Neonatal pulmonary artery reconstruction during shunting to treat and prevent juxtaductal coarctation

Ann Thorac Surg. 2015 Feb;99(2):641-7. doi: 10.1016/j.athoracsur.2014.09.034. Epub 2014 Dec 20.

Abstract

Background: Coarctation of the pulmonary artery may lead to its early obstruction. We investigated the outcomes of a strategy of aggressive reconstruction of the pulmonary arteries in the neonatal period.

Methods: From 2000 to 2013 a total of 162 consecutive neonates (< 90 days) underwent systemic-to-pulmonary shunting. Twenty-eight of them underwent the following concomitant reconstruction of the central pulmonary arteries: end-to-end anastomosis (4), patch reconstruction of the pulmonary arteries (24) with 0.4 mm Gore-Tex (W. L. Gore & Associates, Newark, DE) patch (18), or autologous pericardium (6). Ten patients were directed to univentricular palliation and 18 to biventricular repair.

Results: There was 1 in-hospital death (4%) and 2 deaths after hospital discharge (inter-stage mortality, 7%). The follow-up of the 25 survivors was complete. After a mean of 3 ± 3 years, patients with single ventricle palliation reached the following stages: shunts (2); one and a half ventricle repair (1); bidirectional cavopulmonary shunt (4); and Fontan (2). Fourteen of the patients destined for biventricular physiology reached complete repair while 2 patients were still with shunts. There was no pulmonary artery occlusion. Focal narrowing or pulmonary artery hypoplasia was the main indication for 10 of the subsequent 36 reinterventions.

Conclusions: Neonatal pulmonary artery reconstruction effectively prevents pulmonary artery occlusion and warrants pulmonary artery growth in the majority of cases of juxtaductal pulmonary artery coarctation. A number of these patients needed enlargement of their central pulmonary arteries in subsequent procedures. Indications of this reconstruction at the time of systemic-to-pulmonary shunting remains to be specified.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abnormalities, Multiple / surgery*
  • Cardiac Surgical Procedures / methods
  • Female
  • Heart Defects, Congenital / surgery*
  • Heart Ventricles / abnormalities*
  • Heart Ventricles / surgery*
  • Humans
  • Infant, Newborn
  • Male
  • Pulmonary Artery / abnormalities*
  • Pulmonary Artery / surgery*
  • Retrospective Studies
  • Vascular Surgical Procedures / methods