Results
There was no early death during the study period. The median
postoperative ventilator support time was 10 hours (range, 0-174 hours).
The median intensive care unit stay was 2 days (range, 1-227 days), and
the median hospital stay was 7 days (range, 6-257 days). None of the
patients showed a phrenic nerve palsy following the operation (Table 2).
The change in the angle between the DA and the vertebra (ㅿa) was
measured, and effective aortopexy (ㅿa > 0) was observed in
four patients (80%). A possible reason for the inadequate posterior
aortopexy in patient 5 was related to the surgical approach. We adopted
a posterior aortopexy through the fourth ICS thoracotomy for concomitant
patent ductus arteriosus (PDA) ligation and relief of airway obstruction
on the patient 5. This might have led to an inadequate posterior
aortopexy (Fig. 4A and B, ㅿa = -1). The median postoperative peak PG
across the left PV was 3.1 mmHg (range, 0-20 mmHg), and all but one
patient showed a decreased PG after posterior aortopexy (Table 3).
The median follow-up duration was 34 months (range, 14-89 months). There
was one case of late mortality. Patient 2 had the Rastelli operation for
truncus arteriosus, atrial septal defect, and partial anomalous
pulmonary venous return (PAPVR) at the age of 51 days. The patient
showed persistent pulmonary edema and severe pulmonary hypertension, and
the left PV obstruction was identified between the LA and the DA on
postoperative follow-up echocardiography and CT angiography (Fig. 5A).
In this patient, posterior aortopexy for the left PV obstruction was
performed at the age of 5 months. The PV obstruction pattern was
diffuse, and the PG across the obstructed left PV was still high after
the procedure (20 mmHg, Fig. 5B). The patient also showed a moderate
truncal valve regurgitation, and truncal valve and PAPVR repair were
performed subsequently. However, pulmonary hypertension and PV
obstruction persisted, and the patient eventually died at the age of 14
months. The median cardiothoracic ratio (CTR) at the last follow-up
chest radiography was 0.54 (range, 0.47-0.63) in all five patients.
Patient 4 and 5 demonstrated a decrease in the last follow-up CTR as
compared to the preoperative results (0.57 vs. 0.7 and 0.52 vs. 0.62).
In the last follow-up echocardiography, there was no PV obstruction in
any of the patients except for one case of mortality (Patient 2) (Table
4).