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).