Right ventricular outflow reconstruction with cryopreserved homografts in pediatric patients: Intermediate-term follow-up with serial echocardiographic assessment
Objectives. This study was performed to assess by echocardiography the intermediate-term outcome of cryopreserved homografts employed in pulmonary outflow reconstruction in children and to validate the reliability of Doppler echocardiography in their evaluation. Background. Cryopreserved homografts...
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| Veröffentlicht in: | Journal of the American College of Cardiology 1994-08, Vol.24 (2), p.483-489 |
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| creator | Chan, Kwok Chiu Fyfe, Derek A. McKay, Christine A. Sade, Robert M. Crawford, Fred A. |
| description | Objectives. This study was performed to assess by echocardiography the intermediate-term outcome of cryopreserved homografts employed in pulmonary outflow reconstruction in children and to validate the reliability of Doppler echocardiography in their evaluation.
Background. Cryopreserved homografts have become the most widely used pulmonary conduits. Previous reports have shown the occurrence of homograft regurgitation in the immediate postoperative period and the propensity of regurgitation to progress. Although Doppler echocardiography has been useful in assessing extracardiac valved conduit stenosis, its reliability in assessing a large series of cryopreserved homografts has not been documented.
Methods. Echocardiograms of 41 patients (43 homografts) who underwent operations between December 1986 and October 1992 were retrospectively reviewed. The median age of patients at operation was 37.5 months (range 3 to 333), and the median duration of follow-up was 28.5 months (range 1 to 68). Homograft regurgitation was classified on a scale of 0 to 4+. Pressure gradients across the homografts measured in 23 catheterizations were correlated with corresponding echocardiographic gradients.
Results. Regurgitation: Homograft regurgitation occurred in 100% of patients at follow-up. Progression of severity >2 grades occurred during follow-up in 35% and was associated with operation before age 18 months (p < 0.002) and stenosis progression (p < 0.05) but not with homograft type (aortic or pulmonary). These data predict that 50% of patients operated on before 18 months of age will have severe regurgitation by 15 months postoperatively compared with only 15% operated on after 18 months. Stenosis: At follow-up, 51% of homografts had a stenotic gradient ≥25 mm Hg predominantly at the distal anastomosis, and stenosis progression was related to young age at operation ( |
| doi_str_mv | 10.1016/0735-1097(94)90307-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_76589866</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>0735109794903077</els_id><sourcerecordid>76589866</sourcerecordid><originalsourceid>FETCH-LOGICAL-c466t-5fe8eff3970fe3137dbe2d5a42137cc4ca59fbea85e6b6bdb83048f0d1c2271b3</originalsourceid><addsrcrecordid>eNp9kc1q3DAURkVpSCdp36AFLUpJF06lkSzJWRRK6E8gECjtWsjyVaxiW64kT8jr5EkrZ4ZZdqUL97sHcT6E3lJySQkVn4hkdUVJIy8a_rEhjMhKvkAbWteqYnUjX6LNMfIKnaX0hxAiFG1O0akijCslNujpp7_vM97BlKO3y2AiDkt2Q3jAEWyYUo6LzT5M-MHnHtv4GOYICeIOOtyHMdxH43LCfsIzdN6sFDyb7AswXeGbKUMcnxdQrSN2YSjwapn3wELyZsBg-2BN7PzKm_vCMClBSmPBvEYnzgwJ3hzec_T729df1z-q27vvN9dfbivLhchV7UCBc6yRxAGjTHYtbLva8G2ZreXW1I1rwagaRCvarlWMcOVIR-12K2nLztGHPXeO4e8CKevRJwvDYCYIS9JS1KpRQpQg3wdtDClFcHqOfjTxUVOi12r06l2v3nXD9XM1Wpazdwf-0hYlx6NDF2X__rA3yZrBRTNZn44xTiWjlJfY530Mioudh6iTLbZtkVway7oL_v__-Ad7JrE-</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>76589866</pqid></control><display><type>article</type><title>Right ventricular outflow reconstruction with cryopreserved homografts in pediatric patients: Intermediate-term follow-up with serial echocardiographic assessment</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Chan, Kwok Chiu ; Fyfe, Derek A. ; McKay, Christine A. ; Sade, Robert M. ; Crawford, Fred A.</creator><creatorcontrib>Chan, Kwok Chiu ; Fyfe, Derek A. ; McKay, Christine A. ; Sade, Robert M. ; Crawford, Fred A.</creatorcontrib><description><![CDATA[Objectives. This study was performed to assess by echocardiography the intermediate-term outcome of cryopreserved homografts employed in pulmonary outflow reconstruction in children and to validate the reliability of Doppler echocardiography in their evaluation.
Background. Cryopreserved homografts have become the most widely used pulmonary conduits. Previous reports have shown the occurrence of homograft regurgitation in the immediate postoperative period and the propensity of regurgitation to progress. Although Doppler echocardiography has been useful in assessing extracardiac valved conduit stenosis, its reliability in assessing a large series of cryopreserved homografts has not been documented.
Methods. Echocardiograms of 41 patients (43 homografts) who underwent operations between December 1986 and October 1992 were retrospectively reviewed. The median age of patients at operation was 37.5 months (range 3 to 333), and the median duration of follow-up was 28.5 months (range 1 to 68). Homograft regurgitation was classified on a scale of 0 to 4+. Pressure gradients across the homografts measured in 23 catheterizations were correlated with corresponding echocardiographic gradients.
Results. Regurgitation: Homograft regurgitation occurred in 100% of patients at follow-up. Progression of severity >2 grades occurred during follow-up in 35% and was associated with operation before age 18 months (p < 0.002) and stenosis progression (p < 0.05) but not with homograft type (aortic or pulmonary). These data predict that 50% of patients operated on before 18 months of age will have severe regurgitation by 15 months postoperatively compared with only 15% operated on after 18 months. Stenosis: At follow-up, 51% of homografts had a stenotic gradient ≥25 mm Hg predominantly at the distal anastomosis, and stenosis progression was related to young age at operation (<18 months, p < 0.005) and small conduit size (p < 0.01). Fifty percent of conduits implanted before age 18 months could be predicted to stenose by 21.8 months compared with only 5% of those implanted after age 18 months. The gradient measured from Doppler echocardiography correlated well with the catheterization gradient (r = 0.86).
Conclusions. Cryopreserved homograft dysfunction is frequent and progressive. Young age at operation (<18 months) predicts more rapid deterioration. Doppler echocardiography is reliable in assessing the systolic gradients across homografts. Serial echocardiographic assessment in the follow-up of these patients accurately characterizes these problems.]]></description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/0735-1097(94)90307-7</identifier><identifier>PMID: 8034886</identifier><identifier>CODEN: JACCDI</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Aortic Valve - diagnostic imaging ; Aortic Valve - pathology ; Aortic Valve - surgery ; Aortic Valve Insufficiency - diagnostic imaging ; Aortic Valve Insufficiency - etiology ; Aortic Valve Insufficiency - pathology ; Biological and medical sciences ; Child ; Child, Preschool ; Constriction, Pathologic ; Cryopreservation ; Echocardiography, Doppler ; Female ; Follow-Up Studies ; Heart Valve Prosthesis ; Heart Ventricles - surgery ; Humans ; Infant ; Male ; Medical sciences ; Pulmonary Valve - diagnostic imaging ; Pulmonary Valve - pathology ; Pulmonary Valve - surgery ; Pulmonary Valve Insufficiency - diagnostic imaging ; Pulmonary Valve Insufficiency - etiology ; Pulmonary Valve Insufficiency - pathology ; Retrospective Studies ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart ; Transplantation, Homologous</subject><ispartof>Journal of the American College of Cardiology, 1994-08, Vol.24 (2), p.483-489</ispartof><rights>1994</rights><rights>1994 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c466t-5fe8eff3970fe3137dbe2d5a42137cc4ca59fbea85e6b6bdb83048f0d1c2271b3</citedby><cites>FETCH-LOGICAL-c466t-5fe8eff3970fe3137dbe2d5a42137cc4ca59fbea85e6b6bdb83048f0d1c2271b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/0735109794903077$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>309,310,314,776,780,785,786,3537,23909,23910,25118,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=4173114$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8034886$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chan, Kwok Chiu</creatorcontrib><creatorcontrib>Fyfe, Derek A.</creatorcontrib><creatorcontrib>McKay, Christine A.</creatorcontrib><creatorcontrib>Sade, Robert M.</creatorcontrib><creatorcontrib>Crawford, Fred A.</creatorcontrib><title>Right ventricular outflow reconstruction with cryopreserved homografts in pediatric patients: Intermediate-term follow-up with serial echocardiographic assessment</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description><![CDATA[Objectives. This study was performed to assess by echocardiography the intermediate-term outcome of cryopreserved homografts employed in pulmonary outflow reconstruction in children and to validate the reliability of Doppler echocardiography in their evaluation.
Background. Cryopreserved homografts have become the most widely used pulmonary conduits. Previous reports have shown the occurrence of homograft regurgitation in the immediate postoperative period and the propensity of regurgitation to progress. Although Doppler echocardiography has been useful in assessing extracardiac valved conduit stenosis, its reliability in assessing a large series of cryopreserved homografts has not been documented.
Methods. Echocardiograms of 41 patients (43 homografts) who underwent operations between December 1986 and October 1992 were retrospectively reviewed. The median age of patients at operation was 37.5 months (range 3 to 333), and the median duration of follow-up was 28.5 months (range 1 to 68). Homograft regurgitation was classified on a scale of 0 to 4+. Pressure gradients across the homografts measured in 23 catheterizations were correlated with corresponding echocardiographic gradients.
Results. Regurgitation: Homograft regurgitation occurred in 100% of patients at follow-up. Progression of severity >2 grades occurred during follow-up in 35% and was associated with operation before age 18 months (p < 0.002) and stenosis progression (p < 0.05) but not with homograft type (aortic or pulmonary). These data predict that 50% of patients operated on before 18 months of age will have severe regurgitation by 15 months postoperatively compared with only 15% operated on after 18 months. Stenosis: At follow-up, 51% of homografts had a stenotic gradient ≥25 mm Hg predominantly at the distal anastomosis, and stenosis progression was related to young age at operation (<18 months, p < 0.005) and small conduit size (p < 0.01). Fifty percent of conduits implanted before age 18 months could be predicted to stenose by 21.8 months compared with only 5% of those implanted after age 18 months. The gradient measured from Doppler echocardiography correlated well with the catheterization gradient (r = 0.86).
Conclusions. Cryopreserved homograft dysfunction is frequent and progressive. Young age at operation (<18 months) predicts more rapid deterioration. Doppler echocardiography is reliable in assessing the systolic gradients across homografts. Serial echocardiographic assessment in the follow-up of these patients accurately characterizes these problems.]]></description><subject>Adolescent</subject><subject>Adult</subject><subject>Aortic Valve - diagnostic imaging</subject><subject>Aortic Valve - pathology</subject><subject>Aortic Valve - surgery</subject><subject>Aortic Valve Insufficiency - diagnostic imaging</subject><subject>Aortic Valve Insufficiency - etiology</subject><subject>Aortic Valve Insufficiency - pathology</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Constriction, Pathologic</subject><subject>Cryopreservation</subject><subject>Echocardiography, Doppler</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart Valve Prosthesis</subject><subject>Heart Ventricles - surgery</subject><subject>Humans</subject><subject>Infant</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Pulmonary Valve - diagnostic imaging</subject><subject>Pulmonary Valve - pathology</subject><subject>Pulmonary Valve - surgery</subject><subject>Pulmonary Valve Insufficiency - diagnostic imaging</subject><subject>Pulmonary Valve Insufficiency - etiology</subject><subject>Pulmonary Valve Insufficiency - pathology</subject><subject>Retrospective Studies</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the heart</subject><subject>Transplantation, Homologous</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1994</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1q3DAURkVpSCdp36AFLUpJF06lkSzJWRRK6E8gECjtWsjyVaxiW64kT8jr5EkrZ4ZZdqUL97sHcT6E3lJySQkVn4hkdUVJIy8a_rEhjMhKvkAbWteqYnUjX6LNMfIKnaX0hxAiFG1O0akijCslNujpp7_vM97BlKO3y2AiDkt2Q3jAEWyYUo6LzT5M-MHnHtv4GOYICeIOOtyHMdxH43LCfsIzdN6sFDyb7AswXeGbKUMcnxdQrSN2YSjwapn3wELyZsBg-2BN7PzKm_vCMClBSmPBvEYnzgwJ3hzec_T729df1z-q27vvN9dfbivLhchV7UCBc6yRxAGjTHYtbLva8G2ZreXW1I1rwagaRCvarlWMcOVIR-12K2nLztGHPXeO4e8CKevRJwvDYCYIS9JS1KpRQpQg3wdtDClFcHqOfjTxUVOi12r06l2v3nXD9XM1Wpazdwf-0hYlx6NDF2X__rA3yZrBRTNZn44xTiWjlJfY530Mioudh6iTLbZtkVway7oL_v__-Ad7JrE-</recordid><startdate>19940801</startdate><enddate>19940801</enddate><creator>Chan, Kwok Chiu</creator><creator>Fyfe, Derek A.</creator><creator>McKay, Christine A.</creator><creator>Sade, Robert M.</creator><creator>Crawford, Fred A.</creator><general>Elsevier Inc</general><general>Elsevier Science</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><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></search><sort><creationdate>19940801</creationdate><title>Right ventricular outflow reconstruction with cryopreserved homografts in pediatric patients: Intermediate-term follow-up with serial echocardiographic assessment</title><author>Chan, Kwok Chiu ; Fyfe, Derek A. ; McKay, Christine A. ; Sade, Robert M. ; Crawford, Fred A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c466t-5fe8eff3970fe3137dbe2d5a42137cc4ca59fbea85e6b6bdb83048f0d1c2271b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1994</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aortic Valve - diagnostic imaging</topic><topic>Aortic Valve - pathology</topic><topic>Aortic Valve - surgery</topic><topic>Aortic Valve Insufficiency - diagnostic imaging</topic><topic>Aortic Valve Insufficiency - etiology</topic><topic>Aortic Valve Insufficiency - pathology</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Constriction, Pathologic</topic><topic>Cryopreservation</topic><topic>Echocardiography, Doppler</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart Valve Prosthesis</topic><topic>Heart Ventricles - surgery</topic><topic>Humans</topic><topic>Infant</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Pulmonary Valve - diagnostic imaging</topic><topic>Pulmonary Valve - pathology</topic><topic>Pulmonary Valve - surgery</topic><topic>Pulmonary Valve Insufficiency - diagnostic imaging</topic><topic>Pulmonary Valve Insufficiency - etiology</topic><topic>Pulmonary Valve Insufficiency - pathology</topic><topic>Retrospective Studies</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the heart</topic><topic>Transplantation, Homologous</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chan, Kwok Chiu</creatorcontrib><creatorcontrib>Fyfe, Derek A.</creatorcontrib><creatorcontrib>McKay, Christine A.</creatorcontrib><creatorcontrib>Sade, Robert M.</creatorcontrib><creatorcontrib>Crawford, Fred A.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><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>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chan, Kwok Chiu</au><au>Fyfe, Derek A.</au><au>McKay, Christine A.</au><au>Sade, Robert M.</au><au>Crawford, Fred A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Right ventricular outflow reconstruction with cryopreserved homografts in pediatric patients: Intermediate-term follow-up with serial echocardiographic assessment</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>1994-08-01</date><risdate>1994</risdate><volume>24</volume><issue>2</issue><spage>483</spage><epage>489</epage><pages>483-489</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><coden>JACCDI</coden><abstract><![CDATA[Objectives. This study was performed to assess by echocardiography the intermediate-term outcome of cryopreserved homografts employed in pulmonary outflow reconstruction in children and to validate the reliability of Doppler echocardiography in their evaluation.
Background. Cryopreserved homografts have become the most widely used pulmonary conduits. Previous reports have shown the occurrence of homograft regurgitation in the immediate postoperative period and the propensity of regurgitation to progress. Although Doppler echocardiography has been useful in assessing extracardiac valved conduit stenosis, its reliability in assessing a large series of cryopreserved homografts has not been documented.
Methods. Echocardiograms of 41 patients (43 homografts) who underwent operations between December 1986 and October 1992 were retrospectively reviewed. The median age of patients at operation was 37.5 months (range 3 to 333), and the median duration of follow-up was 28.5 months (range 1 to 68). Homograft regurgitation was classified on a scale of 0 to 4+. Pressure gradients across the homografts measured in 23 catheterizations were correlated with corresponding echocardiographic gradients.
Results. Regurgitation: Homograft regurgitation occurred in 100% of patients at follow-up. Progression of severity >2 grades occurred during follow-up in 35% and was associated with operation before age 18 months (p < 0.002) and stenosis progression (p < 0.05) but not with homograft type (aortic or pulmonary). These data predict that 50% of patients operated on before 18 months of age will have severe regurgitation by 15 months postoperatively compared with only 15% operated on after 18 months. Stenosis: At follow-up, 51% of homografts had a stenotic gradient ≥25 mm Hg predominantly at the distal anastomosis, and stenosis progression was related to young age at operation (<18 months, p < 0.005) and small conduit size (p < 0.01). Fifty percent of conduits implanted before age 18 months could be predicted to stenose by 21.8 months compared with only 5% of those implanted after age 18 months. The gradient measured from Doppler echocardiography correlated well with the catheterization gradient (r = 0.86).
Conclusions. Cryopreserved homograft dysfunction is frequent and progressive. Young age at operation (<18 months) predicts more rapid deterioration. Doppler echocardiography is reliable in assessing the systolic gradients across homografts. Serial echocardiographic assessment in the follow-up of these patients accurately characterizes these problems.]]></abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>8034886</pmid><doi>10.1016/0735-1097(94)90307-7</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Aortic Valve - diagnostic imaging Aortic Valve - pathology Aortic Valve - surgery Aortic Valve Insufficiency - diagnostic imaging Aortic Valve Insufficiency - etiology Aortic Valve Insufficiency - pathology Biological and medical sciences Child Child, Preschool Constriction, Pathologic Cryopreservation Echocardiography, Doppler Female Follow-Up Studies Heart Valve Prosthesis Heart Ventricles - surgery Humans Infant Male Medical sciences Pulmonary Valve - diagnostic imaging Pulmonary Valve - pathology Pulmonary Valve - surgery Pulmonary Valve Insufficiency - diagnostic imaging Pulmonary Valve Insufficiency - etiology Pulmonary Valve Insufficiency - pathology Retrospective Studies Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Transplantation, Homologous |
| title | Right ventricular outflow reconstruction with cryopreserved homografts in pediatric patients: Intermediate-term follow-up with serial echocardiographic assessment |
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