HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): James S. Tweddell Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Tweddell, J. S. Search for Related Content PubMed PubMed Citation Articles by Tweddell, J. S. Related Collections Congenital - cyanotic Related Article

---

Original Articles: Pediatric Cardiac

Invited Commentary

Cardiothoracic Surgery, MS 715 Children's Hospital of Wisconsin, 9000 W Wisconsin Ave, Milwaukee, WI 53226

(Email: jtweddell{at}chw.org).

Valved conduits are commonly used in neonates and small infants for reconstruction of the outflow tract of the right ventricle. These conduits frequently require reoperation in early childhood before the patient is large enough to receive an adult-sized conduit. Generally, a new larger conduit is used for replacement when significant conduit dysfunction (almost always stenosis) develops.

Zachariah and colleagues [1] from Boston Children's Hospital have taken another approach and simply augmented the prior conduit with an additional patch, thus relieving the stenosis, albeit at the cost of pulmonary insufficiency. This retrospective analysis focused on patients aged younger than 10 years who were therefore unlikely to be large enough to accommodate an adult-sized conduit. The authors compared the outcome of 33 patients undergoing conduit augmentation with 147 patients undergoing conduit replacement and found that short-term outcomes were comparable and freedom from conduit reoperation and reintervention were similar. In fact, there was a trend toward longer freedom from conduit reoperation among patients who underwent augmentation.

Although we do not know precisely how these 33 patients were selected, the data suggest that for a subgroup of patients, simple augmentation of the previously placed conduit is a real alternative to conduit replacement. In addition to cost-savings, conduit augmentation is simple to perform and may decrease allosensitization if a new homograft conduit is avoided. As Emerson once pointed out, "a foolish consistency is the hobgoblin of small minds... ." The authors are to be congratulated for seeing the "foolish consistency" of routine conduit replacement and identifying an alternative.

	References

Top References

 

1. Zachariah JPV, Pigula FA, Mayer Jr JE, McElhinney DB. Right ventricle to pulmonary artery conduit augmentation compared with replacement in young children Ann Thorac Surg 2009;88:574-580.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): James S. Tweddell Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Tweddell, J. S. Search for Related Content PubMed PubMed Citation Articles by Tweddell, J. S. Related Collections Congenital - cyanotic Related Article