Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-23T00:36:28.575Z Has data issue: false hasContentIssue false
  • English
  • Français

Growth of left ventricular outflow tract and predictors of future re-intervention after repair for ventricular septal defect and aortic arch obstruction

Published online by Cambridge University Press:  16 March 2017

Abdulraouf Jijeh Open the ORCID record for Abdulraouf Jijeh [Opens in a new window] ,
Muna Ismail  and
Fahad Alhabshan Open the ORCID record for Fahad Alhabshan [Opens in a new window]
Abdulraouf Jijeh
Affiliation:
King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard–Health Affairs, Riyadh, Kingdom of Saudi Arabia
Muna Ismail
Affiliation:
King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard–Health Affairs, Riyadh, Kingdom of Saudi Arabia
Fahad Alhabshan*
Affiliation:
King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard–Health Affairs, Riyadh, Kingdom of Saudi Arabia King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
*
Correspondence to: F. Alhabshan, MD, FESC, Consultant of Pediatric Cardiology, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard–Health Affairs; Assistant Professor, Cardiac Sciences, King Saud Bin Abdulaziz University for Health Sciences, PO Box 22490, Mail Code 1420, Riyadh 11426, Kingdom of Saudi Arabia. Tel: +966 11 801 6770; Fax: +966 11 801 6773; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Ventricular septal defect and aortic arch obstruction are usually associated with a narrow left ventricular outflow tract. The aim of the present study was to analyse the growth and predictors of future obstruction of the left ventricular outflow tract after surgical repair.

Methods

We carried out a retrospective review of patients who underwent repair for ventricular septal defect and aortic arch obstruction – coarctation or interrupted aortic arch – between July, 2002 and June, 2013. Echocardiographic data were reviewed, and the need for re-intervention was evaluated.

Results

A total of 89 patients were included in this study. A significant left ventricular outflow tract growth was noticed after surgical repair. Preoperatively, the mean left ventricular outflow tract Z-score was −1.46±1 (range −5.5 to 1.1) and increased to a mean value of −0.7±1.3 (range −2.7 to 3.2) at last follow-up (p=0.0001), demonstrating relevant growth of the left ventricular outflow tract after repair for ventricular septal defect and aortic arch obstruction. After primary repair, 11 patients (12.3%) required re-intervention with surgical repair for left ventricular outflow tract obstruction after a mean period of 36±21 months. There were no significant differences in age, weight, and indexed aortic valve and left ventricular outflow tract measurements between those who developed obstruction and those who did not.

Conclusion

Significant left ventricular outflow tract growth is expected after repair of ventricular septal defect and aortic arch obstruction. Small aortic valve and left ventricular outflow tract at diagnosis are not risk factors to predict the need for surgical re-intervention for left ventricular outflow tract obstruction in future.

Keywords

ventricular septal defectcoarctation of the aortainterrupted aortic archleft ventricular outflow tract
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 7 , September 2017 , pp. 1323 - 1328
Check for updates
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Abdulraouf Jijeh and Muna Ismail contributed equally to this study.

References

1. Kreutzer, J, Van Praagh, R. Comparison of left ventricular outflow tract obstruction in interruption of the aortic arch and in coarctation of the aorta, with diagnostic, developmental, and surgical implications. Am J Cardiol 2000; 86: 856–862.CrossRefGoogle ScholarPubMed
2. Krauser, DG, Rutkowski, M, Phoon, CK. Left ventricular volume after correction of isolated aortic coarctation in neonates. Am J Cardiol 2000; 85: 904–907, A910.Google Scholar
3. Shiokawa, Y, Becker, AE. The surgical anatomy of the left ventricular outflow tract in hearts with ventricular septal defect and aortic arch obstruction. Ann Thorac Surg 1998; 65: 1381–1387.CrossRefGoogle ScholarPubMed
4. Bove, EL, Minich, LL, Pridjian, AK, et al. The management of severe subaortic stenosis, ventricular septal defect, and aortic arch obstruction in the neonate. J Thorac Cardiovasc Surg 1993; 105: 289–295; discussion 295–286.CrossRefGoogle ScholarPubMed
5. DeLeon, SY, Ilbawi, MN, Roberson, DA, et al. Conal enlargement for diffuse subaortic stenosis. J Thorac Cardiovasc Surg 1991; 102: 814–820.Google Scholar
6. Luciani, GB, Ackerman, RJ, Chang, AC, Wells, WJ, Starnes, VA. One-stage repair of interrupted aortic arch, ventricular septal defect, and subaortic obstruction in the neonate: a novel approach. J Thorac Cardiovasc Surg 1996; 111: 348–358.Google Scholar
7. Geva, T, Hornberger, LK, Sanders, SP, Jonas, RA, Ott, DA, Colan, SD. Echocardiographic predictors of left ventricular outflow tract obstruction after repair of interrupted aortic arch. J Am Coll Cardiol 1993; 22: 1953–1960.CrossRefGoogle ScholarPubMed
8. Apfel, HD, Levenbraun, J, Quaegebeur, JM, Allan, LD. Usefulness of preoperative echocardiography in predicting left ventricular outflow obstruction after primary repair of interrupted aortic arch with ventricular septal defect. Am J Cardiol 1998; 82: 470–473.CrossRefGoogle ScholarPubMed
9. Jonas, RA, Quaegebeur, JM, Kirklin, JW, Blackstone, EH, Daicoff, G. Outcomes in patients with interrupted aortic arch and ventricular septal defect. A multiinstitutional study. Congenital Heart Surgeons Society. J Thorac Cardiovasc Surg 1994; 107: 1099–1109; discussion 1109–1013.CrossRefGoogle ScholarPubMed
10. Rhodes, LA, Colan, SD, Perry, SB, Jonas, RA, Sanders, SP. Predictors of survival in neonates with critical aortic stenosis. Circulation 1991; 84: 2325–2335.CrossRefGoogle ScholarPubMed
11. Alboliras, ET, Mavroudis, C, Pahl, E, Gidding, SS, Backer, CL, Rocchini, AP. Left ventricular growth in selected hypoplastic left ventricles: outcome after repair of coarctation of aorta. Ann Thorac Surg 1999; 68: 549–555.CrossRefGoogle ScholarPubMed
12. Minich, LL, Tani, LY, Hawkins, JA, Shaddy, RE. Possibility of postnatal left ventricular growth in selected infants with non-apex-forming left ventricles. Am Heart J 1997; 133: 570–574.Google Scholar
13. Puchalski, MD, Williams, RV, Hawkins, JA, Minich, LL, Tani, LY. Follow-up of aortic coarctation repair in neonates. J Am Coll Cardiol 2004; 44: 188–191.Google Scholar
14. Kawahira, Y, Kishimoto, H, Iio, M, et al. Subaortic stenosis in coarctation or interruption of the aorta – changes of left ventricular outflow tract dimension after aortic arch repair and pulmonary artery banding. Nihon Kyobu Geka Gakkai Zasshi 1994; 42: 233–236.Google Scholar
15. Chen, PC, Cubberley, AT, Reyes, K, et al. Predictors of reintervention after repair of interrupted aortic arch with ventricular septal defect. Ann Thorac Surg 2013; 96: 621–628.Google Scholar
16. Salem, MM, Starnes, VA, Wells, WJ, et al. Predictors of left ventricular outflow obstruction following single-stage repair of interrupted aortic arch and ventricular septal defect. Am J Cardiol 2000; 86: 1044–1047; A1011.CrossRefGoogle ScholarPubMed
17. Iwahara, M, Ino, T, Nishimoto, K, et al. Clinical features of aortic arch anomaly with malalignment ventricular septal defect. Ann Thorac Surg 1989; 48: 693–696.Google Scholar
18. Levine, JC, Sanders, SP, Colan, SD, Jonas, RA, Spevak, PJ. The risk of having additional obstructive lesions in neonatal coarctation of the aorta. Cardiol Young 2001; 11: 44–53.Google Scholar
19. Sell, JE, Jonas, RA, Mayer, JE, Blackstone, EH, Kirklin, JW, Castaneda, AR. The results of a surgical program for interrupted aortic arch. J Thorac Cardiovasc Surg 1988; 96: 864–877.Google Scholar
20. Hirata, Y, Quaegebeur, JM, Mosca, RS, Takayama, H, Chen, JM. Impact of aortic annular size on rate of reoperation for left ventricular outflow tract obstruction after repair of interrupted aortic arch and ventricular septal defect. Ann Thorac Surg 2010; 90: 588–592.Google Scholar