HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Search for Related Content Related Collections Related Article

J Thorac Cardiovasc Surg 2008;135:344-346
© 2008 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Discussion

Dr Thomas L. Spray (Philadelphia, Pa). Although great improvements in results for stage 1 Norwood procedures have been achieved over the past decade, there continues to be a very significant mortality with this procedure, and the cause of this early mortality remains frustratingly obscure. Many centers have noted higher mortality associated with certain anatomic and genetic risk factors, such as aortic atresia, associated cardiac or noncardiac anomalies, low birth weight, and so on, but this compelling study adds a new and important risk group: patients with aortic atresia, mitral stenosis, and associated coronary fistulae from a small left ventricle. Although these patients represent a minority of the total group of patients with HLHS, they appear to be a major and, perhaps in your series, the major source of mortality, at least in Boston.

Stimulated somewhat by this article, I went back and looked at an experience from our own center over about a 3-year period ending in May 2005 when we began the SVR trial randomization. Of 176 stage 1 operations in that 3-year period, our incidence of aortic atresia/mitral stenosis was about 12%, and therefore a little bit less than what you saw in Boston in your own experience. When I got the comparison mortality data for all of those patients, the overall survival was 92% in the patients without aortic atresia/mitral stenosis and 84% in those with aortic atresia/mitral stenosis. Although the numbers are very small, there were only 19 patients with aortic atresia/mitral stenosis, and that is probably not a statistically significant difference, or at least it leaves some credence to the finding that you have noted here.

Interestingly, though, at about a year, the overall survival rates in the 2 groups were the same, and there was no interstage mortality in the group with aortic . . . [Full Text of this Article]

Related Article

Surgical outcome for patients with the mitral stenosis–aortic atresia variant of hypoplastic left heart syndrome

Vladimiro L. Vida, Emile A. Bacha, Alesandro Larrazabal, Kimberly Gauvreau, Adam L. Dorfman, Gerald Marx, Tal Geva, Audrey C. Marshall, Frank A. Pigula, John E. Mayer, Pedro J. del Nido, and Francis Fynn-Thompson
J. Thorac. Cardiovasc. Surg. 2008 135: 339-346. [Abstract] [Full Text] [PDF]