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The Annals of Thoracic Surgery Jan 2016There are conflicting reports regarding the importance of mitral stenosis and aortic atresia as a risk factor for Norwood mortality. This study reviews outcomes of this...
BACKGROUND
There are conflicting reports regarding the importance of mitral stenosis and aortic atresia as a risk factor for Norwood mortality. This study reviews outcomes of this anatomic subgroup at our institution and examines the utility of preoperative cardiac catheterization and its correlation with clinical outcomes and pathology findings.
METHODS
This is a single-center, retrospective review of hypoplastic left heart syndrome patients who underwent modified Norwood operation between October 2005 and May 2013.
RESULTS
Fourteen of 74 hypoplastic left heart syndrome patients (19%) had mitral stenosis and aortic atresia. Operative mortality for MS/AA was 29% versus 7% for all other hypoplastic left heart syndrome anatomic subgroups (p = 0.04). Although only 19% of the entire cohort, the mitral stenosis and aortic atresia subgroup constituted 50% of the total operative mortality and the only interstage deaths. Autopsies support myocardial ischemia as the mechanism of death. Although preoperative angiography defined the presence of ventriculo-coronary connections, it did not clearly risk stratify patients in regard to operative mortality.
CONCLUSIONS
Mitral stenosis and aortic atresia is a risk factor for perioperative myocardial ischemia and mortality. Further exploration of myocardial reserve is warranted.
Topics: Abnormalities, Multiple; Aortic Valve; Bicuspid Aortic Valve Disease; California; Female; Follow-Up Studies; Heart Defects, Congenital; Heart Valve Diseases; Humans; Hypoplastic Left Heart Syndrome; Infant, Newborn; Male; Mitral Valve Stenosis; Norwood Procedures; Retrospective Studies; Risk Factors; Survival Rate
PubMed: 26602002
DOI: 10.1016/j.athoracsur.2015.09.056 -
The Annals of Thoracic Surgery Jun 2008Aortic atresia has been implicated as a risk factor for decreased survival after stage 1 palliation. Prior studies evaluating the association of anatomic subtypes and...
BACKGROUND
Aortic atresia has been implicated as a risk factor for decreased survival after stage 1 palliation. Prior studies evaluating the association of anatomic subtypes and mortality report conflicting results. Our objective was to determine if mitral valve patency with aortic atresia is associated with increased mortality in hypoplastic left heart syndrome (HLHS).
METHODS
All patients (n = 72) with classic HLHS born between August 1996 and May 2002, who underwent stage I Norwood palliation, had presenting echocardiograms reviewed for patency of the mitral and aortic valves. The cohort was divided into three groups: aortic atresia-mitral atresia (AA-MA), aortic stenosis-mitral stenosis (AS-MS), and aortic atresia-mitral stenosis (AA-MS). Analysis included analysis of variance techniques for continuous variables and the 2-tailed Fisher exact test for categoric variables. Survival analysis was performed using the Kaplan-Meier method with log-rank testing.
RESULTS
Of the 72 patients, 36 had AA-MA, 17 had AS-MS, and 19 had AA-MS. The stage 1 hospital survival was 92% for the entire cohort, 97% for AA-MA, 94% for AS-MS, and 79% for AA-MS (p = 0.05). Interstage mortality was 8% (6 of 72) overall, but was 21% (4 of 19) for AA-MS versus 6% (2 of 36) for AA-MA and 0% for AS/MS. Overall survival to date was 79% for the entire cohort but was 58% for AA-MS, 86% for AA/MA, and 88% for AA-MS (p = 0.015). Aortic atresia alone was not associated with increased mortality (p = 0.2).
CONCLUSIONS
In patients with HLHS, aortic atresia was associated with increased mortality only in the presence of a patent mitral valve. The highest incidence of death was observed primarily during the interstage period.
Topics: Aortic Valve; Child; Child, Preschool; Cohort Studies; Echocardiography, Doppler, Color; Female; Follow-Up Studies; Hospital Mortality; Humans; Hypoplastic Left Heart Syndrome; Infant; Infant, Newborn; Male; Mitral Valve Stenosis; Palliative Care; Postoperative Complications; Retrospective Studies; Risk; Survival Analysis; Ventricular Function, Right
PubMed: 18498820
DOI: 10.1016/j.athoracsur.2008.02.026 -
Archives of Surgery (Chicago, Ill. :... May 1961
Topics: Humans; Mitral Valve
PubMed: 13740233
DOI: 10.1001/archsurg.1961.01300110058009 -
Cardiology in the Young Jun 2022The association of truncus arteriosus communis with interrupted aortic arch and mitral atresia is an exceptionally rare congenital defect. We describe the initial...
The association of truncus arteriosus communis with interrupted aortic arch and mitral atresia is an exceptionally rare congenital defect. We describe the initial decision-making and management of this lesion, which eventually achieved a Fontan palliation.
PubMed: 35657671
DOI: 10.1017/S1047951121005254 -
Journal of Clinical Ultrasound : JCU Oct 2020Congenitally corrected transposition (ccTGA), also known as L-transposition of the great arteries (L-TGA), is a rare cardiac malformation accounting for approximately...
Congenitally corrected transposition (ccTGA), also known as L-transposition of the great arteries (L-TGA), is a rare cardiac malformation accounting for approximately 0.05% of congenital heart disease, characterized by ventricular inversion, discordant ventriculo-arterial connections with a normal visceroatrial relationship. It was first described by Baron Rokitansky in 1875, and prenatal sonographic diagnosis can be difficult. Symptomatology and clinical presentation of this malformation are related to the associated intracardiac defects. We report a rare case of severe, complex cardiac disease: prenatally diagnosed ccTGA with atrial restriction, mitral atresia, Ebsteinoid tricuspid valve, and severe pulmonary valve stenosis, who subsequently developed left pulmonary vein stenosis.
Topics: Atrial Septum; Congenitally Corrected Transposition of the Great Arteries; Female; Humans; Pregnancy; Tricuspid Valve; Ultrasonography, Prenatal
PubMed: 32748445
DOI: 10.1002/jcu.22897 -
Interactive Cardiovascular and Thoracic... Feb 2019We report on a 61-year-old man with a previously unknown interruption of the inferior vena cava who was scheduled to undergo minimally invasive mitral and tricuspid...
We report on a 61-year-old man with a previously unknown interruption of the inferior vena cava who was scheduled to undergo minimally invasive mitral and tricuspid valve surgery. We aimed to establish a cardiopulmonary bypass using femorofemoral cannulation under transoesophageal echocardiography. In spite of multiple attempts, the positioning of the venous wire in the right atrium was not accomplished. The intervention was subsequently performed by an open sternotomy. Further to the intervention, the patient underwent thoraco-abdominal multislice computed tomography that excluded the presence of an abdominal tumour or vena cava thrombosis but revealed atresia of the inferior vena cava.
Topics: Echocardiography, Transesophageal; Heart Atria; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Multidetector Computed Tomography; Tricuspid Valve Insufficiency; Vena Cava, Inferior
PubMed: 30084986
DOI: 10.1093/icvts/ivy240 -
Chest Dec 1975
Topics: Echocardiography; Heart Defects, Congenital; Heart Ventricles; Humans; Infant; Male; Mitral Valve; Tricuspid Valve; Tricuspid Valve Stenosis
PubMed: 1192863
DOI: 10.1378/chest.68.6.818 -
Cardiology in the Young Nov 2022We report the first successful Glenn procedure for pulmonary atresia with intact ventricular septum in the setting of D-transposition of the great arteries. This case...
Pulmonary atresia with intact ventricular septum in the setting of D-transposition of the great arteries associated with hypoplastic left ventricle and severe mitral regurgitation.
We report the first successful Glenn procedure for pulmonary atresia with intact ventricular septum in the setting of D-transposition of the great arteries. This case was complicated by hypoplastic left ventricle and severe mitral regurgitation. Partial closure of the mitral valve at the time of Blalock-Taussig shunting resulted in improvement of heart failure.
Topics: Humans; Transposition of Great Vessels; Heart Ventricles; Mitral Valve Insufficiency; Pulmonary Atresia; Arteries
PubMed: 35225203
DOI: 10.1017/S1047951122000609 -
International Journal of Cardiology May 2011
Review
Topics: Double Outlet Right Ventricle; Heart Ventricles; Humans; Infant, Newborn; Male; Mitral Valve; Pulmonary Atresia; Pulmonary Valve Stenosis
PubMed: 20598383
DOI: 10.1016/j.ijcard.2010.06.004 -
Ryoikibetsu Shokogun Shirizu 1996
Review
Topics: Diagnosis, Differential; Heart Septal Defects, Ventricular; Humans; Mitral Valve; Ultrasonography
PubMed: 9117588
DOI: No ID Found