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Frank L Hanley - One of the best experts on this subject based on the ideXlab platform.

  • Echocardiographic diagnosis alone for the complete repair of major congenital heart Defects
    Journal of the American College of Cardiology, 1999
    Co-Authors: Wayne Tworetzky, Doff B Mcelhinney, Frank L Hanley, V. Mohan Reddy, Michael M. Brook, Norman H Silverman
    Abstract:

    Abstract Objectives. The study was done to determine the diagnostic accuracy of echocardiography alone in the preoperative diagnosis of children with major congenital heart Defects undergoing primary complete repair. Background. Although echocardiography is well established as the first-line imaging technique for the diagnosis of all forms of congenital heart disease, most institutions continue to perform cardiac catheterization prior to complete repair of more complex Defects. Methods. To determine the diagnostic accuracy of echocardiography alone and echocardiography plus catheterization, we reviewed the records of 503 children with major congenital heart Defects who underwent primary complete repair at our institution between July 1992 and June 1997. We included children with transposition of the great arteries, tetralogy of Fallot, double-chamber right ventricle, interrupted aortic arch, aortic coarctation, atrioventricular Septal Defect, truncus arteriosus, Aortopulmonary Septal Defect, and totally anomalous pulmonary venous return. We excluded children with less complex Defects such as isolated shunt lesions, as well as those with the most complex Defects that would require surgical palliation (e.g., functional univentricular heart). We defined major errors as those that increased the surgical risk and minor errors as those that did not. Errors in diagnosis were determined at surgery. Results. Eighty-two percent of children (412 of 503) underwent surgery after preoperative diagnosis by echocardiography alone. There were 9 major (2%) and 10 minor errors in the echocardiography alone group and 7 major and 5 minor errors in the echocardiography plus catheterization group. The most common type of error was misidentification of coronary artery anatomy in patients with transposition of the great arteries. No error in either group resulted in surgical morbidity or mortality. Conclusions. This study suggests that echocardiography alone is an accurate tool for the preoperative diagnosis of major congenital heart Defects in most children undergoing primary complete repair, and may obviate the need for routine diagnostic catheterization.

  • early and late results after repair of Aortopulmonary Septal Defect and associated anomalies in infants 6 months of age
    American Journal of Cardiology, 1998
    Co-Authors: Doff B Mcelhinney, Mohan V Reddy, Wayne Tworetzky, Norman H Silverman, Frank L Hanley
    Abstract:

    Abstract The Richardson classification system for Aortopulmonary Septal Defect (APSD) includes simple Defects between the ascending aorta and pulmonary trunk (type I), Defects extending distally to include the origin of the right main pulmonary artery (type II), and anomalous origin of the right main pulmonary artery from the ascending aorta with no other Aortopulmonary communication (type III). These are rare lesions that must be repaired in early infancy to avoid development of pulmonary vascular disease. Few reports have focused on patients with complex, associated lesions who underwent repair in early infancy. Between 1972 and 1995, 24 patients with Richardson type I (n = 11), II (n = 7), or III (n = 6) Defects underwent repair at ages ranging from 2 to 172 days (median 34). Twelve patients had complex, associated anomalies, including interrupted or hypoplastic arch (n = 9), tetralogy of Fallot with (n = 1) or without (n = 1) pulmonary atresia, and transposition of the great arteries (n = 1). The most recent 7 patients were diagnosed by echocardiography without cardiac catheterization. There were no early or late deaths among the 12 patients with simple APSD. Four patients with complex, associated lesions died in the early postoperative period and another died 4 months after surgery. All 6 surviving patients with interrupted arch have had recurrent obstruction at the arch repair site, although reintervention for this reason has been performed in only 2 patients. Altogether, 6 early survivors have required reintervention, and all survivors are in New York Heart Association class I at follow-up ranging from 2 to 25 years. Thus, long-term survival after repair of APSD in early infancy is excellent. Late sequelae are likely to be related either to associated lesions or to obstruction at the APSD repair site. Almost all cases of APSD in young infants can be diagnosed and evaluated by echocardiography without catheterization.

  • Early and Late Results After Repair of Aortopulmonary Septal Defect and Associated Anomalies in Infants < 6 Months of Age
    American Journal of Cardiology, 1998
    Co-Authors: Doff B Mcelhinney, Wayne Tworetzky, Norman H Silverman, V. Mohan Reddy, Frank L Hanley
    Abstract:

    Abstract The Richardson classification system for Aortopulmonary Septal Defect (APSD) includes simple Defects between the ascending aorta and pulmonary trunk (type I), Defects extending distally to include the origin of the right main pulmonary artery (type II), and anomalous origin of the right main pulmonary artery from the ascending aorta with no other Aortopulmonary communication (type III). These are rare lesions that must be repaired in early infancy to avoid development of pulmonary vascular disease. Few reports have focused on patients with complex, associated lesions who underwent repair in early infancy. Between 1972 and 1995, 24 patients with Richardson type I (n = 11), II (n = 7), or III (n = 6) Defects underwent repair at ages ranging from 2 to 172 days (median 34). Twelve patients had complex, associated anomalies, including interrupted or hypoplastic arch (n = 9), tetralogy of Fallot with (n = 1) or without (n = 1) pulmonary atresia, and transposition of the great arteries (n = 1). The most recent 7 patients were diagnosed by echocardiography without cardiac catheterization. There were no early or late deaths among the 12 patients with simple APSD. Four patients with complex, associated lesions died in the early postoperative period and another died 4 months after surgery. All 6 surviving patients with interrupted arch have had recurrent obstruction at the arch repair site, although reintervention for this reason has been performed in only 2 patients. Altogether, 6 early survivors have required reintervention, and all survivors are in New York Heart Association class I at follow-up ranging from 2 to 25 years. Thus, long-term survival after repair of APSD in early infancy is excellent. Late sequelae are likely to be related either to associated lesions or to obstruction at the APSD repair site. Almost all cases of APSD in young infants can be diagnosed and evaluated by echocardiography without catheterization.

  • Use of autogenous aortic and main pulmonary artery flaps for repair of anomalous origin of the right pulmonary artery from the ascending aorta.
    The Journal of Thoracic and Cardiovascular Surgery, 1996
    Co-Authors: Frank L Hanley
    Abstract:

    in patients with origin of the right (RPA) or left pulmonary artery from the ascending aorta, the RPA or, much less commonly, the left pulmonary artery arises from the ascending aorta in the presence of separate aortic and pulmonary valves and without the interposition Of ductal tissue. 1" 2 The RPA usually originates from the right posterior aspect of the ascending aorta. 3 Physiologically, the alteration creates a large left-to-right shunt. The contralateral lung is therefore subjected to the entire right ventricular output in addition to flow contributed by associated anomalies, such as patent ductus arteriosus, Aortopulmonary Septal Defect, atrial Septal Defect, or ventricular Septal Defect, which have been present in greater than 60% of previous reports. 1 4 Without early operation the natural history of this condition is dismal, with a mortality rate of approximately 70% at 6 months of age and 80% at I year of age. 5 Armer and associates 6 reported the first successful anatomic repair of anomalous origin of the RPA from the ascending aorta with interposition of a polyester fiber graft between the RPA and the main pulmonary artery (MPA). The first successful primary repair was reported by Kirkpatrick, Girod, and King. 7 Traditionally, primary repair is generally reserved for those patients in whom the RPA originates from the posterior aspect of the aorta in close proximity to the MPA. s When the RPA arises from the right lateral aspect of the aorta, the right hilum is often mobilized medially to allow apposition of the RPA and MPA without tension. Alternatively, an interposition synthetic graft is placed either anterior or posterior to the aorta 5, 9 We propose a modified native tissue repair that reduces tension on the RPA-MPA anastomosis. The ascending aorta, proximal aortic arch vessels, the MPA, and both branch pulmonary arteries are widely mobilized. As soon as cardiopulmonary bypass has been established, the RPA is temporarily clamped or snared. The patent ductus arteriosus, if present, is doubly ligated and divided. After crossclamping of the aorta, the anterior aortic circumference is incised transversely at the level of the RPA origin (Fig. 1). Under direct vision, the remaining aortic circumference is transected, with a generous cuff of posterior aortic wall left around the RPA origin (Fig. 2). Alternatively, the posteromedial aspect of the aortic wall can be left intact. Utmost care should be taken to avoid compromise of the left

Yuuji Hamamichi - One of the best experts on this subject based on the ideXlab platform.

  • prenatal diagnosis of Aortopulmonary window with interrupted aortic arch by fetal echocardiography
    Fetal Diagnosis and Therapy, 2010
    Co-Authors: George Hayashi, Futoshi Kayatani, Yukiko Kawazu, Noboru Inamura, Yuuji Hamamichi
    Abstract:

    We report the first case of prenatally diagnosed Aortopulmonary window (APW) with interrupted aortic arch. The mother was referred for fetal echocardiography at 29 weeks’ gestation because of suspected congenital heart disease. On the short-axis view, we clearly imaged the Aortopulmonary Septal Defect at the proximal pulmonary artery and type A interrupted aortic arch. The window was 4 mm and the shunt flow detected by color flow Doppler was right-to-left in systole and early diastole. All aortic arch branches originated from the aorta proximal to the interruption. The well-developed ascending aorta was not continuous with the descending aorta in the sagittal view of the aortic arch. Visualization of the direction of the shunt flow across the APW and each origin of subclavian arteries was useful for the diagnosis of APW with interrupted aortic arch.

L I Jingwei - One of the best experts on this subject based on the ideXlab platform.

  • surgical experience for the treatment of Aortopulmonary Septal Defect
    Chinese Journal of Thoracic and Cardiovaescular Surgery, 2009
    Co-Authors: L I Jinhua, L I Jingwei
    Abstract:

    Objective Aortopulmonary Septal Defect is rare and accounted for abont 0.15% to0.60% of infants and children with congenital heart malformation. Aortopulmonary Septal Defect has similar pathophysiologic findings with patent ductus. Early pul-monary hypertension and congestive heart failure may develop as a result of large left to right shunt from the ascending aorta to the pul-monary artery, with a relatively rapid progression of pathological changes in the pulmonary vessels associated with pulmonary hyperten-sion. This article will describe our surgical experience in the treatment of this disease. Methods From December 1987 to March 2000,16 cases with Aortopulmonary Septal Defect underwent surgical treatment, 11 were males and 5 were females. The mean age and weight were (8.2 ± 7.1) years (range from 5 months to 22 years) and (22.2± 13.9) kg (range from 5.8 to 50.0) respectively. Seven cases were type Ⅰ, seven were type Ⅱ and two were type Ⅲ according to Richardson's classification. The mean scale of aortop-ulmonary Septal Defect was (22.6± 7.3)mm (range from 10 to 35) . Coexistent ventriculor Septal Defect was found in two cases, atri-al Septal Defect was found in another two cases, patent ductus in one case and interrupted aortic arch (type B) in two cases. Cardiac catheterization were perforomed in ten cases, and the systolic and mean pulmonary artery pressure were (75.4± 25.2) mmHg (range from 39 to 120) and (55.1± 25.2) mmHg (range from 21 to81) respectively. All patients underrwent surgical repair under cardiop-ulmonary bypass (CBP) at moderate hypothermic temperature. Deep hypothermic circulatory arrest was used in two cases with inter-rupted aortic arch. The mean duration of aortic clamping and CPB were (70.4± 48.1) minutes and (110.5± 62.9)minutes. Strate-gies for APW repair were trans-aortic with patch closure in thirteen cases, trans-pulmonary in two cases and trans-window in one case.Other coexistent malformations were corrected simultaneously. Results The poet-operative systolic and mean pulmonary artery pres-sure were decreased to (50.2±18.5) mmHg (range from 20 to 78 mmHg) and (40.0± 15.2) mmHg (range from 18 to 65 mmHg) respectively. The mean duration of postoperative mechanical ventilation was (22.6 ±14.5) hours (range 12-70), that for ICU-staying was (45.8 ± 55.5) days (1-70), and that for hospitalization was (49.1 ±32.2) days (14-127). Two APW cases with interrupted aortic arch died of lethal acute renal failure and low cardiac output syndrome perioperatively. During the mean follow-up period of (8.8±7.5) years, there was no re-operation case or late death in 14 survived patients. All of them showed improvement in the heart function except for one patient who had small residual shunt. Pationts who recovered have gone to work or to school with the resolution of their murmus and significant improvement in the pulmonary congestion. Their enlarged hearts before operation have reduced by var-ious extents. Condusion Given the early pathological changes of pulmonary vessels in patients with Aortopulmonary Septal Defect,early diagnosis and surgical treatment, which may decrease the mortality, are of critically important. Coexistent and complicated con-genital Defects such as interrupted aortic arch may increase the mortality in APW cases. Key words: Aortopulmonary Septal Defect; Cardiac surgical procelures

Rupali Gandhi - One of the best experts on this subject based on the ideXlab platform.

George Hayashi - One of the best experts on this subject based on the ideXlab platform.

  • prenatal diagnosis of Aortopulmonary window with interrupted aortic arch by fetal echocardiography
    Fetal Diagnosis and Therapy, 2010
    Co-Authors: George Hayashi, Futoshi Kayatani, Yukiko Kawazu, Noboru Inamura, Yuuji Hamamichi
    Abstract:

    We report the first case of prenatally diagnosed Aortopulmonary window (APW) with interrupted aortic arch. The mother was referred for fetal echocardiography at 29 weeks’ gestation because of suspected congenital heart disease. On the short-axis view, we clearly imaged the Aortopulmonary Septal Defect at the proximal pulmonary artery and type A interrupted aortic arch. The window was 4 mm and the shunt flow detected by color flow Doppler was right-to-left in systole and early diastole. All aortic arch branches originated from the aorta proximal to the interruption. The well-developed ascending aorta was not continuous with the descending aorta in the sagittal view of the aortic arch. Visualization of the direction of the shunt flow across the APW and each origin of subclavian arteries was useful for the diagnosis of APW with interrupted aortic arch.