Abstract
Objective We retrospectively analyzed the surgical results of pulmonary blood flow studies to guide ventricular septal defect (VSD) closure in the correction of pulmonary atresia and ventricular septal defect with major aortopulmonary collateral arteries (PA/VSD/MAPCAs). Methods A total of 57 children who were diagnosed with PA/VSD/MAPCAs and who underwent intraoperative pulmonary blood flow studies at our hospital between August 2016 and June 2019 were included. Surgery and cardiopulmonary bypass records were collected. The receiver operating characteristic (ROC) curve was used to verify the accuracy of pulmonary blood flow studies to predict VSD closure. Results Complete VSD closure was achieved in 39 of 57 children (68.42%), with a median age of 2 years and 5 months (range: 7 months to 15 years and 9 months) and a median weight of 11.0 kg (5.7–36.5 kg). Partial VSD repair was recorded for 21 children (36.84%), including 4 children (19.05%) who underwent VSD closure in the later stages and 13 children (61.90%) who were under follow-up and waiting to undergo complete VSD closure. There was only one child (1.75%) with VSD left. After eliminating the data of four unqualified cases, the ROC curve for predicting VSD closure based on 53 pulmonary blood flow studies was obtained at a p value of <0.001, with an area under the curve of 0.922. The maximum Youden's index was 0.713, which corresponded to an optimal mean pulmonary artery pressure cutoff value of 24.5 mmHg. Conclusion The functional evaluation provided by pulmonary blood flow studies is highly accurate to predict intraoperative VSD repair. We recommend using pulmonary blood flow studies with a mean pulmonary artery pressure of ≤25 mmHg during blood perfusion at 3.0 L/min/m2 as the standard to repair VSD.
Highlights
Right ventricular systolic pressure (RVSP) was replaced by pulmonary artery systolic pressure, and left ventricular systolic pressure (LVSP) was replaced by peripheral systemic systolic pressure. en, the RVSP/LVSP ratio was calculated after cardiopulmonary bypass (CPB) was stopped
All continuous variables are expressed as mean ± standard deviation or median, while categorical variables are expressed as frequency and percentage. e area under the receiver operating characteristic (ROC) curve (AUC) was used to verify the accuracy of pulmonary blood flow studies to predict ventricular septal defect (VSD) closure
Because children with type C PA/VSD have MAPCAs, pulmonary vascular indices alone cannot fully reflect the state of the entire pulmonary vascular bed. erefore, Reddy et al [1] proposed the concept of total neopulmonary artery index (TNPAI), which lists pulmonary arteries, together with MAPCAs planned to be unifocalized and included into the pulmonary circulation, in the calculation formula. erefore, TNPAI is relatively comprehensive in evaluating pulmonary vascular development among patients with type C PA/VSD, and it can be used as one of the important indices for preoperative pulmonary vascular evaluation
Summary
We retrospectively analyzed the surgical results of pulmonary blood flow studies to guide ventricular septal defect (VSD) closure in the correction of pulmonary atresia and ventricular septal defect with major aortopulmonary collateral arteries (PA/VSD/MAPCAs). A total of 57 children who were diagnosed with PA/VSD/MAPCAs and who underwent intraoperative pulmonary blood flow studies at our hospital between August 2016 and June 2019 were included. E receiver operating characteristic (ROC) curve was used to verify the accuracy of pulmonary blood flow studies to predict VSD closure. We recommend using pulmonary blood flow studies with a mean pulmonary artery pressure of ≤25 mmHg during blood perfusion at 3.0 L/min/m2 as the standard to repair VSD. Erefore, we retrospectively analyzed the surgical results of pulmonary blood flow studies to guide VSD closure in children with PA/ VSD/MAPCAs at our hospital Considering the differences in flow study methods used by different centers, it is imperative to verify the accuracy of the method used at our hospital. erefore, we retrospectively analyzed the surgical results of pulmonary blood flow studies to guide VSD closure in children with PA/ VSD/MAPCAs at our hospital
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
