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Ann Thorac Surg 2009;87:596. doi:10.1016/j.athoracsur.2008.11.048
© 2009 The Society of Thoracic Surgeons
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Original Articles: Pediatric Cardiac

Invited Commentary

Tom Karl, MD

Queensland Paediatric Cardiac Services, Mater Children's Hospital, Raymond Terrace, S. Brisbane, Qu 4101, Australia

(Email: tom.karl{at}mater.org.au).

In a recent PubMed search using the terms "pulmonary arteries" and "congenital heart disease," results included 2,249 citations spanning more than 50 years. The benefits and disadvantages of systemic-to-pulmonary artery (PA) shunts have been endlessly debated during this time period for both biventricular and univentricular hearts. Despite this extensive history, the authors have (incredibly) managed to present some important new findings, in a simple, well-conducted study, resulting in this important article [1]. The essence of their findings is that infants who fail to derive satisfactory growth benefits from systemic to PA shunts are likely to have important histologic abnormalities at the time of subsequent surgical repair. Moreover, the risk factors cited (low SO 2, high hematocrit, right ventricular end diatolic pressure > 12 mm Hg, and so forth) are like a textbook description of problems relating to univentricular palliation. Avoidance of shunts altogether has been advocated as a solution, and although this may be possible in most cases of tetralogy of Fallot, the alternatives in more complex univentricular patients who are at highest risk for poor growth are limited. The authors are to be commended, and we can expect that further delineation of the timing of acquisition of the PA abnormalities (fetal vs early postnatal vs post-shunted) will be possible, and perhaps they will be useful in planning a better operative strategy for the long term.


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 References
 

  1. Chowdhury UK, Bishnoi AK, Ray R, et al. Central pulmonary artery histopathology in patients with cyanotic congenital heart diseases Ann Thorac Surg 2009;87:589-596.e1–3.[Abstract/Free Full Text]

Related Article

Central Pulmonary Artery Histopathology in Patients With Cyanotic Congenital Heart Diseases
Ujjwal K. Chowdhury, Arvind K. Bishnoi, Ruma Ray, Mani Kalaivani, Poonam Malhotra Kapoor, Srikrishna M. Reddy, Anand K. Mishra, and Raghu M. Gonvindappa
Ann. Thorac. Surg. 2009 87: 589-596. [Abstract] [Full Text] [PDF]




This Article
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