Techniques for pulmonary artery narrowing in patients with congenital heart disease and ductal-dependent systemic circulation

V.V. Suvorov

St. Petersburg Pediatric Medical University

V.V. Zaytsev

St. Petersburg Pediatric Medical University

N.G. Pilyugov

St. Petersburg State Pediatric Medical University

R.B. Badurov

St. Petersburg State Pediatric Medical University

D.D. Kupatadze

St. Petersburg Pediatric Medical University

M.I. Komissarov

St. Petersburg State Pediatric Medical University

E.V. Dolgova

St. Petersburg State Pediatric Medical University

L.M. Kolbaya

St. Petersburg State Pediatric Medical University

I.Yu. Aleshin

St. Petersburg State Pediatric Medical University

Techniques for pulmonary artery narrowing in patients with congenital heart disease and ductal-dependent systemic circulation

Authors:

V.V. Suvorov, V.V. Zaytsev, N.G. Pilyugov, R.B. Badurov, D.D. Kupatadze, M.I. Komissarov, E.V. Dolgova, L.M. Kolbaya, I.Yu. Aleshin

More about the authors

Journal: Russian Journal of Cardiology and Cardiovascular Surgery. 2023;16(1): 24‑31

DOI: 10.17116/kardio20231601124

Downloaded: 55

To cite this article:

Suvorov VV, Zaytsev VV, Pilyugov NG, Badurov RB, Kupatadze DD, Komissarov MI, Dolgova EV, Kolbaya LM, Aleshin IYu. Techniques for pulmonary artery narrowing in patients with congenital heart disease and ductal-dependent systemic circulation. Russian Journal of Cardiology and Cardiovascular Surgery. 2023;16(1):24‑31. (In Russ., In Engl.)
https://doi.org/10.17116/kardio20231601124

Доказательная гастроэнтерология: pro et contra

Актуальные вопросы педиатрической практики

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OBJECTIVE

To determine intraoperative criteria of effectiveness of pulmonary artery narrowing in correction of critical congenital heart defects (CHD).

MATERIAL AND METHODS

We analyzed treatment outcomes in 37 patients with critical CHD who underwent hybrid surgery (bilateral pulmonary artery narrowing and stenting of patent ductus arteriosus (PDA)). Patients were divided into 3 groups depending on surgery. The first procedure was carried out in one stage with PDA stenting. After median sternotomy, two Gore-Tex vascular cuffs 1—2 mm wide and 3—3.5 mm in diameter were applied. Method No. 2 was based on the use of lavsan thread for pulmonary artery narrowing. Effectiveness of surgeries was assessed considering invasive blood pressure and oxygen saturation after pulmonary artery narrowing. Method No. 3 was distinguished by intraoperative assessment of blood flow at the site of pulmonary artery narrowing. A cuff for bilateral narrowing was made from a Gore-Tex vascular prosthesis. Surgery No. 1 was performed in 14 (37.8%) patients, No. 2 — in 8 (21.6%) patients, No. 3 — in 15 (40.6%) patients. Multiple logistic regression was used to identify the factors influencing hemodynamic efficiency of pulmonary artery narrowing.

RESULTS

All procedures resulted Qp/Qs=1/1 in 5 (35.7%), 3 (37.5%) and 14 (93.3%) patients, respectively. Statistical analysis revealed that technique No. 3 (odds ratio (OR) 0.013; 95% CI 0.001—0.314; p=0.007) combined with intraoperative assessment of blood flow at the site of narrowing of the left pulmonary artery (OR 17.526; 95% CI 1.944—325.462; p=0.045) were significant criteria for achieving Qp/Qs=1/1 after surgery in children with critical CHD.

CONCLUSION

The third method of bilateral pulmonary artery narrowing contributes to the most effective balance of pulmonary and systemic circulation in patients with critical CHD. This approach combined with intraoperative assessment of blood flow at the site of pulmonary artery narrowing is the most optimal criterion for achieving the ratio Qp/Qs=1/1.

Keywords:

hybrid surgery

Norwood hybrid surgery

bilateral pulmonary artery narrowing

pulmonary artery narrowing

treatment of critical CHD

Authors:

V.V. Suvorov

St. Petersburg Pediatric Medical University

V.V. Zaytsev

St. Petersburg Pediatric Medical University

N.G. Pilyugov

St. Petersburg State Pediatric Medical University

R.B. Badurov

St. Petersburg State Pediatric Medical University

D.D. Kupatadze

St. Petersburg Pediatric Medical University

M.I. Komissarov

St. Petersburg State Pediatric Medical University

E.V. Dolgova

St. Petersburg State Pediatric Medical University

L.M. Kolbaya

St. Petersburg State Pediatric Medical University

I.Yu. Aleshin

St. Petersburg State Pediatric Medical University

Received:

17.06.2021

Accepted:

06.01.2022

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