Surgical Strategies and Outcomes in Patients With Shone Complex

A Retrospective Review

James D. St. Louis, Mary M. Bannan, William A Lutin, Henry B Wiles

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: Multilevel obstruction of left-sided heart structures was originally characterized by Shone and colleagues. The formulation of an appropriate operative strategy remains problematic. Surgical outcomes have generally been poor. This review examines operative strategies and mid-term outcomes. Methods: A retrospective review was done of 28 patients who presented with the diagnosis of Shone complex at a median age of 14 days, with 46% presenting within the first week of life. At presentation, 5 patients were in cardiovascular collapse, and 10 were at New York Heart Association functional class III or IV. All patients had a structurally abnormal mitral complex. A mean transvalvular pressure gradient of 8 mm or greater existed in 15 patients, 6 had a supraannular mitral ring, and 26 had a coarctation of the aorta. Twelve mitral valve operations were done, with an average time from presentation to operative intervention of 15 months. Results: Two patients were lost to follow-up. Of 26 remaining patients, 2 died after a second operative intervention. The average follow-up of 24 patients was 6.3 years (range, 1 to 16 years). Overall survival was 93%. All surviving patients are in class I or II congestive heart failure. Conclusions: Long-term survival of patients diagnosed with Shone complex is excellent. Operative strategies for this complex group should be individualized. Mitral interventions may generally be deferred.

Original languageEnglish (US)
Pages (from-to)1357-1363
Number of pages7
JournalAnnals of Thoracic Surgery
Volume84
Issue number4
DOIs
StatePublished - Oct 1 2007

Fingerprint

Aortic Coarctation
Survival
Lost to Follow-Up
Mitral Valve
Heart Failure
Pressure

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Surgical Strategies and Outcomes in Patients With Shone Complex : A Retrospective Review. / St. Louis, James D.; Bannan, Mary M.; Lutin, William A; Wiles, Henry B.

In: Annals of Thoracic Surgery, Vol. 84, No. 4, 01.10.2007, p. 1357-1363.

Research output: Contribution to journalArticle

St. Louis, James D. ; Bannan, Mary M. ; Lutin, William A ; Wiles, Henry B. / Surgical Strategies and Outcomes in Patients With Shone Complex : A Retrospective Review. In: Annals of Thoracic Surgery. 2007 ; Vol. 84, No. 4. pp. 1357-1363.
@article{150188c2c2c9492e8a0d04766e54c993,
title = "Surgical Strategies and Outcomes in Patients With Shone Complex: A Retrospective Review",
abstract = "Background: Multilevel obstruction of left-sided heart structures was originally characterized by Shone and colleagues. The formulation of an appropriate operative strategy remains problematic. Surgical outcomes have generally been poor. This review examines operative strategies and mid-term outcomes. Methods: A retrospective review was done of 28 patients who presented with the diagnosis of Shone complex at a median age of 14 days, with 46{\%} presenting within the first week of life. At presentation, 5 patients were in cardiovascular collapse, and 10 were at New York Heart Association functional class III or IV. All patients had a structurally abnormal mitral complex. A mean transvalvular pressure gradient of 8 mm or greater existed in 15 patients, 6 had a supraannular mitral ring, and 26 had a coarctation of the aorta. Twelve mitral valve operations were done, with an average time from presentation to operative intervention of 15 months. Results: Two patients were lost to follow-up. Of 26 remaining patients, 2 died after a second operative intervention. The average follow-up of 24 patients was 6.3 years (range, 1 to 16 years). Overall survival was 93{\%}. All surviving patients are in class I or II congestive heart failure. Conclusions: Long-term survival of patients diagnosed with Shone complex is excellent. Operative strategies for this complex group should be individualized. Mitral interventions may generally be deferred.",
author = "{St. Louis}, {James D.} and Bannan, {Mary M.} and Lutin, {William A} and Wiles, {Henry B}",
year = "2007",
month = "10",
day = "1",
doi = "10.1016/j.athoracsur.2007.05.003",
language = "English (US)",
volume = "84",
pages = "1357--1363",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "4",

}

TY - JOUR

T1 - Surgical Strategies and Outcomes in Patients With Shone Complex

T2 - A Retrospective Review

AU - St. Louis, James D.

AU - Bannan, Mary M.

AU - Lutin, William A

AU - Wiles, Henry B

PY - 2007/10/1

Y1 - 2007/10/1

N2 - Background: Multilevel obstruction of left-sided heart structures was originally characterized by Shone and colleagues. The formulation of an appropriate operative strategy remains problematic. Surgical outcomes have generally been poor. This review examines operative strategies and mid-term outcomes. Methods: A retrospective review was done of 28 patients who presented with the diagnosis of Shone complex at a median age of 14 days, with 46% presenting within the first week of life. At presentation, 5 patients were in cardiovascular collapse, and 10 were at New York Heart Association functional class III or IV. All patients had a structurally abnormal mitral complex. A mean transvalvular pressure gradient of 8 mm or greater existed in 15 patients, 6 had a supraannular mitral ring, and 26 had a coarctation of the aorta. Twelve mitral valve operations were done, with an average time from presentation to operative intervention of 15 months. Results: Two patients were lost to follow-up. Of 26 remaining patients, 2 died after a second operative intervention. The average follow-up of 24 patients was 6.3 years (range, 1 to 16 years). Overall survival was 93%. All surviving patients are in class I or II congestive heart failure. Conclusions: Long-term survival of patients diagnosed with Shone complex is excellent. Operative strategies for this complex group should be individualized. Mitral interventions may generally be deferred.

AB - Background: Multilevel obstruction of left-sided heart structures was originally characterized by Shone and colleagues. The formulation of an appropriate operative strategy remains problematic. Surgical outcomes have generally been poor. This review examines operative strategies and mid-term outcomes. Methods: A retrospective review was done of 28 patients who presented with the diagnosis of Shone complex at a median age of 14 days, with 46% presenting within the first week of life. At presentation, 5 patients were in cardiovascular collapse, and 10 were at New York Heart Association functional class III or IV. All patients had a structurally abnormal mitral complex. A mean transvalvular pressure gradient of 8 mm or greater existed in 15 patients, 6 had a supraannular mitral ring, and 26 had a coarctation of the aorta. Twelve mitral valve operations were done, with an average time from presentation to operative intervention of 15 months. Results: Two patients were lost to follow-up. Of 26 remaining patients, 2 died after a second operative intervention. The average follow-up of 24 patients was 6.3 years (range, 1 to 16 years). Overall survival was 93%. All surviving patients are in class I or II congestive heart failure. Conclusions: Long-term survival of patients diagnosed with Shone complex is excellent. Operative strategies for this complex group should be individualized. Mitral interventions may generally be deferred.

UR - http://www.scopus.com/inward/record.url?scp=34548687738&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34548687738&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2007.05.003

DO - 10.1016/j.athoracsur.2007.05.003

M3 - Article

VL - 84

SP - 1357

EP - 1363

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 4

ER -