Analysis of Pulmonary Arteries Growth after Initial Shunt Palliation in Neonates and Infants

IF 0.3 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Congenital Heart Disease Pub Date : 2023-01-01 DOI:10.32604/chd.2023.042341

François-Xavier Van Vyve, Karlien Carbonez, Geoffroy de Beco, Stéphane Moniotte, Jean E. Rubay, Mona Momeni, Laurent Houtekie, Alain J. Poncelet

{"title":"Analysis of Pulmonary Arteries Growth after Initial Shunt Palliation in Neonates and Infants","authors":"François-Xavier Van Vyve, Karlien Carbonez, Geoffroy de Beco, Stéphane Moniotte, Jean E. Rubay, Mona Momeni, Laurent Houtekie, Alain J. Poncelet","doi":"10.32604/chd.2023.042341","DOIUrl":null,"url":null,"abstract":"Objective: Despite increasing enthusiasm for neonatal repair, patients with ductal-dependent circulation (pulmonary/systemic) or restrictive pulmonary blood flow still require initial palliation. Ductal stenting has emerged as an endovascular approach whereas modified-Blalock-Taussig and central shunt remain surgical references. In this study, we analyzed the relationship between pulmonary artery growth, sites of shunt connection, or antegrade pulmonary blood flow in surgically placed shunts. The need for secondary catheter-based interventions or pulmonary arterioplasty was also investigated. Methods: A retrospective single-center study analyzing 175 patients undergoing surgery for a central or modified-Blalock-Taussig shunt. Outcome growth variables were right pulmonary artery/left pulmonary artery diameters/Z scores, the indexed sum area (right pulmonary artery + left pulmonary artery), and the pulmonary symmetry index. Three imaging modalities were used: angiography, computed tomography, and echocardiography. Results: At baseline, pulmonary arteries were larger in patients with antegrade pulmonary blood flow (Nakata index 137 vs. 114, p = 0.047) as well as in patients receiving a modified-Blalock-Taussig shunt (Nakata index 138 vs. 84, p < 0.001). At the time of shunt takedown, both the right pulmonary artery and left pulmonary artery had normalized their diameter. The Nakata index increased from 134 to 233 mm2/m2 (p < 0.001). The pulmonary artery index remained stable (0.86) over time. During the inter-stage period, shunt-related pulmonary artery stenosis and juxta-ductal stenosis were diagnosed in 16 (10%) and 17 patients (11%), respectively. Conclusions: Surgical shunt palliation allows normal pulmonary artery growth. Pulmonary artery stenosis was either shunt-related (10%) or secondary to juxta-ductal stenosis (11%). Close echographic follow-up allows early diagnosis and treatment of juxta-ductal stenosis.","PeriodicalId":10666,"journal":{"name":"Congenital Heart Disease","volume":"274 1","pages":"0"},"PeriodicalIF":0.3000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Congenital Heart Disease","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.32604/chd.2023.042341","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Objective: Despite increasing enthusiasm for neonatal repair, patients with ductal-dependent circulation (pulmonary/systemic) or restrictive pulmonary blood flow still require initial palliation. Ductal stenting has emerged as an endovascular approach whereas modified-Blalock-Taussig and central shunt remain surgical references. In this study, we analyzed the relationship between pulmonary artery growth, sites of shunt connection, or antegrade pulmonary blood flow in surgically placed shunts. The need for secondary catheter-based interventions or pulmonary arterioplasty was also investigated. Methods: A retrospective single-center study analyzing 175 patients undergoing surgery for a central or modified-Blalock-Taussig shunt. Outcome growth variables were right pulmonary artery/left pulmonary artery diameters/Z scores, the indexed sum area (right pulmonary artery + left pulmonary artery), and the pulmonary symmetry index. Three imaging modalities were used: angiography, computed tomography, and echocardiography. Results: At baseline, pulmonary arteries were larger in patients with antegrade pulmonary blood flow (Nakata index 137 vs. 114, p = 0.047) as well as in patients receiving a modified-Blalock-Taussig shunt (Nakata index 138 vs. 84, p < 0.001). At the time of shunt takedown, both the right pulmonary artery and left pulmonary artery had normalized their diameter. The Nakata index increased from 134 to 233 mm2/m2 (p < 0.001). The pulmonary artery index remained stable (0.86) over time. During the inter-stage period, shunt-related pulmonary artery stenosis and juxta-ductal stenosis were diagnosed in 16 (10%) and 17 patients (11%), respectively. Conclusions: Surgical shunt palliation allows normal pulmonary artery growth. Pulmonary artery stenosis was either shunt-related (10%) or secondary to juxta-ductal stenosis (11%). Close echographic follow-up allows early diagnosis and treatment of juxta-ductal stenosis.

查看原文本刊更多论文

新生儿和婴儿初始分流缓解后肺动脉生长的分析

目的:尽管对新生儿修复的热情越来越高，但导管依赖循环(肺/全身)或肺血流受限的患者仍然需要初始姑息治疗。导管支架置入术已成为血管内入路，而改良的blalock - taussig和中央分流术仍然是手术参考。在这项研究中，我们分析了肺动脉生长、分流器连接部位或手术放置分流器中顺行肺血流之间的关系。是否需要二次导管介入或肺动脉成形术也进行了研究。方法:一项回顾性单中心研究分析了175例接受中央或改良blalock - taussig分流术手术的患者。结果增长变量为右肺动脉/左肺动脉直径/Z评分、指标面积之和(右肺动脉+左肺动脉)和肺对称性指数。使用三种成像方式:血管造影、计算机断层扫描和超声心动图。结果:在基线时，顺行肺血流患者(Nakata指数137 vs. 114, p = 0.047)和接受改良blalock - taussig分流术的患者(Nakata指数138 vs. 84, p < 0.001)的肺动脉更大。取下分流管时，右肺动脉和左肺动脉的直径均已正常化。Nakata指数从134 mm2/m2增加到233 mm2/m2 (p < 0.001)。随着时间的推移，肺动脉指数保持稳定(0.86)。在期中，分别有16例(10%)和17例(11%)患者被诊断为分流相关性肺动脉狭窄和导管旁狭窄。结论:手术分流姑息可使正常肺动脉生长。肺动脉狭窄要么与分流相关(10%)，要么继发于导管旁狭窄(11%)。密切的超声随访可以早期诊断和治疗导管旁狭窄。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Congenital Heart Disease CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

0.40

自引率

33.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Congenital Heart Disease is an open-access journal focusing on congenital heart disease in children and adults. Though the number of infants born with heart disease each year is relatively small (approximately 1% of the population), advances in treating such malformations have led to increased life spans for this population. Consequently, today most patients treated for congenital heart disease are over the age of 20. What are the special needs of adults with congenital heart disease? What are the latest developments in the care of the fetus, infants, and children? Who should treat these patients? How should they be treated? Congenital Heart Disease focuses on these questions and more. Conceived as a forum for the most up-to-date information on congenital heart disease, the journal is led by Editor-in-Chief Vladimiro L. Vida, MD, Ph.D., Professor in Cardiac Surgery, University of Padua in Italy, as well as an international editorial board. Congenital Heart Disease publishes articles on heart disease as it relates to the following areas: • Basic research of congenital heart disease • Clinical pediatric and adult cardiology • Cardiac imaging • Preventive cardiology • Diagnostic and interventional cardiac catheterization • Electrophysiology • Surgery • Long-term follow-up, particularly as it relates to older children and adult congenital heart disease • Exercise and exercise physiology in the congenital patient • Post-op and critical care • Common disorders such as syncope, chest pain, murmurs, as well as acquired disorders such as Kawasaki syndrome The journal includes clinical studies, invited editorials, state-of-the-art reviews, case reports, articles focusing on the history and development of congenital heart disease, and CME material. Occasional issues focus on special topics. Readership: Congenital Heart Disease was created for pediatric cardiologists; adult cardiologists who care for patients with congenital heart disease; pediatric and pediatric cardiology nurses; surgeons; radiologists; anesthesiologists; critical care physicians and nurses; and adult support staff involved in the care of patients with congenital heart disease.