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Pulmonary artery stenosis in hybrid single-ventricle palliation: High incidence of left pulmonary artery intervention  Otto Rahkonen, MD, PhD, Rajiv R.

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Presentation on theme: "Pulmonary artery stenosis in hybrid single-ventricle palliation: High incidence of left pulmonary artery intervention  Otto Rahkonen, MD, PhD, Rajiv R."— Presentation transcript:

1 Pulmonary artery stenosis in hybrid single-ventricle palliation: High incidence of left pulmonary artery intervention  Otto Rahkonen, MD, PhD, Rajiv R. Chaturvedi, MD, PhD, Lee Benson, MD, Osami Honjo, MD, PhD, Christopher A. Caldarone, MD, Kyong-Jin Lee, MD  The Journal of Thoracic and Cardiovascular Surgery  Volume 149, Issue 4, Pages e2 (April 2015) DOI: /j.jtcvs Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

2 Figure 1 Angiograms representative of PA problems after stage II hybrid surgery are shown. A, Severe stenosis distal to LPA patch. B, Asymmetric PA tree. Note the diffusely hypoplastic LPA and well-developed RPA. C, Total occlusion of LPA (arrows; retained ductal stent). D, Proximal and mid-section stenosis of LPA with previously implanted LPA stent. Note the retained ductal stent (arrowheads) at the level of LPA obstruction. The Journal of Thoracic and Cardiovascular Surgery  , e2DOI: ( /j.jtcvs ) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

3 Figure 2 Flow chart of outcomes after stage I hybrid procedure. Number of patients is shown in parentheses. ∗A total of 18 patients were excluded from the study analyses. †One patient underwent transplantation after the biventricular repair. ‡Failed, patients were converted to the Norwood (n = 3, 2 alive). §Failed, to proceed to Fontan completion because of unfavorable hemodynamics. ||Patient underwent Fontan takedown. The Journal of Thoracic and Cardiovascular Surgery  , e2DOI: ( /j.jtcvs ) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

4 Figure 3 A, Diameter of LPA and RPA (millimeters). PA measurements were made immediately proximal to the first lobar branch. Data are shown as mean + 1 standard deviation across all patients. *P < .05 compared with LPA. B and C, Box plots showing LPA (B) and RPA (C) z scores. Data are expressed as boxplots showing median and interquartile range. Whiskers indicate maximum and minimum values. †P < .01 compared with stage I. D, Kaplan–Meier transplantation-free survival curve (n = 54), excluding patients bridged to transplantation or biventricular repair, or salvage hybrid procedure. Number of patients is shown above the x-axis. E, Kaplan–Meier curve for PA interventions in patients who underwent hybrid stage II surgery. Starting point is the day of hybrid stage II surgery. Number of patients is shown above the x-axis. Pre FO, Pre Fontan catheterization; Post FO, post Fontan catheterization; LPA, left pulmonary artery; StI, Stage I; RPA, right pulmonary artery; PA, pulmonary artery; HLHS, hypoplastic left heart syndrome. The Journal of Thoracic and Cardiovascular Surgery  , e2DOI: ( /j.jtcvs ) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

5 Figure 4 A, Site of PA interventions. Percentages demonstrate the site of obstruction in all patients after hybrid stage II surgery (n = 34). Percentages below the lobar branches demonstrate the ratio of the patients with stenosed or lost branches. Numbers of interventions at different sites of PAs are shown in boxes (balloon dilatation/stent implantation). Patients who had balloon dilatation and subsequently stent implantation during the same procedure because of the unsuccessful balloon dilatation were included in the stent group only. B, Flow chart of sequential LPA interventions after balloon dilatation (balloon) or stent implantation (stent). Number of patients is shown in parentheses. LLL, Left lower lobe; LPA, left pulmonary artery; LUL, left upper lobe; RLL, right lower lobe; RPA, right pulmonary artery; RUL, right upper lobe; SVC, superior vena cava. The Journal of Thoracic and Cardiovascular Surgery  , e2DOI: ( /j.jtcvs ) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions


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