Early systemic-to-pulmonary artery shunt intervention in neonates with congenital heart disease
Objective To determine the incidence, risk factors, and outcomes after early, unplanned intervention on systemic-to-pulmonary artery shunts in neonates. Methods We retrospectively studied all neonates undergoing systemic-to-pulmonary artery shunt placement at The Children’s Hospital of Philadelphia...
Gespeichert in:
| Veröffentlicht in: | The Journal of thoracic and cardiovascular surgery 2011-07, Vol.142 (1), p.106-112 |
|---|---|
| Hauptverfasser: | , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 112 |
|---|---|
| container_issue | 1 |
| container_start_page | 106 |
| container_title | The Journal of thoracic and cardiovascular surgery |
| container_volume | 142 |
| creator | O’Connor, Matthew J., MD Ravishankar, Chitra, MD Ballweg, Jean A., MD Gillespie, Matthew J., MD Gaynor, J. William, MD Tabbutt, Sarah, MD, PhD Dominguez, Troy E., MD |
| description | Objective To determine the incidence, risk factors, and outcomes after early, unplanned intervention on systemic-to-pulmonary artery shunts in neonates. Methods We retrospectively studied all neonates undergoing systemic-to-pulmonary artery shunt placement at The Children’s Hospital of Philadelphia between September 1, 2002, and May 1, 2005. Patients requiring transcatheter or surgical systemic-to-pulmonary artery shunt intervention before discharge were compared with those not undergoing shunt intervention. Results A total of 206 patients underwent shunt placement. Diagnoses included hypoplastic left heart syndrome (62.1%), pulmonary atresia (15%), tricuspid atresia (4.9%), tetralogy of Fallot (2.4%), and other lesions with obstruction to systemic (10.7%) or pulmonary blood flow (4.9%). Twenty-one interventions occurred in 20 patients (9.7%). Risk factors for intervention included heterotaxy syndrome ( P = . 04), congenital abnormality ( P = . 04), and a trend toward lower birthweight. In patients with a modified Blalock–Taussig shunt, similar risk factors were identified and the incidence of intervention decreased with increasing shunt size. In-hospital mortality was 30% (6/20) for the cases and 8.1% (15/186) for the nonintervention group ( P = . 02). Long-term survival was significantly lower in patients requiring intervention ( P = . 002). This group also had a higher incidence of infections ( P |
| doi_str_mv | 10.1016/j.jtcvs.2010.10.033 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_873122083</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0022522310012493</els_id><sourcerecordid>873122083</sourcerecordid><originalsourceid>FETCH-LOGICAL-c488t-8d5ae529c7f1e7756dbced199924801d43471697ae665f8f9744189829d3e8403</originalsourceid><addsrcrecordid>eNqFkk2LFDEQhoMo7rj6CwTpi3jqMV_dSQ4KsqwfsOBBBW8hm6520nanx1R6ZP696Z1RwYunoornrY-XIuQpo1tGWfty2A7ZH3DL6V1lS4W4RzaMGlW3uvl6n2wo5bxuOBcX5BHiQClVlJmH5IIzrrg2ekPstUvjscIjZpiCr_Nc75dxmqNLx8qlDCXgbom5CrEkB4g5zLEkVYQCZcDqZ8i7ys_xG8SQ3VjtoOiqLiA4hMfkQe9GhCfneEm-vL3-fPW-vvn47sPVm5vaS61zrbvGQcONVz0DpZq2u_XQMWMMl5qyTgqpWGuUg7Ztet0bJSUrB3DTCdCSikvy4tR3n-YfC2C2U0AP4-jKngtarQTjnGpRSHEifZoRE_R2n8JUzrWM2tVYO9g7Y-1q7FosxhbVs3P_5XaC7o_mt5MFeH4GHHo39slFH_AvJ7kRyrSFe3XioLhxCJAs-gCxXBsS-Gy7Ofxnkdf_6P0YYigjv8MRcJiXFIvRllnkltpP6w-sL8AoZVwaIX4BCXitVg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>873122083</pqid></control><display><type>article</type><title>Early systemic-to-pulmonary artery shunt intervention in neonates with congenital heart disease</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>O’Connor, Matthew J., MD ; Ravishankar, Chitra, MD ; Ballweg, Jean A., MD ; Gillespie, Matthew J., MD ; Gaynor, J. William, MD ; Tabbutt, Sarah, MD, PhD ; Dominguez, Troy E., MD</creator><creatorcontrib>O’Connor, Matthew J., MD ; Ravishankar, Chitra, MD ; Ballweg, Jean A., MD ; Gillespie, Matthew J., MD ; Gaynor, J. William, MD ; Tabbutt, Sarah, MD, PhD ; Dominguez, Troy E., MD</creatorcontrib><description>Objective To determine the incidence, risk factors, and outcomes after early, unplanned intervention on systemic-to-pulmonary artery shunts in neonates. Methods We retrospectively studied all neonates undergoing systemic-to-pulmonary artery shunt placement at The Children’s Hospital of Philadelphia between September 1, 2002, and May 1, 2005. Patients requiring transcatheter or surgical systemic-to-pulmonary artery shunt intervention before discharge were compared with those not undergoing shunt intervention. Results A total of 206 patients underwent shunt placement. Diagnoses included hypoplastic left heart syndrome (62.1%), pulmonary atresia (15%), tricuspid atresia (4.9%), tetralogy of Fallot (2.4%), and other lesions with obstruction to systemic (10.7%) or pulmonary blood flow (4.9%). Twenty-one interventions occurred in 20 patients (9.7%). Risk factors for intervention included heterotaxy syndrome ( P = . 04), congenital abnormality ( P = . 04), and a trend toward lower birthweight. In patients with a modified Blalock–Taussig shunt, similar risk factors were identified and the incidence of intervention decreased with increasing shunt size. In-hospital mortality was 30% (6/20) for the cases and 8.1% (15/186) for the nonintervention group ( P = . 02). Long-term survival was significantly lower in patients requiring intervention ( P = . 002). This group also had a higher incidence of infections ( P < . 001) and extracorporeal membrane oxygenation ( P < . 001), and longer hospital stay ( P = . 001). Conclusions In neonates undergoing systemic-to-pulmonary artery shunt placement, approximately 10% underwent shunt intervention before discharge. Some factors, such as low birthweight, shunt size, noncardiac congenital abnormalities, and heterotaxy syndrome, may help identify patients at risk. Patients undergoing intervention experienced increased morbidity and mortality.</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2010.10.033</identifier><identifier>PMID: 21272898</identifier><identifier>CODEN: JTCSAQ</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Blalock-Taussig Procedure - adverse effects ; Blalock-Taussig Procedure - mortality ; Cardiac Catheterization - adverse effects ; Cardiac Catheterization - mortality ; Cardiology. Vascular system ; Cardiothoracic Surgery ; Chi-Square Distribution ; Communicable Diseases - etiology ; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava ; Extracorporeal Membrane Oxygenation ; Female ; Heart ; Heart Defects, Congenital - mortality ; Heart Defects, Congenital - physiopathology ; Heart Defects, Congenital - surgery ; Hemodynamics ; Hospital Mortality ; Hospitals, Pediatric ; Humans ; Infant, Newborn ; Kaplan-Meier Estimate ; Length of Stay ; Logistic Models ; Male ; Medical sciences ; Philadelphia ; Pneumology ; Pulmonary Artery - physiopathology ; Pulmonary Artery - surgery ; Pulmonary Circulation ; Reoperation ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2011-07, Vol.142 (1), p.106-112</ispartof><rights>The American Association for Thoracic Surgery</rights><rights>2011 The American Association for Thoracic Surgery</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c488t-8d5ae529c7f1e7756dbced199924801d43471697ae665f8f9744189829d3e8403</citedby><cites>FETCH-LOGICAL-c488t-8d5ae529c7f1e7756dbced199924801d43471697ae665f8f9744189829d3e8403</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022522310012493$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24293796$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21272898$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>O’Connor, Matthew J., MD</creatorcontrib><creatorcontrib>Ravishankar, Chitra, MD</creatorcontrib><creatorcontrib>Ballweg, Jean A., MD</creatorcontrib><creatorcontrib>Gillespie, Matthew J., MD</creatorcontrib><creatorcontrib>Gaynor, J. William, MD</creatorcontrib><creatorcontrib>Tabbutt, Sarah, MD, PhD</creatorcontrib><creatorcontrib>Dominguez, Troy E., MD</creatorcontrib><title>Early systemic-to-pulmonary artery shunt intervention in neonates with congenital heart disease</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>Objective To determine the incidence, risk factors, and outcomes after early, unplanned intervention on systemic-to-pulmonary artery shunts in neonates. Methods We retrospectively studied all neonates undergoing systemic-to-pulmonary artery shunt placement at The Children’s Hospital of Philadelphia between September 1, 2002, and May 1, 2005. Patients requiring transcatheter or surgical systemic-to-pulmonary artery shunt intervention before discharge were compared with those not undergoing shunt intervention. Results A total of 206 patients underwent shunt placement. Diagnoses included hypoplastic left heart syndrome (62.1%), pulmonary atresia (15%), tricuspid atresia (4.9%), tetralogy of Fallot (2.4%), and other lesions with obstruction to systemic (10.7%) or pulmonary blood flow (4.9%). Twenty-one interventions occurred in 20 patients (9.7%). Risk factors for intervention included heterotaxy syndrome ( P = . 04), congenital abnormality ( P = . 04), and a trend toward lower birthweight. In patients with a modified Blalock–Taussig shunt, similar risk factors were identified and the incidence of intervention decreased with increasing shunt size. In-hospital mortality was 30% (6/20) for the cases and 8.1% (15/186) for the nonintervention group ( P = . 02). Long-term survival was significantly lower in patients requiring intervention ( P = . 002). This group also had a higher incidence of infections ( P < . 001) and extracorporeal membrane oxygenation ( P < . 001), and longer hospital stay ( P = . 001). Conclusions In neonates undergoing systemic-to-pulmonary artery shunt placement, approximately 10% underwent shunt intervention before discharge. Some factors, such as low birthweight, shunt size, noncardiac congenital abnormalities, and heterotaxy syndrome, may help identify patients at risk. Patients undergoing intervention experienced increased morbidity and mortality.</description><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Blalock-Taussig Procedure - adverse effects</subject><subject>Blalock-Taussig Procedure - mortality</subject><subject>Cardiac Catheterization - adverse effects</subject><subject>Cardiac Catheterization - mortality</subject><subject>Cardiology. Vascular system</subject><subject>Cardiothoracic Surgery</subject><subject>Chi-Square Distribution</subject><subject>Communicable Diseases - etiology</subject><subject>Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava</subject><subject>Extracorporeal Membrane Oxygenation</subject><subject>Female</subject><subject>Heart</subject><subject>Heart Defects, Congenital - mortality</subject><subject>Heart Defects, Congenital - physiopathology</subject><subject>Heart Defects, Congenital - surgery</subject><subject>Hemodynamics</subject><subject>Hospital Mortality</subject><subject>Hospitals, Pediatric</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Kaplan-Meier Estimate</subject><subject>Length of Stay</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Philadelphia</subject><subject>Pneumology</subject><subject>Pulmonary Artery - physiopathology</subject><subject>Pulmonary Artery - surgery</subject><subject>Pulmonary Circulation</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkk2LFDEQhoMo7rj6CwTpi3jqMV_dSQ4KsqwfsOBBBW8hm6520nanx1R6ZP696Z1RwYunoornrY-XIuQpo1tGWfty2A7ZH3DL6V1lS4W4RzaMGlW3uvl6n2wo5bxuOBcX5BHiQClVlJmH5IIzrrg2ekPstUvjscIjZpiCr_Nc75dxmqNLx8qlDCXgbom5CrEkB4g5zLEkVYQCZcDqZ8i7ys_xG8SQ3VjtoOiqLiA4hMfkQe9GhCfneEm-vL3-fPW-vvn47sPVm5vaS61zrbvGQcONVz0DpZq2u_XQMWMMl5qyTgqpWGuUg7Ztet0bJSUrB3DTCdCSikvy4tR3n-YfC2C2U0AP4-jKngtarQTjnGpRSHEifZoRE_R2n8JUzrWM2tVYO9g7Y-1q7FosxhbVs3P_5XaC7o_mt5MFeH4GHHo39slFH_AvJ7kRyrSFe3XioLhxCJAs-gCxXBsS-Gy7Ofxnkdf_6P0YYigjv8MRcJiXFIvRllnkltpP6w-sL8AoZVwaIX4BCXitVg</recordid><startdate>20110701</startdate><enddate>20110701</enddate><creator>O’Connor, Matthew J., MD</creator><creator>Ravishankar, Chitra, MD</creator><creator>Ballweg, Jean A., MD</creator><creator>Gillespie, Matthew J., MD</creator><creator>Gaynor, J. William, MD</creator><creator>Tabbutt, Sarah, MD, PhD</creator><creator>Dominguez, Troy E., MD</creator><general>Mosby, Inc</general><general>Elsevier</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>20110701</creationdate><title>Early systemic-to-pulmonary artery shunt intervention in neonates with congenital heart disease</title><author>O’Connor, Matthew J., MD ; Ravishankar, Chitra, MD ; Ballweg, Jean A., MD ; Gillespie, Matthew J., MD ; Gaynor, J. William, MD ; Tabbutt, Sarah, MD, PhD ; Dominguez, Troy E., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c488t-8d5ae529c7f1e7756dbced199924801d43471697ae665f8f9744189829d3e8403</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Blalock-Taussig Procedure - adverse effects</topic><topic>Blalock-Taussig Procedure - mortality</topic><topic>Cardiac Catheterization - adverse effects</topic><topic>Cardiac Catheterization - mortality</topic><topic>Cardiology. Vascular system</topic><topic>Cardiothoracic Surgery</topic><topic>Chi-Square Distribution</topic><topic>Communicable Diseases - etiology</topic><topic>Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava</topic><topic>Extracorporeal Membrane Oxygenation</topic><topic>Female</topic><topic>Heart</topic><topic>Heart Defects, Congenital - mortality</topic><topic>Heart Defects, Congenital - physiopathology</topic><topic>Heart Defects, Congenital - surgery</topic><topic>Hemodynamics</topic><topic>Hospital Mortality</topic><topic>Hospitals, Pediatric</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Kaplan-Meier Estimate</topic><topic>Length of Stay</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Philadelphia</topic><topic>Pneumology</topic><topic>Pulmonary Artery - physiopathology</topic><topic>Pulmonary Artery - surgery</topic><topic>Pulmonary Circulation</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>O’Connor, Matthew J., MD</creatorcontrib><creatorcontrib>Ravishankar, Chitra, MD</creatorcontrib><creatorcontrib>Ballweg, Jean A., MD</creatorcontrib><creatorcontrib>Gillespie, Matthew J., MD</creatorcontrib><creatorcontrib>Gaynor, J. William, MD</creatorcontrib><creatorcontrib>Tabbutt, Sarah, MD, PhD</creatorcontrib><creatorcontrib>Dominguez, Troy E., MD</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>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>O’Connor, Matthew J., MD</au><au>Ravishankar, Chitra, MD</au><au>Ballweg, Jean A., MD</au><au>Gillespie, Matthew J., MD</au><au>Gaynor, J. William, MD</au><au>Tabbutt, Sarah, MD, PhD</au><au>Dominguez, Troy E., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early systemic-to-pulmonary artery shunt intervention in neonates with congenital heart disease</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2011-07-01</date><risdate>2011</risdate><volume>142</volume><issue>1</issue><spage>106</spage><epage>112</epage><pages>106-112</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><coden>JTCSAQ</coden><abstract>Objective To determine the incidence, risk factors, and outcomes after early, unplanned intervention on systemic-to-pulmonary artery shunts in neonates. Methods We retrospectively studied all neonates undergoing systemic-to-pulmonary artery shunt placement at The Children’s Hospital of Philadelphia between September 1, 2002, and May 1, 2005. Patients requiring transcatheter or surgical systemic-to-pulmonary artery shunt intervention before discharge were compared with those not undergoing shunt intervention. Results A total of 206 patients underwent shunt placement. Diagnoses included hypoplastic left heart syndrome (62.1%), pulmonary atresia (15%), tricuspid atresia (4.9%), tetralogy of Fallot (2.4%), and other lesions with obstruction to systemic (10.7%) or pulmonary blood flow (4.9%). Twenty-one interventions occurred in 20 patients (9.7%). Risk factors for intervention included heterotaxy syndrome ( P = . 04), congenital abnormality ( P = . 04), and a trend toward lower birthweight. In patients with a modified Blalock–Taussig shunt, similar risk factors were identified and the incidence of intervention decreased with increasing shunt size. In-hospital mortality was 30% (6/20) for the cases and 8.1% (15/186) for the nonintervention group ( P = . 02). Long-term survival was significantly lower in patients requiring intervention ( P = . 002). This group also had a higher incidence of infections ( P < . 001) and extracorporeal membrane oxygenation ( P < . 001), and longer hospital stay ( P = . 001). Conclusions In neonates undergoing systemic-to-pulmonary artery shunt placement, approximately 10% underwent shunt intervention before discharge. Some factors, such as low birthweight, shunt size, noncardiac congenital abnormalities, and heterotaxy syndrome, may help identify patients at risk. Patients undergoing intervention experienced increased morbidity and mortality.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>21272898</pmid><doi>10.1016/j.jtcvs.2010.10.033</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0022-5223 |
| ispartof | The Journal of thoracic and cardiovascular surgery, 2011-07, Vol.142 (1), p.106-112 |
| issn | 0022-5223 1097-685X |
| language | eng |
| recordid | cdi_proquest_miscellaneous_873122083 |
| source | MEDLINE; Elsevier ScienceDirect Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Blalock-Taussig Procedure - adverse effects Blalock-Taussig Procedure - mortality Cardiac Catheterization - adverse effects Cardiac Catheterization - mortality Cardiology. Vascular system Cardiothoracic Surgery Chi-Square Distribution Communicable Diseases - etiology Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava Extracorporeal Membrane Oxygenation Female Heart Heart Defects, Congenital - mortality Heart Defects, Congenital - physiopathology Heart Defects, Congenital - surgery Hemodynamics Hospital Mortality Hospitals, Pediatric Humans Infant, Newborn Kaplan-Meier Estimate Length of Stay Logistic Models Male Medical sciences Philadelphia Pneumology Pulmonary Artery - physiopathology Pulmonary Artery - surgery Pulmonary Circulation Reoperation Retrospective Studies Risk Assessment Risk Factors Time Factors Treatment Outcome |
| title | Early systemic-to-pulmonary artery shunt intervention in neonates with congenital heart disease |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-21T21%3A59%3A28IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Early%20systemic-to-pulmonary%20artery%20shunt%20intervention%20in%20neonates%20with%20congenital%20heart%20disease&rft.jtitle=The%20Journal%20of%20thoracic%20and%20cardiovascular%20surgery&rft.au=O%E2%80%99Connor,%20Matthew%20J.,%20MD&rft.date=2011-07-01&rft.volume=142&rft.issue=1&rft.spage=106&rft.epage=112&rft.pages=106-112&rft.issn=0022-5223&rft.eissn=1097-685X&rft.coden=JTCSAQ&rft_id=info:doi/10.1016/j.jtcvs.2010.10.033&rft_dat=%3Cproquest_cross%3E873122083%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=873122083&rft_id=info:pmid/21272898&rft_els_id=1_s2_0_S0022522310012493&rfr_iscdi=true |