[I-P27-05] Pulmonary Artery CoarctationがModified Blalock-Taussig Shunt術後肺動脈成長に及ぼす因子の検討
Keywords:Pulmonary artery growth, Pulmonary artery coarctation , Modified Blalock-Taussig Shunt
OBJECTIVES: Pulmonary artery coarctation (PACoA) poses a risk of hypoplastic/distorted PA and subsequent failure to achieve the two-ventricle repair/Fontan operation. We sought to assess the impact of PACoA on PA growth after modified Blalock-Taussig shunt (MBTS). METHODS: Retrospective chart review was performed in 91 patients, including 15 single ventricle who had a MBTS as first palliation. Preoperative echocardiography showed PACoA in 27 (30%) patients (at right PA in 5, at left PA in 22). The laterality of shunt was right PA in 60 patients and left PA in 27 patients. Concomitant PA plasty (autologous tissue in 4 and Goretex in 8 patients) was performed in 12 patients who had PACoA with a diameter less than 3 mm.RESULTS: PA growth was observed after MBTS and there was no difference between contralateral and ipsilateral side of MBTS (right PA z-score: -1.9+/-2.5 to -0.98+/-2.1, p=0.017; left PA z-score: -2.9+/-2.5 to -1.5+/- 2.5, p＜0.001). Left PA z-score after MBTS in patients with PACoA was significantly lower than that of patients without PACoA (-4.8+/-2.5 vs. -1.9+/-1.8, p＜0.001). There were no significant differences in PA growth and reintervention between patients with PA plasty and the ones without. Multivariable risk analysis for surgical reintervention showed shunt anastomosed to the site of PACoA (p=0.002), and using Goretex for PA plasty (p=0.007). CONCLUSION: PA CoA, even PA plasty performed, was an independent risk factor for poor PA growth and subsequent need for reintervention. PA Plasty with autologous tissue and contralateral MBTS should be considered.