PMID- 25769466
OWN - NLM
STAT- MEDLINE
DCOM- 20160919
LR  - 20151216
IS  - 1873-734X (Electronic)
IS  - 1010-7940 (Linking)
VI  - 49
IP  - 1
DP  - 2016 Jan
TI  - Efficacy of the 'intrapulmonary-artery septation' surgical approach for Fontan 
      candidates with unilateral pulmonary arterial hypoplasiadagger.
PG  - 183-7
LID - 10.1093/ejcts/ezv091 [doi]
AB  - OBJECTIVES: The bilaterally unbalanced development of pulmonary arteries (PAs), 
      as a result of unilateral pulmonary arterial hypoplasia (PAhypo) makes patients 
      either ineligible for the Fontan operation or candidates for the one-lung Fontan 
      operation. In the present study, we examined the efficacy of 
      intrapulmonary-artery septation (IPAS), a technique we reported in 2007 in which 
      a septation is constructed within the central PA, in patients with unilateral 
      PAhypo. METHODS: Sixteen patients with unilateral PAhypo and an affected PA index 
      of </=60 mm(2)/m(2), including non-confluent PA (NCPA), underwent IPAS between 
      January 2000 and March 2012; patients with pulmonary venous obstruction were 
      excluded from this study. We compared the affected PA index values before and 
      after IPAS and after the Fontan operation as well as the bilateral pulmonary 
      blood flow ratio using pulmonary scintigraphy. The post-Fontan operation values 
      of central venous pressure (CVP), pulmonary vascular resistance (PVR), 
      ventricular end-diastolic pressure (VEDP), cardiac index (CI) and arterial oxygen 
      saturation (SaO2) at the most recent cardiac catheterization, as well as the 
      pre-IPAS and post-Fontan New York Heart Association (NYHA) classification levels 
      were examined. RESULTS: One patient died after IPAS (survival rate, 93.8%). 
      Thirteen (86.7%) of the surviving 15 patients underwent the Fontan operation. The 
      mean PA indexes were 25.5 +/- 18.9 mm(2)/m(2) before IPAS and 67.9 +/- 34.2 
      mm(2)/m(2) after IPAS (P = 0.003); the mean PA index was 71.1 +/- 50.0 mm(2)/m(2) 
      after the Fontan operation. Restenosis did not occur after the Fontan operation, 
      and the PA diameters were maintained. The mean affected/unaffected lung blood 
      flow ratio was 0.89 +/- 0.67. The most recent cardiac catheterization after the 
      Fontan operation indicated the following values: CVP, 11.7 +/- 1.8 mmHg; PVR, 1.3 +/- 
      0.4 U m(2); EDP, 5.7 +/- 2.0 mmHg; CI, 3.1 +/- 0.5 l/min/m(2) and SaO2, 94.9 +/- 2.0%. 
      The mean pre-IPAS and post-Fontan NYHA levels were 2.3 +/- 0.6 and 1.2 +/- 0.4, 
      respectively (P = 0.0002). CONCLUSIONS: With IPAS, the affected PA diameters 
      increased significantly, and were maintained after the Fontan operation, and 
      continuity of the native PAs was achieved. IPAS is very effective for patients 
      suffering from otherwise intractable diseases.
CI  - (c) The Author 2015. Published by Oxford University Press on behalf of the European 
      Association for Cardio-Thoracic Surgery. All rights reserved.
FAU - Tachi, Maiko
AU  - Tachi M
AD  - Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, 
      Shizuoka, Japan.
FAU - Murata, Masaya
AU  - Murata M
AD  - Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, 
      Shizuoka, Japan.
FAU - Ide, Yujiro
AU  - Ide Y
AD  - Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, 
      Shizuoka, Japan.
FAU - Ito, Hiroki
AU  - Ito H
AD  - Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, 
      Shizuoka, Japan.
FAU - Kanno, Kazuyoshi
AU  - Kanno K
AD  - Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, 
      Shizuoka, Japan.
FAU - Imai, Kenta
AU  - Imai K
AD  - Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, 
      Shizuoka, Japan.
FAU - Sakamoto, Kisaburo
AU  - Sakamoto K
AD  - Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, 
      Shizuoka, Japan k-sakamoto@i.shizuoka-pho.jp.
LA  - eng
PT  - Journal Article
DEP - 20150313
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
MH  - Adolescent
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Follow-Up Studies
MH  - *Fontan Procedure
MH  - Humans
MH  - Infant
MH  - Male
MH  - Pulmonary Artery/*abnormalities/*surgery
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Vascular Malformations/mortality/*surgery
MH  - Young Adult
OTO - NOTNLM
OT  - Fontan
OT  - Glenn shunt
OT  - One-lung Fontan
OT  - Pulmonary artery index
OT  - Unilateral pulmonary arterial hypoplasia
EDAT- 2015/03/15 06:00
MHDA- 2016/09/20 06:00
CRDT- 2015/03/15 06:00
PHST- 2014/09/14 00:00 [received]
PHST- 2015/02/03 00:00 [accepted]
PHST- 2015/03/15 06:00 [entrez]
PHST- 2015/03/15 06:00 [pubmed]
PHST- 2016/09/20 06:00 [medline]
AID - ezv091 [pii]
AID - 10.1093/ejcts/ezv091 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2016 Jan;49(1):183-7. doi: 10.1093/ejcts/ezv091. Epub 
      2015 Mar 13.