., Shah, Sanket, Shekerdemian, Lara S., Shirali, Girish S., Siegel, Bryan, Silversides, Candice, Simpson, John, Sinha, Manish D., Siu, Samuel, Skinner, Jonathan, Smith, Liz, Soquet, Jerome, Spicer, Diane E., Srivastava, Deepak, Stephens, Paul, Jr, St. George-Hyslop, Cecilia, Stumper, Oliver, Szwast, Anita, Tanem, Jena, Taylor, Andrew M., Tretter, Justin T., Tweddell, James S., Tworetzky, Wayne, Unolt, Marta, Urbina, Elaine, Utens, Elisabeth M.W.J., Van, Glen S., Vanderlaan, Rachel D., Verghese, George, Versacci, Paolo, Villa, Chet Ridall, Vricella, Luca A., Wagner, Jonathan, Webster, Gregory, Wernovsky, Gil, Wilson, Nigel, Wise-Faberowski, Lisa, Yacub, Magdi, and Yoo, Shi-Joon

Published
2020
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39. Double Outlet Right Ventricle With Right-Sided Aorta From the Left-Sided Morphologically Right Ventricle in the Setting of Discordant Atrioventricular Connections

Author

Talwar, Sachin, Anderson, Robert H., Bhoje, Amolkumar, Crucean, Adrian, Gupta, Saurabh Kumar, Choudhary, Shiv Kumar, and Airan, Balram

Abstract

We describe the anatomic findings in a 2-year-old patient with double outlet right ventricle with right-sided aorta in the setting of usual atrial arrangement and discordant atrioventricular connections, making comparison with a specimen from the pathological archive of the Birmingham Children’s Hospital in the United Kingdom having this rare combination of anatomic features. We discuss the challenges involved in diagnosis and management.

Published
2020
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41. An Unusual Combination of Double Inlet Left Ventricle With Discordant Ventriculoarterial Connections and Bilateral Arterial Ducts

Author

Alpat, Safak, Crucean, Adrian, Desai, Tarak, McGuirk, Simon, Anderson, Robert H., Botha, Phil, and Barron, David

Abstract

The presence of bilaterally persistent arterial ducts is an uncommon abnormality. Here, we describe the anatomy and successful management of an unusual patient with bilateral ducts in the setting of double inlet left ventricle, discordant ventriculoarterial connections, aortic atresia, and a severely hypoplastic and serpentine aortic arch.

Published
2020
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49. Postoperative outcome in patients with anomalous origin of one pulmonary artery branch from the aorta

Author

Prifti, Edvin, Crucean, Adrian, Bonacchi, Massimo, Bernabei, Massimo, Leacche, Marzia, Murzi, Bruno, Bartolozzi, Fabio, and Vanini, Vittorio

Subjects
*AORTA, *OPERATIVE surgery
Abstract

Objectives: The aim was to review our experience with the surgical repair of the anomalous origin of one pulmonary branch from the aorta (AOPA). Materials and method: Between January 1991 and March 2002, eight patients with AOPA underwent surgical correction. Three patients presented isolated AOPA. Five patients presented right AOPA and three, left AOPA. Implantation of the AOPA to the main pulmonary artery was performed by: (I) direct anastomosis in two patients with left AOPA; (II) interposition of a synthetic graft in one patient with left AOPA; (III) employing an autologous pericardial patch in two patients with right AOPA; (IV) using an aortic flap in three other patients with right AOPA. The mean follow-up time was 37.7 months. Results: One patient died postoperatively due to progressive heart failure unresponsive to inotropic support. Early postoperative pulmonary hypertension crisis was identified in another patient. Within 1 year after surgery, the mean residual gradient across the anastomotic site at follow-up was 14±8 mmHg. The patient undergoing interposition of a synthetic graft presented a residual gradient of 29 mmHg and underwent reoperation at almost 2.5 years after the first correction. The residual gradient in patients undergoing correction according to technique I was 17±3 mmHg, and in patients undergoing implantation of the AOPA according to techniques III or IV was 9.5±4.6 mmHg (P=0.11). Similarly, the Tc-99m scintigraphy demonstrated that a lower lung perfusion (the lung perfused from the respective AOPA compared with the contralateral lung) in patients undergoing AOPA implantation according to technique I was 59±6(%) and in patients undergoing techniques III or IV was 72±4.5(%) (P=0.038). At follow-up, all patients were alive. Conclusion: The AOPA from the aorta is a rare but important entity, necessitating a scrupulous preoperative and intraoperative evaluation. Patients presenting this anomaly may undergo correction using various surgical techniques with acceptable results. The techniques employing autologous tissues for enlarging and lengthening the AOPA seems to be associated with less restenosis at the anastomotic site, however, larger series of patients are required to confirm such outcome. [Copyright &y& Elsevier]

Published
2003
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50. Early and long term outcome of the arterial switch operation for transposition of the great arteries: predictors and functional evaluation

Author

Prifti, Edvin, Crucean, Adrian, Bonacchi, Massimo, Bernabei, Massimo, Murzi, Bruno, Luisi, Stefano Vincenzo, and Vanini, Vittorio

Subjects
*TRANSPOSITION of great vessels, *PULMONARY stenosis
Abstract

Objectives: The aims of this report were to study the early and late outcome in terms of mortality, freedom from reoperation, predictors for late pulmonary stenosis (PAS) and insufficiency of the neo-aortic valve (AVI) in patients with transposition of the great arteries (TGA) undergoing arterial switch operation (ASO). Materials and methods: Between January 1990 and December 2001, 134 patients with TGA underwent ASO. The patients were divided in Group I (n=88)-TGA with intact ventricular septum and Group II (n=46)-TGA with ventricular septal defect (VSD). The pulmonary artery was reconstructed employing the direct anastomosis technique (PT-I) in 21 (15.7%) patients, the double-patch technique (PT-II) in 41 (30.6%), single pantaloon patch (partial circumference) (PT-III) in 46 (34%) and single pantaloon patch (total circumference) (PT-IV) in 35 (26%) patients. The mean follow-up was 3.4±1.3 years. Results: The hospital mortality was 17 (12.7%) patients. The mortality in Group I was significantly lower than Group II (P=0.002). The overall actuarial survival at 1, 3 and 5 years follow-up resulted to be 98, 93, and 91.5%, resulting to be significantly higher in Group I (P=0.032). The multivariate analysis revealed the complex TGA (P=0.007), VSD (P=0.032), coronary anomalies (P=0.004), aortic coarctation or hypoplastic aortic arch (P=0.021), left ventricular outflow tract obstruction (LVOTO) or moderate PAS (P=0.041) as strong predictors for poor free-reoperation cumulative survival. A strong inverse correlation was found between the mean trans-pulmonary gradient at follow-up and the age at the operation (r=−0.41, P<0.0001). The univariate analysis revealed the PT-I technique (P=0.002), prior moderate PAS (P=0.0001), and age <1 month (P=0.018) as strong predictors for moderate-to-severe PAS. The neo-AVI incidence was significantly higher in Group II (P=0.011). Predictors for neo-AVI were male sex (P=0.003), preoperative neo-AV Z-score >1 (P<0.001), prior or concomitant operation for aortic coarctation or hypoplastic aortic arch (P=0.001), LV retraining (P=0.003). Conclusion: ASO remains the procedure of choice for the treatment of various forms of TGA with acceptable early and later outcome in terms of overall survival and free reoperation. Strong predictors for poor overall free-reoperation survival are complex TGA, VSD, coronary anomalies, aortic coarctation and LVOTO or moderate PAS. The pulmonary artery reconstruction using a single ‘pantaloon patch’ seems to offer less residual stenosis. Patients with a VSD and a significant mismatch between the neo-aortic root and distal aorta are at a higher risk for developing postoperative neo-AVI. [Copyright &y& Elsevier]

Published
2002
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