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The Journal of Thoracic and Cardiovascular Surgery, Vol 88, 610-619, Copyright © 1984 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
S Nakata, Y Imai, Y Takanashi, H Kurosawa, K Tezuka, M Nakazawa, M Ando and A Takao
A new angiographic method for quantitative standardization of cross-
sectional area of bilateral pulmonary arteries, the PA-index, and
retrospective analysis of the PA-index in different types of operative
procedures are presented. This study included 40 subjects in the normal
control group, 46 patients in the tetralogy group, 26 patients in the
Rastelli group, and 15 patients in the Fontan group. The normal value of
the PA-index was 330 +/- 30 mm2/BSA and was consistent in a wide range of
body surface areas from infancy to adolescence. The PA-index in the
tetralogy and Rastelli groups ranged from 100 to 400 mm2/BSA. There were no
early deaths in the tetralogy group, but the incidence of low cardiac
output was higher in patients with a smaller PA-index, especially when the
PA-index was less than 150 mm2/BSA. Low cardiac output was more severe in
the Rastelli group. The operative mortality was significantly affected by
the PA-index. In the Rastelli group, all of the patients with a PA-index of
less than 200 mm2/BSA died, whereas the mortality rate in patients with a
PA-index of more than 200 was only 6% (p less than 0.01). The mortality
rate was not influenced by any other factors, such as aortic cross-clamp
time or age at operation. In the Fontan group, two patients with a PA-index
of less than 250 mm2/BSA died of severe heart failure, and 12 of 13
patients with a PA- index of more than 250 survived (p less than 0.01). Our
results indicated the validity of the PA-index in predicting the
postoperative prognosis of the various entities. In tetralogy, all patients
with a PA- index over 100 mm2/BSA can undergo correction safely; in
Rastelli operation, those with a PA-index under 200 should have a
palliative procedure first, whereas those with a PA-index over 250 can be
considered good candidates for the Fontan procedure. The PA-index may also
serve a useful guide in comparing surgical results from different
institutions with patients having anomalies of varying severity.
ARTICLES
A new method for the quantitative standardization of cross-sectional areas of the pulmonary arteries in congenital heart diseases with decreased pulmonary blood flow
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Y. Imai, Y. Takanashi, S. Hoshino, M. Terada, M. Aoki, and J. Ohta MODIFIED FONTAN PROCEDURE IN NINETY-NINE CASES OF ATRIOVENTRICULAR VALVE REGURGITATION J. Thorac. Cardiovasc. Surg., February 1, 1997; 113(2): 262 - 269. [Abstract] [Full Text]
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V. M. Reddy, D. B. McElhinney, P. Moore, E. Petrossian, and F. L. Hanley PULMONARY ARTERY GROWTH AFTER BIDIRECTIONAL CAVOPULMONARY SHUNT: IS THERE A CAUSE FOR CONCERN? J. Thorac. Cardiovasc. Surg., November 1, 1996; 112(5): 1180 - 1192. [Abstract] [Full Text]
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T. Yagihara, F. Yamamoto, K. Nishigaki, O. Matsuki, H. Uemura, T. Isizaka, O. Takahashi, T. Kamiya, and Y. Kawashima SURGERY FOR CONGENTIAL HEART DISEASEUNIFOCALIZATION FOR PULMONARY ATRESIA WITH VENTRICULAR SEPTAL DEFECT AND MAJOR AORTOPULMONARY COLLATERAL ARTERIES J. Thorac. Cardiovasc. Surg., August 1, 1996; 112(2): 392 - 402. [Abstract] [Full Text]
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N. Ad, E. Birk, J. Barak, S. Diamant, E. Snir, and B. A. Vidne A ONE-WAY VALVED ATRIAL SEPTAL PATCH: A NEW SURGICAL TECHNIQUE AND ITS CLINICAL APPLICATION J. Thorac. Cardiovasc. Surg., April 1, 1996; 111(4): 841 - 848. [Abstract] [Full Text]
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K. Miyaji, M. Shimada, A. Sekiguchi, A. Ishizawa, and T. Isoda Usefulness of Pulsatile Bidirectional Cavopulmonary Shunt in High-Risk Fontan Patients Ann. Thorac. Surg., March 1, 1996; 61(3): 845 - 850. [Abstract] [Full Text]
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Y. Toyoda, M. Yamaguchi, H. Ohashi, M. Imai, Y. Oshima, N. Yoshimura, and T. Yamashita Staged Repair of Tetralogy of Fallot and Pulmonary Atresia Without Central Pulmonary Arteries Ann. Thorac. Surg., January 1, 1996; 61(1): 210 - 213. [Abstract] [Full Text]
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H. Uemura, T. Yagihara, Y. Kawashima, K. Okada, T. Kamiya, and R. H. Anderson Use of the Bidirectional Glenn Procedure in the Presence of Forward Flow From the Ventricles to the Pulmonary Arteries Circulation, November 1, 1995; 92(9): 228 - 232. [Abstract] [Full Text]
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R. D. Mainwaring, J. J. Lamberti, K. Uzark, and R. L. Spicer Bidirectional Glenn : Is Accessory Pulmonary Blood Flow Good or Bad? Circulation, November 1, 1995; 92(9): 294 - 297. [Abstract] [Full Text]
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K. Hashimoto, H. Kurosawa, K. Tanaka, M. Yamagishi, K. Koyanagi, S. Ishii, and R. Nagahori Total cavopulmonary connection without the use of prosthetic material: Technical considerations and hemodynamic consequences J. Thorac. Cardiovasc. Surg., September 1, 1995; 110(3): 625 - 632. [Abstract] [Full Text]
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H. Uemura, T. Yagihara, Y. Kawashima, K. Yamashita, and T. Kamiya Intrapulmonary Reconstruction of Pulmonary Arteries Using a Heterologous Pericardial Roll Ann. Thorac. Surg., June 1, 1995; 59(6): 1464 - 1469. [Abstract] [Full Text]
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V. M. Reddy, J. R. Liddicoat, and F. L. Hanley Primary Bidirectional Superior Cavopulmonary Shunt in Infants Between 1 and 4 Months of Age Ann. Thorac. Surg., May 1, 1995; 59(5): 1120 - 1125. [Abstract] [Full Text]
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T. Beppu, Y. Imai, and Y. Fukui A computerized control system for cardiopulmonary bypass J. Thorac. Cardiovasc. Surg., March 1, 1995; 109(3): 428 - 438. [Abstract] [Full Text]
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Y. Imai, K. Sawatari, S. Hoshino, K. Ishihara, M. Nakazawa, and K. Momma Ventricular function after anatomic repair in patients with atrioventricular discordance J. Thorac. Cardiovasc. Surg., May 1, 1994; 107(5): 1272 - 1283. [Abstract] [Full Text]
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A. M. Mendelsohn, E. L. Bove, F. M. Lupinetti, D. C. Crowley, T. R. Lloyd, and R. H. Beekman III Central pulmonary artery growth patterns after the bidirectional Glenn procedure J. Thorac. Cardiovasc. Surg., May 1, 1994; 107(5): 1284 - 1290. [Abstract] [Full Text]
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