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Balram Airan - One of the best experts on this subject based on the ideXlab platform.

  • crossed pulmonary arteries in a patient with Persistent Truncus Arteriosus
    The Annals of Thoracic Surgery, 2016
    Co-Authors: Sachin Talwar, Palleti Rajashekar, Saurabh Kumar Gupta, Gurpreet Singh Gulati, Balram Airan
    Abstract:

    We report a 14-month-old child with Persistent Truncus Arteriosus and crossed pulmonary arteries. The potential advantage of crossed pulmonary artery arrangement in achieving surgical correction is discussed.

  • Persistent Truncus Arteriosus repaired beyond infancy
    Indian Journal of Thoracic and Cardiovascular Surgery, 2012
    Co-Authors: Sachin Talwar, S.s. Kothari, Anita Saxena, R Saxena, Shiv Kumar Choudhary, Rajnish Juneja, Balram Airan
    Abstract:

    Introduction Patients with untreated Persistent Truncus Arteriosus (PTA) usually do not survive or develop irreversible pulmonary vascular obstructive disease beyond infancy. The present study reports the anatomic and hemodynamic data, and results of surgery in patients undergoing surgical repair of PTA beyond 1 year of age.

Sachin Talwar - One of the best experts on this subject based on the ideXlab platform.

  • crossed pulmonary arteries in a patient with Persistent Truncus Arteriosus
    The Annals of Thoracic Surgery, 2016
    Co-Authors: Sachin Talwar, Palleti Rajashekar, Saurabh Kumar Gupta, Gurpreet Singh Gulati, Balram Airan
    Abstract:

    We report a 14-month-old child with Persistent Truncus Arteriosus and crossed pulmonary arteries. The potential advantage of crossed pulmonary artery arrangement in achieving surgical correction is discussed.

  • Persistent Truncus Arteriosus repaired beyond infancy
    Indian Journal of Thoracic and Cardiovascular Surgery, 2012
    Co-Authors: Sachin Talwar, S.s. Kothari, Anita Saxena, R Saxena, Shiv Kumar Choudhary, Rajnish Juneja, Balram Airan
    Abstract:

    Introduction Patients with untreated Persistent Truncus Arteriosus (PTA) usually do not survive or develop irreversible pulmonary vascular obstructive disease beyond infancy. The present study reports the anatomic and hemodynamic data, and results of surgery in patients undergoing surgical repair of PTA beyond 1 year of age.

J Skovranek - One of the best experts on this subject based on the ideXlab platform.

  • long term results after correction of Persistent Truncus Arteriosus in 83 patients
    European Journal of Cardio-Thoracic Surgery, 2010
    Co-Authors: Tomas Tlaskal, V Chaloupecky, J Skovranek, Bohumil Hučín, Roman Gebauer, Sylvia Krupickova, Oleg Reich, Petr Tax
    Abstract:

    Objective: This study aims to analyse long-term results after correction of Truncus Arteriosus in all patients operated in one institution over 28 years. Methods: Between 1981 and 2009, 83 patients, median age 54 days, underwent repair of Truncus Arteriosus. Interrupted aortic arch was present in 14 (17%), severe truncal valve insufficiency in 10 (12%) and non-confluent pulmonary arteries in five (6%) patients. Repair with reconstruction of the right ventricular to pulmonary artery continuity was performed using a valved conduit in 80, and other methods in three patients. At the same time, correction of interrupted aortic arch was done in 14 and truncal valve repair in eight patients. Survivors were repeatedlyexamined echocardiographicallyfor assessmentof residualheart lesions.Results:Theearly mortalitywas 19 (23%). Out of 35 patients operated between 1981 and 1996, 17 (46%) died, and out of 48 patients operated between 1997 and 2009, two (4%) died. Operation before 1997 (p = 0.001) and aortic cross-clamping time >90 min (p = 0.009) were found to be risk factors of death. Eight (10%) patients died late, a median of 68 days after surgery. Fifty-seven (69%) patients were followed for 10.9 6.7 years. Three (4%) patients were lost. Twenty-five (30%) patients are alive with their original conduit 7.5 5.2 years after correction. Twenty-eight patients required 41 re-operations for conduit dysfunction with first replacement at mean 5.8 4.1 (range 0.1—14.1 years) years after correction. Nine (11%) patients required 12 truncal valve replacements. Eleven (13%) patients required balloon dilatation or stent for conduit obstruction, pulmonary branch stenosis, aortic arch obstruction or stenosis of vena cava. Recent clinical examination was undertaken in 53 (64%) patients and 49 (59% or 77% of early survivors) are in good/very good condition. Conclusions: Truncus Arteriosus remains a challenging heart disease. With growing experience, the early mortality decreased to 4%, but numerous re-interventions for conduit obstruction, pulmonary branch stenosis and truncal valve insufficiency are required. Surgery before 1997 and prolonged cross-clamping were risk factors of death. Pulmonary homografts had the best re-intervention-free survival. Statistically, however, the difference between conduits was not significant. Dysplastic valve and truncal valve insufficiency represent risk factors presenting the need for truncal valve replacement. # 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

  • repair of Persistent Truncus Arteriosus with interrupted aortic arch
    European Journal of Cardio-Thoracic Surgery, 2005
    Co-Authors: Tomas Tlaskal, Vladimir Kucera, Pavel Vojtovic, V Chaloupecky, Bohumil Hučín, Roman Gebauer, J Skovranek
    Abstract:

    Objective: The aim of our study was to analyse experience with repair of Truncus Arteriosus with interrupted aortic arch. Methods: Between 1993 and 2004, eight consecutive patients underwent repair of Truncus Arteriosus with interrupted aortic arch. The median age was 6.5 days (range 1—85 days) and median weight was 3.2 kg (range 2.6—4.8 kg). Five patients had type A and 3 patients had type B aortic arch interruption. The repair was performed in deep hypothermia with circulatory arrest in 4 patients and isolated selective low-flow perfusion of the head and the heart in the last 4 patients. The repair consisted in aortic arch reconstruction by direct anastomosis between descending and ascending aorta, closure of ventricular septal defect and reconstruction of the right ventricular to pulmonary artery continuity using a valved conduit. Results: One (12.5%) patient died from sepsis and hepato-renal failure 18 days after surgery. Seven (87.5%) patients were followed up for 2.0—11.7 years (median2.6years).Nopatientdiedafterthedischargefromhospital.In4patients1—3reinterventionswererequired0.6—10.0yearsafterrepair. Reoperations wereperformedfor conduitobstructionin2 patients, aorticregurgitationin2 patients, rightpulmonaryartery stenosisin 2 patients andairwayobstructionin1 patient.In2 patientsconcommitantaorticvalveand conduitreplacementwasrequired.Balloonangioplastyfor aortic arch obstruction was necessary in 1 patient, and for bilateral pulmonary branch stenosis in 1 patient. Five (28.6%) surviving patients are in NYHA class I and 2 (71.4%) patients are in NYHA class II. Conclusions: Primary repair of Persistent Truncus Arteriosus with interrupted aortic arch can be done with low mortality and good mid-term results. Aortic arch reconstruction in isolated low-flow perfusion of the head and the heart influences favourably the postoperative recovery. The main postoperative problems are associated with conduit obstruction and aortic insufficiency. # 2005 Elsevier B.V. All rights reserved.

Tomas Tlaskal - One of the best experts on this subject based on the ideXlab platform.

  • long term results after correction of Persistent Truncus Arteriosus in 83 patients
    European Journal of Cardio-Thoracic Surgery, 2010
    Co-Authors: Tomas Tlaskal, V Chaloupecky, J Skovranek, Bohumil Hučín, Roman Gebauer, Sylvia Krupickova, Oleg Reich, Petr Tax
    Abstract:

    Objective: This study aims to analyse long-term results after correction of Truncus Arteriosus in all patients operated in one institution over 28 years. Methods: Between 1981 and 2009, 83 patients, median age 54 days, underwent repair of Truncus Arteriosus. Interrupted aortic arch was present in 14 (17%), severe truncal valve insufficiency in 10 (12%) and non-confluent pulmonary arteries in five (6%) patients. Repair with reconstruction of the right ventricular to pulmonary artery continuity was performed using a valved conduit in 80, and other methods in three patients. At the same time, correction of interrupted aortic arch was done in 14 and truncal valve repair in eight patients. Survivors were repeatedlyexamined echocardiographicallyfor assessmentof residualheart lesions.Results:Theearly mortalitywas 19 (23%). Out of 35 patients operated between 1981 and 1996, 17 (46%) died, and out of 48 patients operated between 1997 and 2009, two (4%) died. Operation before 1997 (p = 0.001) and aortic cross-clamping time >90 min (p = 0.009) were found to be risk factors of death. Eight (10%) patients died late, a median of 68 days after surgery. Fifty-seven (69%) patients were followed for 10.9 6.7 years. Three (4%) patients were lost. Twenty-five (30%) patients are alive with their original conduit 7.5 5.2 years after correction. Twenty-eight patients required 41 re-operations for conduit dysfunction with first replacement at mean 5.8 4.1 (range 0.1—14.1 years) years after correction. Nine (11%) patients required 12 truncal valve replacements. Eleven (13%) patients required balloon dilatation or stent for conduit obstruction, pulmonary branch stenosis, aortic arch obstruction or stenosis of vena cava. Recent clinical examination was undertaken in 53 (64%) patients and 49 (59% or 77% of early survivors) are in good/very good condition. Conclusions: Truncus Arteriosus remains a challenging heart disease. With growing experience, the early mortality decreased to 4%, but numerous re-interventions for conduit obstruction, pulmonary branch stenosis and truncal valve insufficiency are required. Surgery before 1997 and prolonged cross-clamping were risk factors of death. Pulmonary homografts had the best re-intervention-free survival. Statistically, however, the difference between conduits was not significant. Dysplastic valve and truncal valve insufficiency represent risk factors presenting the need for truncal valve replacement. # 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

  • repair of Persistent Truncus Arteriosus with interrupted aortic arch
    European Journal of Cardio-Thoracic Surgery, 2005
    Co-Authors: Tomas Tlaskal, Vladimir Kucera, Pavel Vojtovic, V Chaloupecky, Bohumil Hučín, Roman Gebauer, J Skovranek
    Abstract:

    Objective: The aim of our study was to analyse experience with repair of Truncus Arteriosus with interrupted aortic arch. Methods: Between 1993 and 2004, eight consecutive patients underwent repair of Truncus Arteriosus with interrupted aortic arch. The median age was 6.5 days (range 1—85 days) and median weight was 3.2 kg (range 2.6—4.8 kg). Five patients had type A and 3 patients had type B aortic arch interruption. The repair was performed in deep hypothermia with circulatory arrest in 4 patients and isolated selective low-flow perfusion of the head and the heart in the last 4 patients. The repair consisted in aortic arch reconstruction by direct anastomosis between descending and ascending aorta, closure of ventricular septal defect and reconstruction of the right ventricular to pulmonary artery continuity using a valved conduit. Results: One (12.5%) patient died from sepsis and hepato-renal failure 18 days after surgery. Seven (87.5%) patients were followed up for 2.0—11.7 years (median2.6years).Nopatientdiedafterthedischargefromhospital.In4patients1—3reinterventionswererequired0.6—10.0yearsafterrepair. Reoperations wereperformedfor conduitobstructionin2 patients, aorticregurgitationin2 patients, rightpulmonaryartery stenosisin 2 patients andairwayobstructionin1 patient.In2 patientsconcommitantaorticvalveand conduitreplacementwasrequired.Balloonangioplastyfor aortic arch obstruction was necessary in 1 patient, and for bilateral pulmonary branch stenosis in 1 patient. Five (28.6%) surviving patients are in NYHA class I and 2 (71.4%) patients are in NYHA class II. Conclusions: Primary repair of Persistent Truncus Arteriosus with interrupted aortic arch can be done with low mortality and good mid-term results. Aortic arch reconstruction in isolated low-flow perfusion of the head and the heart influences favourably the postoperative recovery. The main postoperative problems are associated with conduit obstruction and aortic insufficiency. # 2005 Elsevier B.V. All rights reserved.

Margaret L. Kirby - One of the best experts on this subject based on the ideXlab platform.

  • pulmonary atresia or Persistent Truncus Arteriosus is it important to make the distinction and how do we do it
    Circulation Research, 2008
    Co-Authors: Margaret L. Kirby
    Abstract:

    See related article, Circ Res 2008:103:142–148 The congenital cardiac anomaly known as tetralogy of Fallot (TOF) is characterized by right ventricular outflow tract obstruction caused by subpulmonary stenosis, dextroposition (overriding) of the aorta, a ventricular septal defect, and right ventricular hypertrophy. The right ventricular hypertrophy is secondary to the presence of right ventricular outflow obstruction (pulmonic valvar or subvalvar stenosis or in the most severe case, atresia). Cyanosis in these patients is attributable to the passage of systemic venous blood into the aorta, bypassing the lungs, with the degree of cyanosis dependent on the severity of the outflow tract obstruction. The malformations that are classified as Persistent Truncus Arteriosus (PTA) are characterized by a single multicuspid semilunar valve with a single vessel, the Truncus, arising from the ventricles and giving rise to systemic, pulmonary, and coronary circulations. Thus, both PTA and TOF with pulmonary atresia are characterized by a single vessel emanating from the heart. In PTA, the septation that would divide the common arterial trunk into an aorta and pulmonary trunk is missing, whereas in TOF with pulmonary atresia, it is unclear whether this septation is missing or misplaced. Diagnosis of TOF with pulmonary atresia relies on the presence of a pulmonary valve remnant by clinical imaging. This criterion permits differentiation of TOF with pulmonary atresia and PTA. However, if the pulmonary atresia develops embryonically before a valve is formed, then this criterion would not distinguish PTA from TOF with pulmonary atresia. New findings in experimental mouse models by Theveniau-Ruissy et al reported recently in Circulation Research shed unexpected light on the embryogenesis of these defects and may allow differentiation of the 2 defects in ways that have not been used previously.1 The myocardium and smooth muscle at the arterial pole, that is, the subaortic and subpulmonary myocardium …