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Pulmonary artery coarctation repair in univentricular heart: indications and optimal timing

Published online by Cambridge University Press:  24 July 2023

Koji Miwa Open the ORCID record for Koji Miwa [Opens in a new window] ,
Shigemitsu Iwai ,
Tomomitsu Kanaya  and
Shota Kawai
Koji Miwa*
Affiliation:
Department of Cardiovascular Surgery, Osaka Women’s and Children’s Hospital, Osaka, Japan
Shigemitsu Iwai
Affiliation:
Department of Cardiovascular Surgery, Osaka Women’s and Children’s Hospital, Osaka, Japan
Tomomitsu Kanaya
Affiliation:
Department of Cardiovascular Surgery, Osaka Women’s and Children’s Hospital, Osaka, Japan
Shota Kawai
Affiliation:
Department of Cardiovascular Surgery, Osaka Women’s and Children’s Hospital, Osaka, Japan
*
Corresponding author: K. Miwa; Email: komiwa0712@gmail.com
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Abstract

Background:

To analyse surgical outcomes of pulmonary artery coarctation in univentricular hearts, focusing on surgical indications and optimal timing.

Methods:

We retrospectively reviewed 49 patients with pulmonary artery coarctation in univentricular hearts treated at our institution between 1993 and 2022. Twenty-eight patients were diagnosed before first-stage palliation. Of these, 14 underwent systemic-pulmonary shunt only as first-stage palliation (Group 1), and 14 underwent systemic-pulmonary shunt plus surgical pulmonary artery plasty as first-stage palliation (Group 2). Twenty-one patients diagnosed after first-stage palliation underwent surgical pulmonary artery plasty at the time of bidirectional Glenn procedure (Group 3).

Results:

Follow-up period after initial palliation was 6±8 years. The Fontan procedure was successful in 35 patients (71%) aged 28±26 months (range 18–139). Freedom from interstage death (Group 1, 53%; Group 2, 85%; Group 3, 93%) and interstage reintervention (Group 1, 50%; Group 2, 75%; Group 3, 73%) rates were significantly lower in Group 1 (p = 0.01). Five and four patients in Group 1 and Group 3, respectively, needed additional shunts before the bidirectional Glenn procedure. In Group 1, one patient with a non-confluent pulmonary artery achieved hemi-lung Fontan circulation. In Group 2, one patient suffering with a non-confluent pulmonary artery could not achieve Fontan circulation, whereas another patient with pulmonary venous obstruction achieved hemi-lung Fontan circulation.

Conclusions:

Surgical pulmonary artery plasty performed at first-stage palliation improved outcomes of pulmonary artery coarctation in univentricular hearts, particularly when pulmonary artery coarctation had already progressed during the neonatal period or early infancy.

Keywords

Univentricular heartpulmonary artery coarctationpulmonary artery reconstructionsurgical management
Type
Original Article
Information
Cardiology in the Young , Volume 34 , Issue 3 , March 2024 , pp. 505 - 512
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Copyright
© The Author(s), 2023. Published by Cambridge University Press

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