Pediatric cardiac transplantation despite atrial and venous return anomalies

Chartrand, C

doi:10.1016/0003-4975(91)90986-z

Cited by 29 publications

(14 citation statements)

References 3 publications

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“…Early and late survival is poor compared to other forms of congenital cardiac diseases. 24,25,[51][52][53]…”

Section: Discussionmentioning

confidence: 99%

“…Dacron conduits placed between the right-sided atrium and the left superior caval vein, along with counter-clockwise rotation of an anastomosis to the left sided inferior caval vein, have permitted restoration of continuity of the systemic venous return. 24,25,[51][52][53] Correction of associated cardiac anomalies Additional associated congenital cardiac anomalies are all been treated on their own merits. [14][15][16][17][18][19][20][21][22] Outcomes in the short and long term Despite the advances made in diagnosis and surgical treatment, the overall prognosis remains less than satisfactory in either the long or the short term.…”

Section: Cardiac Transplantationmentioning

confidence: 99%

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Surgical Management of Hearts with Isomeric Atrial Appendages

Chowdhury

Anderson

Spicer

et al. 2022

Preprint

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Background and aim: On the basis of previously published accounts, coupled with our own experience, we have assessed the surgical approaches to patients with isomeric atrial appendages. Methods: We reviewed pertinent published studies on surgical treatment of individuals with isomeric atrial appendages, with the pertinent surgical details provided by most of the manuscripts. Results: Half of patients with right isomerism, and two-thirds of those with left isomerism have bilateral superior caval veins. Azygos extension of the inferior caval vein is reported in three-quarters of those with left isomerism. The coronary sinus is universally absent in right isomerism, along with totally anomalous pulmonary venous connection, and is absent in two-fifths of those with left isomerism.. Univentricular atrioventricular connections are expected in up to three-quarters of those with right isomerism. Atrioventricular septal defect is reported in up to four-fifths, more frequently in right isomerism, with such patients typically having discordant ventriculoatrial connections or double outlet right ventricle. Reported mortalities extend to 85% for those with right, and 50% for those with left isomerism. In right isomerism, mortality is up to 54% for systemic-to-pulmonary arterial shunting, up to 75% for univentricular repair, and up to 95% for repair of totally anomalous pulmonary venous connection itself. No more than one-quarter had undergone Fontan completion, with reported mortalities of 21%. Conclusion: Early surgical results are satisfactory in patients with left isomerism, but disappointing for those with right. Recent advances in cardiac and liver transplantation may offer improved survival.

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“…Early and late survival is poor compared to other forms of congenital cardiac diseases. 24,25,[51][52][53]…”

Section: Discussionmentioning

confidence: 99%

Section: Cardiac Transplantationmentioning

confidence: 99%

Surgical Management of Hearts with Isomeric Atrial Appendages

Chowdhury

Anderson

Spicer

et al. 2022

Preprint

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“…Third, the conventional technique of transplantation [40] may not be possible in the context of congenital heart disease because of the unusual anatomy, and the distortion of various structures by previous surgery. However, technical adjustments, including the cannulation techniques, have been described to deal with such possible distortions and malformations [26][27][28][29][30][31]. Therefore, no anatomic variation, nor any form of distortion caused by previous surgery, would preclude transplantation.…”

Section: The Operationmentioning

confidence: 99%

Transplantation for adults with congenital heart disease☆

Hosseinpour

Cullen

Tsang

2006

European Journal of Cardio-Thoracic Surgery

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Heart transplantation is a recognised treatment for end-stage heart failure of any cause including congenital heart disease. Congenital heart disease has contributed relatively little to the adult heart transplant activities in the past two decades. However, this is likely to change as an increasing number of children with congenital heart disease reach adulthood because of the advances in paediatric cardiology and surgery. Some of these grown-ups with congenital heart disease (GUCH patients) will need transplantation for late myocardial dysfunction either secondary to uncorrected lesions, or despite previous repair or palliative surgery. These patients are managed along the same clinical principles as those with cardiac failure of other aetiologies, despite the lack of any evidence to support this approach. Nevertheless, they introduce new challenges. First, some may have pulmonary vascular disease and require heart-lung transplantation, or lung transplantation combined with repair of their cardiac defects. Second, those with failing Fontan circulation are usually much sicker than other transplant candidates, with protein-losing enteropathy along with renal and hepatic dysfunction. Third, a suitable donor organ may not be found due to elevated levels of antibodies in response to previous blood transfusions and possibly the previous implantation of homografts. Fourth, the operation may be technically difficult because of the presence of adhesions secondary to previous operations, collaterals, and unusual anatomy. Fifth, postoperative care may be complicated because of predisposition to bleeding, infection and pulmonary hypertension, and the presence of residual aortopulmonary collaterals resulting in a significant left-to-right shunt. Despite a higher early mortality, the overall results of heart transplantation so far have been encouraging with survivals similar to that of adults with acquired heart disease and that of the paediatric population. However, this may change as the proportion of high-risk patients (failing Fontans) increases. GUCH patients with Eisenmenger's syndrome may be offered lung transplantation with repair of the cardiac defect or heart-lung transplantation. However, because of the limited success of these approaches, and improved management of pulmonary hypertension, patient selection remains difficult.

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“…Among cases previously reported, transplantation was accomplished by a variety of detailed reconstructive techniques, such as interposed spiral saphenous vein graft, 3 superior and inferior intraatrial baffles, 4,5 composite cavopericardial graft to right innominate vein and diaphragmatic pericardial tunnel, 2,6,7 and separate right and left pulmonary vein cuffs. 8 Use of a Dacron conduit between the right atrium and left SVC 9 and counterclockwise rotation with the left-sided IVC anastomosis 10 have also been used to restore continuity of systemic venous return.…”

Section: Commentmentioning

confidence: 99%