Primary repair of tetralogy of Fallot in infants: Transatrial/transpulmonary or transventricular approach

Sun, Guolin; Wang, Xuefeng; Chen, Jinjin; Ma, Rong; Li, Fuping; Chen, Lin; Ye, Xiao

doi:10.1016/j.asjsur.2013.01.005

Cited by 8 publications

(7 citation statements)

References 27 publications

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“…Several previous observations regarding KD gene expression are supported by the data in the present study. The muted signature for interferon signaling was in sharp contrast to the expression profiles for viral-infected subjects, especially those infected with H1N1 [ 39 , 40 ]. The low abundance of interferon and interferon-induced transcripts was also observed in a study of gene expression profiles in acute KD subjects compared to subjects with adenovirus infection [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Global gene expression profiling identifies new therapeutic targets in acute Kawasaki disease

et al. 2014

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BackgroundGlobal gene expression profiling can provide insight into the underlying pathophysiology of disease processes. Kawasaki disease (KD) is an acute, self-limited vasculitis whose etiology remains unknown. Although the clinical illness shares certain features with other pediatric infectious diseases, the occurrence of coronary artery aneurysms in 25% of untreated patients is unique to KD.MethodsTo gain further insight into the molecular mechanisms underlying KD, we investigated the acute and convalescent whole blood transcriptional profiles of 146 KD subjects and compared them with the transcriptional profiles of pediatric patients with confirmed bacterial or viral infection, and with healthy control children. We also investigated the transcript abundance in patients with different intravenous immunoglobulin treatment responses and different coronary artery outcomes.ResultsThe overwhelming signature for acute KD involved signaling pathways of the innate immune system. Comparison with other acute pediatric infections highlighted the importance of pathways involved in cell motility including paxillin, relaxin, actin, integrins, and matrix metalloproteinases. Most importantly, the IL1β pathway was identified as a potential therapeutic target.ConclusionOur study revealed the importance of the IL-1 signaling pathway and a prominent signature of innate immunity and cell migration in the acute phase of the illness.Electronic supplementary materialThe online version of this article (doi:10.1186/s13073-014-0102-6) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Global gene expression profiling identifies new therapeutic targets in acute Kawasaki disease

et al. 2014

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“…In the sample of 100 patients, 41% were females and median age was 8 [5][6][7][8][9][10][11] years. The TEE derived RVOT gradients obtained in AA Sax, Arch Sax and TG RV outflow view were 26.46±6.98, 26.60±6.55, and 22.64±6.21 mmHg, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…In the sample of 100 patients, 41% were females and median age was 8 [5][6][7][8][9][10][11] The correlation between intraoperative direct (needle) and TEE assessment of RVOT pressure gradient obtained in AA Sax, Arch Sax, and TG RV outflow view were 0.588 (p<0.001), 0.283 (p<0.001), and 0.383 (p<0.001), respectively. The Bland-Altman plot for the assessment of agreement between the measurement of intraoperative RVOT pressure gradient through direct and different views of TEE are presented in Figure 1 through Figure 3.…”

Section: Resultsmentioning

confidence: 99%

“…3 In the early years of 90s decade, the transatrial/transpulmonary approach was preferred for the TOF repair due to its added advantage in preservation of pulmonic valve and circumventing the right ventricular (RV) functional impairment due to ventriculotomy as well as avoiding the deleterious long-term effects of the transannular patch. 7,8 However, unacceptably high rates of post-operative morbidities due to a residual RVOT obstruction remained the key limitations of these surgical techniques. 9 The optimal TOF repair depends on the adequate relief of RVOT obstruction along with minimum impairment of pulmonic valve.…”

Section: Introductionmentioning

confidence: 99%

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Correlation between Intraoperative Direct and Transesophageal Echocardiographic Assessment of Right Ventricular Outflow Tract Pressure Gradient in Patients Undergoing Tetralogy of Fallot Repair

et al. 2023

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Objectives: The objective of this study was to determine the correlation between intraoperative direct (needle) and transesophageal echocardiographic (TEE) assessment of right ventricular outflow tract (RVOT) pressure gradient in patients undergoing Tetralogy of Fallot (TOF) repair. Methodology: A total of 100 patients underwent for TOF repair were included. After completion of surgery and successful weaning from cardiopulmonary bypass, the TEE derived RVOT gradients were obtained from, the midesophageal ascending aortic short axis (AA Sax) view, upper esophageal aortic arch short axis (Arch Sax) view and trans-gastric RV outflow (TG RV outflow) view. Direct (needle) derived pressures from right ventricular (RV) and pulmonary artery (PA) were obtained by surgeon using a saline filled pressure transducer system. Correlation coefficient was computed between intraoperative direct and TEE assessment of RVOT gradient was evaluated. Results: In the sample of 100 patients, 41% were females and median age was 8 [5-11] years. The TEE derived RVOT gradients obtained in AA Sax, Arch Sax and TG RV outflow view were 26.46±6.98, 26.60±6.55, and 22.64±6.21 mmHg, respectively. Intraoperative RVOT pressure gradient was 19.05±8.9 mmHg. The correlation between intraoperative direct (needle) and TEE assessment of RVOT pressure gradient obtained in AA Sax, Arch Sax, and TG RV outflow view were 0.588 (p<0.001), 0.283 (p<0.001), and 0.383 (p<0.001), respectively. Conclusion: Intraoperative TEE assessment of RVOT pressure gradient showed a moderate correlation with the direct (needle) assessment. The ascending aorta short axis view was found to be the superior esophageal view.

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“…Both techniques have their pros and cons. Advantages of TA/TP approach include shorter cardiopulmonary bypass (CPB) and aortic clamp time (ACT), smoother separation from CPB, minimal use of inotropes, lesser post-operative bleeding, lesser blood products transfusion, lesser reopening rate, smoother course in ICU, earlier extubation, minimal pleural drainage, minimal ICU and hospital stay, lesser mortality, an earlier hospital discharge 5 and low rate of repeat sternotomy for right ventricular outflow tract (RVOT) reconstruction 6 . TAP/TV correction is done to get the required RVOT dimension when the pulmonary valve is either hypoplastic/severely stenosed along with a ver tight infundibular stenosis.…”

Section: S882mentioning

confidence: 99%

Surgery of Tetralogy of Fallot-15 Year Experience at Afic-Nihd Rawalpindi

Zaidi

Khan

Bakht

et al. 2021

PAFMJ

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Objective: To compare trans-atrial/Trans-pulmonary and trans-annular/trans-ventricular techniques of surgical correction of tetralogy of fallot. Study Design: Descriptive cross sectional study. Place and Duration of Study: AFIC-NIHD Rawalpindi, from Jan 2005 to Jan 2020. Methodology: Pre-op variables included age, gender, weight, SaO2 and any previous operation (like Modified Blalock Taussig Shunt.) Operative variables were any previous Blalock Taussig Shunts and if present, then their takedown, Cardiopulmonary Bypass Time, Aortic Clamp Time, any Right Ventricle - Pulmonary Artery conduit, Main Pulmonary Artery patch-plasty, Left Pulmonary Artery/ Right Pulmonary Artery patch-plasty, dosage of inotropes and pacing started during weaning off CPB. Post-op variables were mechanical ventilation time (hrs), ventilation time >72 hrs, dosage and duration of inotropes, pacing >24 hrs, renal complications, neurological complications, sepsis, low cardiac output, re-ventilation, tachyarrythmias, any re-opening surgery, mean intensive care unit stay (hrs), overall hospital stay (days) and overall all-cause mortality. Results: A total of 1271 TOF patients were operated. In (38.6%) cases Trans-atrial / Trans-pulmonary approach was used while in 780 (61.3%) correction was done by TAP/TV technique. In both techniques, male patients were 365 (66.4%) vs. 73 (64.1%) females. Mean age was 5 ± 2.3 vs. 4 ± 2.5 years, MPA patch-plasty was 190 ± 5 (38.6%) vs. 780 ± 8 (100%) (p-0.058), RPA/LPA Patch Plasty was 25 ± 6 (5%) vs. 180 ± 10 (23%) (p- 0.025), In ICU, Ventilation hours was 25 ± 8 and 30 ± 12, Ventilation >72 Hrs was 15 (3%) vs. 65 (8.3%) (p-0.015), Inotrope duration >72 Hours was 90 (18.3%) vs. 400 (51.2%) (p-0.338), pacing >24 hours was 30 (6.1%) vs. 150 (19.2%) (p-0.0001), renal complications were 10 (2.3%) vs. 35 (4.4%) (p- 0.285), Neurological complications were 7 (1.4%) vs. 15 (1.9%) (p0.553), Sepsis was 11 (2.2%) vs. 47 (6%) (p-0.33), Low cardiac output was 15 (3%) vs. 66 (8.4%) (p- 1.000), re-ventilation was 10 (2%) vs. 110 (14%) (p- 0.41), Tachy-arrhythmia was 25 (5%) vs. 150 (19.2%) (p- 0.11), re-openings were 19 (3.8%) vs. 65 (8.3%) (p- 0.0003), ICU stay (Hours) was 87 ± 8 vs. 108 ± 10, Mortality was 35 (7.1%) vs. 75 (9.6%) (p-0.094), Mean hospital stay (Days) was 12.2 ± 2.5 vs. 15.8 ± 4.9. Conclusion: Fifteen years’ experience of Tetralogy of fallot corrections at AFIC-NIHD indicates that Trans-atrial / Trans-pulmonary approach is more beneficial to patients due to high survival rate, less morbidity, less hospital stay and an early discharge. This ultimately translates into less financial burden on the patients, hospital, society and the country at large.

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Primary repair of tetralogy of Fallot in infants: Transatrial/transpulmonary or transventricular approach

Abstract: Transatrial/transpulmonary repair of TOF is associated with excellent surgical results and immediately follow-up.

Cited by 8 publications

References 27 publications

Global gene expression profiling identifies new therapeutic targets in acute Kawasaki disease

Global gene expression profiling identifies new therapeutic targets in acute Kawasaki disease

Correlation between Intraoperative Direct and Transesophageal Echocardiographic Assessment of Right Ventricular Outflow Tract Pressure Gradient in Patients Undergoing Tetralogy of Fallot Repair

Surgery of Tetralogy of Fallot-15 Year Experience at Afic-Nihd Rawalpindi

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