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J Thorac Cardiovasc Surg 2005;130:1071
© 2005 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Pulmonary atresia with intact ventricular septum: Predictors of early and medium-term outcome in a population-based study

^a Royal Brompton Hospital, London, United Kingdom
^b National Heart and Lung Institute, Imperial College, London, United Kingdom
^c Wessex Cardiothoracic Centre, Southampton General Hospital, Southampton, United Kingdom
^d London School of Hygiene and Tropical Medicine, London, United Kingdom
^e Institute of Child Health, University College, University of London, London, United Kingdom
^f Children's Hospital of Pittsburgh, Pittsburgh, Pa.

Received for publication September 30, 2004; revisions received May 15, 2005; accepted for publication May 18, 2005.

^_* Address for reprints: Piers Daubeney, MRCP, Royal Brompton Hospital, Sydney St, London, SW3 6NP. (Email: p.daubeney{at}rbh.nthames.nhs.uk).

OBJECTIVES: Pulmonary atresia with intact ventricular septum is a form of congenital heart disease usually associated with right-heart hypoplasia, with considerable morphologic heterogeneity and often poor outlook. Ascertainment of risk factors for poor outcome is an important step if an improvement in outcome is to be achieved.

METHODS: The UK and Ireland Collaborative study of Pulmonary Atresia with Intact Ventricular Septum is an ongoing population-based study of all patients born with this disease from 1991 through 1995. All available clinical, morphologic, and investigative variables were directly reviewed, and risk factor analysis was performed for poor outcome.

RESULTS: One hundred eighty-three patients presented with pulmonary atresia with intact ventricular septum. Fifteen underwent no procedure, and all died. Of the remainder, 67 underwent a right ventricular outflow tract procedure (catheter or surgical), 18 underwent an outflow tract procedure with shunt, and 81 underwent a systemic-to-pulmonary shunt alone. One- and 5-year survival was 70.8% and 63.8%, respectively. Results from Cox proportional hazards model analysis showed that low birth weight (P = .024), unipartite right ventricular morphology (P = .001), and the presence of a dilated right ventricle (P < .001) were independent risk factors for death. The presence of coronary artery fistulae, right ventricular dependence, or the tricuspid valvar z score did not prove to be risk factors for death. After up to 9 years of follow-up, 29% have achieved a biventricular repair, 3% a so-called one-and-a-half ventricular repair, and 10.5% a univentricular repair, with 16.5% still having a mixed circulation (41% died).

CONCLUSIONS: This population-based study has shown which features at presentation place an infant in a high-risk group. This is important information for counseling in fetal life and for surgical strategy after birth.

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