Инновационная медицина Кубани (Feb 2019)
Management of congenital heart diseases with conduit application in pulmonary position in newborns and infants
Abstract
Background. History of conduits application in cardiovascular surgery extends back for more than 100 years. With their use it became possible to help newborns and infants with difficult congenital heart diseases. Various types of conduits are used and well-known and have advantages and shortcomings, but it is difficult to choose an “ideal” conduit. The main problem of all types is repeated operations, which sometimes are repeated throughout the patient’s life.Objective. Show immediate and medium term results with conduit application in pulmonary position in infants.Material and Methods. From January 2006 to June, 2016 in our Clinic we have operated on 48 patients and performed reconstructions of the right ventricular outflow tract applying many different conduits. Age range was from 14 days to 1 year (4,82 ± 4,09 months), mean weight was 4,7 ± 2,3 kg (2,9-10,2 kg).Results. In immediate postoperative period 7 patients died (overall mortality rate was 14,59%). In all discharged patients according to ECG data mean blood flow rate on the conduit was 2,42 ± 0,72 m/s (from 1,3 to 3,9 m/s), and a mean gradient was 22,22 ± 17,17 mm Hg (from 4 to 60 mm Hg). We performed 18 repeated operations. Early reoperation was necessary in 3 cases(8,82%) (during the 1 year after the primary surgery), in cases the reason was conduit stenosis, in 1 patient there was a right ventricle aneurysm. We avoid repeated surgery in cases with conduit Contegra application with mean follow-up period 16,3 ± 11 months (1-62 months).Conclusion. 1. Conduit selection for implantation in the pulmonary position has a tendency to be a serious challenge in infants and newborns treated for complicated congenital heart disorders.2. Repeated surgeries were not necessary when we applied conduits Contegra with mean follow-up 16,3 ± 11 months (1-62 months), but to make some authentic conclusions a more prolonged follow-up period is required.
