Fate of the pulmonic valve after proximal pulmonary artery-to-ascending aorta anastomosis for aortic outflow obstruction

Transection of the main pulmonary artery and end-to-side anastomosis of the proximal pulmonary artery to the ascending aorta has been increasingly used in palliative surgery for cardiac malformations such as single ventricle with small outlet foramen (bulboventricular foramen) and hypoplastic left-h...

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Bibliographic Details
Published in:	The American journal of cardiology Vol. 62; no. 7; pp. 435 - 438
Main Authors:	Chin, Alvin J., Barber, Gerald, Helton, J.Gregg, Alboliras, Ernerio T., Aglira, Beth Ann, Pigott, John D., Norwood, William I.
Format:	Journal Article
Language:	English
Published:	New York, NY Elsevier Inc 01-09-1988 Elsevier
Subjects:	Anastomosis, Surgical Aorta - surgery Aortic Diseases - etiology Aortic Diseases - surgery Aortic Valve Stenosis - etiology Biological and medical sciences Cardiology. Vascular system Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava Constriction, Pathologic Heart Heart Defects, Congenital - complications Humans Infant Infant, Newborn Medical sciences Postoperative Complications Postoperative Period Pulmonary Artery - surgery Pulmonary Valve - physiopathology Pulmonary Valve Insufficiency - diagnosis Pulmonary Valve Insufficiency - etiology Ultrasonography Vascular Patency Human Ascending aorta Heart Doppler ultrasound study Palliative surgery Congenital Ultrasonic investigation Surgical anastomosis Cardiovascular disease Infant Pulmonary valve Pulmonary artery Left ventricle Outflow obstruction Heart disease Regurgitation Hemodynamics New born
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Summary:	Transection of the main pulmonary artery and end-to-side anastomosis of the proximal pulmonary artery to the ascending aorta has been increasingly used in palliative surgery for cardiac malformations such as single ventricle with small outlet foramen (bulboventricular foramen) and hypoplastic left-heart syndrome. To evaluate pulmonary valve competence after this operation, we used color Doppler flow mapping to examine 45 survivors of pulmonary artery-to-ascending aorta anastomosis a median of 202 days postoperatively. Of 37 patients with hypoplastic left heart syndrome, mild regurgitation was detected in 9 (24%) and moderate regurgitation in 1 (3%). Of 8 with other lesions, mild regurgitation was observed in 2 and moderate regurgitation in 1. Seven of 11 patients imaged ≥ 12 months postoperatively had regurgitation. In summary, one-fourth of survivors developed mild pulmonary regurgitation. Its presence should not be considered a contraindication to eventual application of Fontan's principle, although further follow-up appears warranted because the long-term fate of pulmonary valve function is not yet known.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0002-9149 1879-1913
DOI:	10.1016/0002-9149(88)90973-3