Improved results with selective management in pulmonary atresia with intact ventricular septum

Objective: Late outcome of neonatal pulmonary atresia with intact ventricul ar; septum remains poor in most reported series. We have followed a selecti ve approach toward either single ventricle repair versus complete or partia l biventricular repair based on the presence of right ventricle-dependent c oronary circulation and growth of the right ventricle, Methods: A retrospec tive chart review was conducted of 47 patients who underwent surgery betwee n January 1991 and September 1998, Results: Sixteen (34%) patients had a ri ght ventricle-dependent coronary circulation, with a tricuspid valve Z-scor e of -3.0 +/- 0.66 versus -2.0 +/- 0.95 (P = .002) for those without a righ t ventricle-dependent corollary circulation. A systemic-pulmonary artery sh unt only was performed in all patients with a right ventricle-dependent cor onary circulation, with 1 death, Fourteen of 16 patients with a right ventr icle-dependent coronary circulation underwent a bidirectional Glenn shunt a t a median of 9 months after their first operation, 9 of whom have had a Fo ntan procedure (no deaths), In the 31 (66%) patients without a right ventri cle-dependent coronary circulation, 6 patients underwent only a systemic-pu lmonary artery shunt, 23 had a shunt and right ventricular decompression, a nd 2 had only a transannular patch. In this group, 10 patients received a 2 -ventricle repair, 6 a 1.5-ventricle repair, and 8 patients had a Fontan pr ocedure. There was I early death and the overall survival was 98% at 1 year , 5 Sears, and 7 Sears. Conclusions: If patients are stratified well, excel lent survival can be achieved in the treatment of pulmonary atresia with in tact ventricular septum, This result may be at the price of achieving a 1-v entricle as opposed to a 2-ventricle repair.