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The Journal of Thoracic and Cardiovascular Surgery, Vol 98, 738-750, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
K Sawatari, Y Imai, H Kurosawa, Y Isomatsu and K Momma
A new staged operation for total correction of pulmonary atresia and
ventricular septal defect with major aortopulmonary collateral arteries has
been developed. In first-stage repair (complete unifocalization),
intrapulmonary arteries were unified at the hilum with equine pericardial
conduits (intrapulmonary bridges). In case of absent or severely
hypoplastic central pulmonary arteries, new central pulmonary arteries were
created. Finally, the unifocalization was completed by modified
Blalock-Taussig shunts with the ligation of collateral arteries. In
second-stage repair, right ventricular-pulmonary arterial continuity was
established with a trileaflet pericardial conduit and closure of the
ventricular septal defect. From January 1982 through July 1988, 34
patients, whose ages ranged from 1 month to 24 years (mean 6.6 years),
underwent first-stage repair with two resultant late deaths (mortality rate
5.9%). Second-stage repair has been completed in 16 patients. There were
two early deaths (mortality rate 12%) from bacterial infection.
Postoperative right ventricular/left ventricular systolic pressure ratios
ranged from 0.36 to 1.0 (mean 0.72). In four patients in whom the ratio was
1.0, the ventricular septal defect had been closed with a perforated patch.
By complete unifocalization with the intrapulmonary bridge technique and
the creation of new central pulmonary arteries, the majority of patients
with major aortopulmonary collateral arteries can have successful repair.
ARTICLES
Staged operation for pulmonary atresia and ventricular septal defect with major aortopulmonary collateral arteries. New technique for complete unifocalization
Department of Pediatric Cardiovascular Surgery, Heart Institute of Japan, Tokyo.
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