Sinusoidal Communication is Regressed or not through the Staged Surgery for Fontan Candidate with PA/IVS?

#CH/PED 02-O-7
Congenital Heart Surgery/Pediatric Congenital Cardiac. SESSION-2
Oral

Sinusoidal Communication is Regressed or not through the Staged Surgery for Fontan Candidate with PA/IVS?

Satoshi Matsuo, Naoki Masaki, Sadahiro Sai

Miyagi Children’s Hospital, Sendai, Japan

Date, time and location: 2018.05.25 15:30, Press Hall, 2F

Abstract

(Objectives) 30−75％ of pulmonary atresia with intact ventricular septum (PA/IVS) are accompanied with sinusoidal communication (SC) . It has been unknown how much the extent of SC changes though staged surgeries and whether supply of venous blood to myocardium through SC affects myocardial ischemia (MI) or not. We investigated changes on the extent of SC and MI due to SC over the course of staged surgeries in PA/IVS patients.

(Methods) Thirteen consecutive PA/IVS patients with SC underwent BTshunt from October 2010 to July 2016 were retrospectively reviewed. All patients were referred to the single ventricle repair pathway. The degree of SC regression was scored from 0 (none) to 4 (stenosis / occlusion of coronary artery) by angiography. Right ventricle dependent coronary circulation (RVDCC) defines SC score 4. The sum of scores on three major vessels was defined as SC score. MI was evaluated by I-123 labelled BMIPP scintigraphy.

(Results) RVEDV at first stage was 21.4±8.2 %ofN. Three patients (23.1%) had RVDCC. TCPC was completed in 10 patients. The others await TCPC. There was no mortality. SC score (before BTshunt, before BDGS, before TCPC, 1 year after TCPC) was 7.0±1.7, 4.2±2.2, 3.9±2.1, and 2.6±1.3. SC score significantly decreased between BTshunt and BDGS (P=0.01). SC regression was found in 10 patients (76.9%) including RVDCC cases. However ischemia of left ventricle was observed in 4 of 7 (57.1%) patients at BT shunt, 6 of 10 (60%) at BDGS, 5 of 8 (62.5%) at TCPC, 4 of 7 (57.1%) at 1 year after TCPC. But no significant event due to MI was clinically found in this patient group.

(Conclusions)SC was regressed in more than 70% cases. Even in such cases, MI might be persistently observed through staged surgeries. These MI lesions must be taken care regardless of the regression of SC.