Three-Patch Reconstruction of Hourglass Supravalvar Pulmonary Artery Stenosis Mid-Term Results
Background Some patients with pulmonary stenosis present with a complex multilevel disease that involves the valve, the leaflets, and the sinotubular junction (STJ) forming an hourglass appearance. We herein report the mid-term results of our experience with the reconstruction of the supravalvar nar...
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| Veröffentlicht in: | World journal for pediatric & congenital heart surgery 2024-01, Vol.15 (1), p.89-93 |
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| creator | Amir, Gabriel Lowenthal, Alexander Bruckheimer, Elchanan Dagan, Tamir Schiller, Ofer Shostak, Eran Frenkel, Georgy Birk, Einat |
| description | Background
Some patients with pulmonary stenosis present with a complex multilevel disease that involves the valve, the leaflets, and the sinotubular junction (STJ) forming an hourglass appearance. We herein report the mid-term results of our experience with the reconstruction of the supravalvar narrowing using three pericardial patches.
Material and Methods
Retrospective analysis of patient charts and echocardiography studies of patients who underwent three-patch reconstruction of the pulmonary valve (PV) from 2013 to 2022. After PV transection distal to STJ, vertical incisions into the sinuses were performed, and leaflets were trimmed and thinned. The three sinuses were augmented using three pericardial patches.
Results
Nineteen patients underwent repair of hourglass supravalvar pulmonary stenosis. Mean weight at surgery was 9.4 kg (median 7.2, range 4.7-35); 16 patients underwent previous catheterization with unsuccessful balloon dilatation of the PV (13 pts.). Preoperative aortic/pulmonary annulus ratio was 1.02 (median 1, range 0.89-1.25). After surgery, gradients across the PV were significantly reduced (94 ± 26 vs 29 ± 9 mm Hg, P = .02). Postoperatively, 14 patients had mild or no pulmonary insufficiency (PI) and five had mild to moderate PI. At a mean follow-up of 71 months (median 78 months, range 8-137), gradients continued to decrease (29 ± 9 vs 15 ± 5 mm Hg, P |
| doi_str_mv | 10.1177/21501351231196485 |
| format | Article |
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Some patients with pulmonary stenosis present with a complex multilevel disease that involves the valve, the leaflets, and the sinotubular junction (STJ) forming an hourglass appearance. We herein report the mid-term results of our experience with the reconstruction of the supravalvar narrowing using three pericardial patches.
Material and Methods
Retrospective analysis of patient charts and echocardiography studies of patients who underwent three-patch reconstruction of the pulmonary valve (PV) from 2013 to 2022. After PV transection distal to STJ, vertical incisions into the sinuses were performed, and leaflets were trimmed and thinned. The three sinuses were augmented using three pericardial patches.
Results
Nineteen patients underwent repair of hourglass supravalvar pulmonary stenosis. Mean weight at surgery was 9.4 kg (median 7.2, range 4.7-35); 16 patients underwent previous catheterization with unsuccessful balloon dilatation of the PV (13 pts.). Preoperative aortic/pulmonary annulus ratio was 1.02 (median 1, range 0.89-1.25). After surgery, gradients across the PV were significantly reduced (94 ± 26 vs 29 ± 9 mm Hg, P = .02). Postoperatively, 14 patients had mild or no pulmonary insufficiency (PI) and five had mild to moderate PI. At a mean follow-up of 71 months (median 78 months, range 8-137), gradients continued to decrease (29 ± 9 vs 15 ± 5 mm Hg, P < .001).
Conclusion
The three-patch technique for the repair of supravalvar pulmonary stenosis is simple, reproducible, and achieves excellent and long-standing relief of the right ventricular outflow tract gradient.</description><identifier>ISSN: 2150-1351</identifier><identifier>EISSN: 2150-136X</identifier><identifier>DOI: 10.1177/21501351231196485</identifier><identifier>PMID: 37853700</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Echocardiography ; Follow-Up Studies ; Humans ; Infant ; Pulmonary Artery - surgery ; Pulmonary Valve - surgery ; Pulmonary Valve Stenosis - diagnostic imaging ; Pulmonary Valve Stenosis - surgery ; Retrospective Studies ; Stenosis, Pulmonary Artery ; Treatment Outcome</subject><ispartof>World journal for pediatric & congenital heart surgery, 2024-01, Vol.15 (1), p.89-93</ispartof><rights>The Author(s) 2023</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c292t-6a0b4d25e0163dead9f3b5d2042e39bac45b9248baae92afeadccf720eeebdc3</cites><orcidid>0000-0002-4607-1133 ; 0000-0001-7245-8377</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/21501351231196485$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/21501351231196485$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21819,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37853700$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Amir, Gabriel</creatorcontrib><creatorcontrib>Lowenthal, Alexander</creatorcontrib><creatorcontrib>Bruckheimer, Elchanan</creatorcontrib><creatorcontrib>Dagan, Tamir</creatorcontrib><creatorcontrib>Schiller, Ofer</creatorcontrib><creatorcontrib>Shostak, Eran</creatorcontrib><creatorcontrib>Frenkel, Georgy</creatorcontrib><creatorcontrib>Birk, Einat</creatorcontrib><title>Three-Patch Reconstruction of Hourglass Supravalvar Pulmonary Artery Stenosis Mid-Term Results</title><title>World journal for pediatric & congenital heart surgery</title><addtitle>World Journal for Pediatric and Congenital Heart Surgery</addtitle><description>Background
Some patients with pulmonary stenosis present with a complex multilevel disease that involves the valve, the leaflets, and the sinotubular junction (STJ) forming an hourglass appearance. We herein report the mid-term results of our experience with the reconstruction of the supravalvar narrowing using three pericardial patches.
Material and Methods
Retrospective analysis of patient charts and echocardiography studies of patients who underwent three-patch reconstruction of the pulmonary valve (PV) from 2013 to 2022. After PV transection distal to STJ, vertical incisions into the sinuses were performed, and leaflets were trimmed and thinned. The three sinuses were augmented using three pericardial patches.
Results
Nineteen patients underwent repair of hourglass supravalvar pulmonary stenosis. Mean weight at surgery was 9.4 kg (median 7.2, range 4.7-35); 16 patients underwent previous catheterization with unsuccessful balloon dilatation of the PV (13 pts.). Preoperative aortic/pulmonary annulus ratio was 1.02 (median 1, range 0.89-1.25). After surgery, gradients across the PV were significantly reduced (94 ± 26 vs 29 ± 9 mm Hg, P = .02). Postoperatively, 14 patients had mild or no pulmonary insufficiency (PI) and five had mild to moderate PI. At a mean follow-up of 71 months (median 78 months, range 8-137), gradients continued to decrease (29 ± 9 vs 15 ± 5 mm Hg, P < .001).
Conclusion
The three-patch technique for the repair of supravalvar pulmonary stenosis is simple, reproducible, and achieves excellent and long-standing relief of the right ventricular outflow tract gradient.</description><subject>Echocardiography</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Infant</subject><subject>Pulmonary Artery - surgery</subject><subject>Pulmonary Valve - surgery</subject><subject>Pulmonary Valve Stenosis - diagnostic imaging</subject><subject>Pulmonary Valve Stenosis - surgery</subject><subject>Retrospective Studies</subject><subject>Stenosis, Pulmonary Artery</subject><subject>Treatment Outcome</subject><issn>2150-1351</issn><issn>2150-136X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1Lw0AQhhdRbKn9AV4kRy-p-5mPYylqhYrF5uDJsNlM2pQkW3ezBf-9W1p7EZzLDMMzD8yL0C3BE0Li-IESgQkThDJC0ogn4gIND7uQsOjj8jwLMkBja7fYF48Y4_waDVicCBZjPESf2cYAhEvZq03wDkp3tjdO9bXuAl0Fc-3MupHWBiu3M3Ivm700wdI1re6k-Q6mpgffVj102tY2eK3LMAPTepV1TW9v0FUlGwvjUx-h7Okxm83Dxdvzy2y6CBVNaR9GEhe8pAIwiVgJskwrVoiSYk6BpYVUXBQp5UkhJaRUVp5QqoopBoCiVGyE7o_andFfDmyft7VV0DSyA-1sTpM45V5GYo-SI6qMttZAle9M3fpfcoLzQ7D5n2D9zd1J74oWyvPFb4wemBwBK9eQb31onf_2H-MPFJiCZA</recordid><startdate>202401</startdate><enddate>202401</enddate><creator>Amir, Gabriel</creator><creator>Lowenthal, Alexander</creator><creator>Bruckheimer, Elchanan</creator><creator>Dagan, Tamir</creator><creator>Schiller, Ofer</creator><creator>Shostak, Eran</creator><creator>Frenkel, Georgy</creator><creator>Birk, Einat</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4607-1133</orcidid><orcidid>https://orcid.org/0000-0001-7245-8377</orcidid></search><sort><creationdate>202401</creationdate><title>Three-Patch Reconstruction of Hourglass Supravalvar Pulmonary Artery Stenosis Mid-Term Results</title><author>Amir, Gabriel ; Lowenthal, Alexander ; Bruckheimer, Elchanan ; Dagan, Tamir ; Schiller, Ofer ; Shostak, Eran ; Frenkel, Georgy ; Birk, Einat</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c292t-6a0b4d25e0163dead9f3b5d2042e39bac45b9248baae92afeadccf720eeebdc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Echocardiography</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Infant</topic><topic>Pulmonary Artery - surgery</topic><topic>Pulmonary Valve - surgery</topic><topic>Pulmonary Valve Stenosis - diagnostic imaging</topic><topic>Pulmonary Valve Stenosis - surgery</topic><topic>Retrospective Studies</topic><topic>Stenosis, Pulmonary Artery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Amir, Gabriel</creatorcontrib><creatorcontrib>Lowenthal, Alexander</creatorcontrib><creatorcontrib>Bruckheimer, Elchanan</creatorcontrib><creatorcontrib>Dagan, Tamir</creatorcontrib><creatorcontrib>Schiller, Ofer</creatorcontrib><creatorcontrib>Shostak, Eran</creatorcontrib><creatorcontrib>Frenkel, Georgy</creatorcontrib><creatorcontrib>Birk, Einat</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>World journal for pediatric & congenital heart surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Amir, Gabriel</au><au>Lowenthal, Alexander</au><au>Bruckheimer, Elchanan</au><au>Dagan, Tamir</au><au>Schiller, Ofer</au><au>Shostak, Eran</au><au>Frenkel, Georgy</au><au>Birk, Einat</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Three-Patch Reconstruction of Hourglass Supravalvar Pulmonary Artery Stenosis Mid-Term Results</atitle><jtitle>World journal for pediatric & congenital heart surgery</jtitle><addtitle>World Journal for Pediatric and Congenital Heart Surgery</addtitle><date>2024-01</date><risdate>2024</risdate><volume>15</volume><issue>1</issue><spage>89</spage><epage>93</epage><pages>89-93</pages><issn>2150-1351</issn><eissn>2150-136X</eissn><abstract>Background
Some patients with pulmonary stenosis present with a complex multilevel disease that involves the valve, the leaflets, and the sinotubular junction (STJ) forming an hourglass appearance. We herein report the mid-term results of our experience with the reconstruction of the supravalvar narrowing using three pericardial patches.
Material and Methods
Retrospective analysis of patient charts and echocardiography studies of patients who underwent three-patch reconstruction of the pulmonary valve (PV) from 2013 to 2022. After PV transection distal to STJ, vertical incisions into the sinuses were performed, and leaflets were trimmed and thinned. The three sinuses were augmented using three pericardial patches.
Results
Nineteen patients underwent repair of hourglass supravalvar pulmonary stenosis. Mean weight at surgery was 9.4 kg (median 7.2, range 4.7-35); 16 patients underwent previous catheterization with unsuccessful balloon dilatation of the PV (13 pts.). Preoperative aortic/pulmonary annulus ratio was 1.02 (median 1, range 0.89-1.25). After surgery, gradients across the PV were significantly reduced (94 ± 26 vs 29 ± 9 mm Hg, P = .02). Postoperatively, 14 patients had mild or no pulmonary insufficiency (PI) and five had mild to moderate PI. At a mean follow-up of 71 months (median 78 months, range 8-137), gradients continued to decrease (29 ± 9 vs 15 ± 5 mm Hg, P < .001).
Conclusion
The three-patch technique for the repair of supravalvar pulmonary stenosis is simple, reproducible, and achieves excellent and long-standing relief of the right ventricular outflow tract gradient.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>37853700</pmid><doi>10.1177/21501351231196485</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0002-4607-1133</orcidid><orcidid>https://orcid.org/0000-0001-7245-8377</orcidid></addata></record> |
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| subjects | Echocardiography Follow-Up Studies Humans Infant Pulmonary Artery - surgery Pulmonary Valve - surgery Pulmonary Valve Stenosis - diagnostic imaging Pulmonary Valve Stenosis - surgery Retrospective Studies Stenosis, Pulmonary Artery Treatment Outcome |
| title | Three-Patch Reconstruction of Hourglass Supravalvar Pulmonary Artery Stenosis Mid-Term Results |
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