Abstract
In a recent PubMed search using the terms “pulmonary arteries” and “congenital heart disease,” results included 2,249 citations spanning more than 50 years. The benefits and disadvantages of systemic-to-pulmonary artery (PA) shunts have been endlessly debated during this time period for both biventricular and univentricular hearts. Despite this extensive history, the authors have (incredibly) managed to present some important new findings, in a simple, well-conducted study, resulting in this important article [1Chowdhury U.K. Bishnoi A.K. Ray R. et al.Central pulmonary artery histopathology in patients with cyanotic congenital heart diseases.Ann Thorac Surg. 2009; 87 (.e1–3): 589-596Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar]. The essence of their findings is that infants who fail to derive satisfactory growth benefits from systemic to PA shunts are likely to have important histologic abnormalities at the time of subsequent surgical repair. Moreover, the risk factors cited (low SO2, high hematocrit, right ventricular end diatolic pressure > 12 mm Hg, and so forth) are like a textbook description of problems relating to univentricular palliation. Avoidance of shunts altogether has been advocated as a solution, and although this may be possible in most cases of tetralogy of Fallot, the alternatives in more complex univentricular patients who are at highest risk for poor growth are limited. The authors are to be commended, and we can expect that further delineation of the timing of acquisition of the PA abnormalities (fetal vs early postnatal vs post-shunted) will be possible, and perhaps they will be useful in planning a better operative strategy for the long term. Central Pulmonary Artery Histopathology in Patients With Cyanotic Congenital Heart DiseasesThe Annals of Thoracic SurgeryVol. 87Issue 2PreviewThis study evaluated the pulmonary arterial (PA) wall histopathology and the risk factors related to histopathology and inadequate pulmonary artery growth in patients with cyanotic congenital heart diseases (CHDs) undergoing primary or second-stage operations after different types of systemic-to-PA shunts with or without pulmonary arterioplasty. Full-Text PDF
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