Jeong Ryul Lee

Surgical results of patients with a functional single ventricle

OBJECTIVEnOverall mortality of the patients with a functional single ventricle is still high, though excellent mid- and long-term results of the modified Fontan procedure have been reported. This study assessed the factors that affect the surgical outcomes mainly in the pre-Fontan stage and performed long-term survival analysis.nnnMETHODSnBetween January 1988 and December 2000, 405 patients with a functional single ventricle underwent surgical interventions and were followed up until June 2001. The mean follow-up period was 74.5+/-69.4 months and 95% of the patients were followed up completely. Their median age was 2.5 months at the time of shunt or pulmonary artery banding (PAB), 8.6 months at BCPS, and 28.6 months at the Fontan operation. The variables of the anatomical lesions with single ventricle physiology, combined abnormalities, surgical pathways leading to the Fontan stage, age at operation, study periods, and type of the Fontan procedure were analyzed. The role of BCPS in the long-term results was evaluated.nnnRESULTSnOverall survival after birth was 60.1+/-2.8% at 10 years. In multivariate analysis, complete atrioventricular septal defect-typed lesion, pulmonary venous obstruction, total anomalous pulmonary venous connection, and interruption of aortic arch were risk factors for long-term survival, while pulmonary stenosis was demonstrated as a favorable prognostic factor. In this study, there was no significant survival difference between the early and late study period. Actuarial mortality in the pre-Fontan stage was 41.3% in the non-BCPS group and 16.3% in the BCPS group (P<0.001). The 10-year survival rates of the populations in staged and primary Fontan groups were not significantly different (P=0.24). The long-term survival rate of the atriopulmonary Fontan group was significantly lower than that of lateral tunnel Fontan (60.3+/-6.3% vs. 86.8+/-3.1% at 10 years, P=0.0001).nnnCONCLUSIONnThis study revealed that the overall survival was disappointing and there were still problems that need to be solved in the pre-Fontan stage to improve the overall survival. The role of BCPS was not to contribute to the longer survival after Fontan operation, but to lower mortality in the pre-Fontan stage, which can offer a higher probability to proceed to the Fontan procedure successfully.

Lecompte procedure for complete transposition of the great arteries with ventricular septal defect and pulmonary stenosis

From December 1988 to February 1993, 19 patients were treated by the Lecompte procedure for complete transposition of the great arteries associated with a ventricular septal defect and pulmonary stenosis. The mean age at operation was 3.1 +/- 0.8 years (mean +/- standard error). This technique consisted of resecting the outlet septum, constructing a tunnel that connected the left ventricle to the aorta, closing the proximal pulmonary arterial stump, pulling the distal pulmonary artery down to the right ventriculotomy site directly, and covering anteriorly with the fixed autologous pericardium. Operative mortality was 5.3%. The mean follow-up was 24.2 +/- 3 months, with no late death. One reoperation was performed because of residual right ventricular outflow tract obstruction. All survivors were studied by echocardiography at intervals of 6 months to 1 year. In all survivors (except for 1 child who underwent reoperation), the estimated pressure gradient between the right ventricle and the pulmonary artery, the structure of the left ventricular outflow tract, left ventricular function, and right ventricular contractility were all satisfactory.

Modified extracardiac Fontan in a patient with separate hepatic venous drainage

We describe an alternative technique to the extracardiac Fontan procedure in a patient with a univentricular heart, in which the inferior caval vein and the hepatic vein drained separately into the common atrium and the intraatrial orifice of the hepatic vein was adjacent to the opening of the left lower pulmonary vein.

Systemic immune modulation using chemokine receptor 7 expressing porcine Sertoli cells

Abstract:u2002 Background:u2002 Sertoli cells (SC) are known to have active mechanism for evading humoral immune response and are known to have immune modulatory effects in the presence of other antigens. This has led us to hypothesize that systemic immune modulating effect of SC might be optimized by their residence on peripheral lymph node. This study was designed to evaluate our new strategy to promote preventive or therapeutic effects of SC in systemic immune modulation for organ transplantation.

Extracardiac Fontan with T-shape conduit in non-confluent pulmonary arteries

A 34 months-old male patient with double inlet right ventricle with nonconfluent pulmonary arteries who underwent successful extracardiac fenestarated Fontan procedure using pre-designed T-shaped PTFE vascular graft after multi-step rehabilitation of the diminutive hilar pulmonary arteries. At first we performed 6 mm confluent pulmonary artery vascular graft implantation with 4 mm BT shunt at patients 4 weeks old. At 9 months of patient, we upsized the confluent pulmonary arterial graft to 8 mm with bidirectional cavopulmonary connection, and, at 34 months, we performed extracardiac conduit Fontan procedure with pre-designed T-shape conduit including the confluent pulmonary arterial portion at last. Patient shows excellent functional status and development.