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The Journal of Thoracic and Cardiovascular Surgery, Vol 97, 878-885, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
ET Alboliras, AJ Chin, G Barber, JG Helton, JD Pigott and WI Norwood
Pulmonary artery architecture and symmetry after palliative operations for
hypoplastic left heart syndrome may affect subsequent suitability for a
modified Fontan operation. Two-dimensional echocardiography was used to
measure pulmonary artery diameter and assess symmetry after two types of
systemic-pulmonary artery shunts: modified right Blalock- Taussig shunt (14
patients) and central shunt (from underside of aortic arch gusset to
pulmonary artery confluence) (14 patients). Age, weight, preoperative
diameter of right and left pulmonary arteries (proximal, middle, and distal
segments), and mean interval between preoperative and postoperative
echocardiographic studies (20.2 +/- 4.4 days in the Blalock shunt group;
19.1 +/- 6.8 days in the central shunt group) were similar. Early
postoperatively, patients with a Blalock shunt showed a significant
decrease in the diameter of all pulmonary artery segments except the distal
right pulmonary artery. The diameters tapered from distal right to distal
left pulmonary artery in this group. Patients with the central shunt had a
significant decrease in the diameter of all pulmonary artery segments.
There were no significant differences when cross comparisons were made of
the various pulmonary arterial segments in patients after a central shunt.
Similar findings persisted in 19 patients from both groups who had a late
postoperative echocardiogram (mean interval between studies = 271 days in
the group of 10 patients with Blalock shunt and 167 days in the group of
nine patients with a central shunt). In conclusion, the central shunt
preserves pulmonary artery symmetry, which may be important in candidates
for the Fontan operation in infancy.
ARTICLES
Pulmonary artery configuration after palliative operations for hypoplastic left heart syndrome
Division of Cardiology, Children's Hospital of Philadelphia, PA 19104.
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