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ARTICLE |

Staged Correction of Pulmonary Atresia and Absent Right Pulmonary Artery FREE

J. Scott Rankin, MD; Richard J. Sterba, MD; Joannes H. Karis, MD; H. Newland Oldham, Jr, MD
[+] Author Affiliations

Accepted for publication Nov 17, 1982.

Reprint requests to Box 3851, Duke University Medical Center, Durham, NC 27710 (Dr Rankin).


Arch Surg. 1983;118(8):974-978. doi:10.1001/archsurg.1983.01390080076019
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• Repair of pulmonary atresia with an extra-anatomic conduit has been difficult in patients with absent central pulmonary arteries. Although several methods have been employed successfully, each has inherent problems. Our technique uses a staged approach to complete pulmonary revascularization using the systemic-pulmonary collateral arteries for reconstruction of the involved lung. In our patient, this type of repair was associated with excellent late postoperative symptomatic and hemodynamic results. Complete revascularization of both lungs during correction of pulmonary atresia may improve the surgical management of this condition.

(Arch Surg 1983;118:974-978)

REFERENCES

Kouchoukos NT, Barcia A, Bargeron LM, et al:  Surgical treatment of congenital pulmonary atresia with ventricular septal defect . J Thorac Cardiovasc Surg 1971;;61:70-84.
Danielson GK, Wallace RB, McGoon DC: Pulmonary atresia: Surgical considerations and results of definitive repair. Proceedings of the US-USSR Joint Symposium on Congenital Heart Disease, 1977, pp 251-267.
Bailey WW, Kirklin JW, Bargeron LM Jr, et al:  Late results with synthetic valved conduits from venous ventricle to pulmonary arteries . Circulation 1977;;56( (suppl 2) ):73-79.
Norwood WI, Freed MO, Rocchini AP, et al:  Experience with valved conduits for repair of congenital cardiac lesions . Ann Thorac Surg 1977;;24: 223-232.
Alfieri O, Blackstone EH, Kirklin JW, et al:  Surgical treatment of tetralogy of Fallot with pulmonary atresia . J Thorac Cardiovasc Surg 1978;;76:321-335.
Berry BE, McGoon DC, Ritter DG, et al:  Absence of anatomic origin from heart of pulmonary arterial supply . J Thorac Cardiovasc Surg 1974;;68:119-125.
Ebert PA, Robinson SJ, Stanger P, et al:  Pulmonary artery conduits in infants younger than 6 months of age . J Thorac Cardiovasc Surg 1976;;72: 351-356.
Mistrot JJ, Bernhard WF, Rosenthal A, et al:  Tetralogy of Fallot with a single pulmonary artery: Operative repair . Ann Thorac Surg 1977;;23:249-253.
Malm JR, Blumenthal S, Bowman FO Jr, et al:  Factors that modify hemodynamic results in total correction of tetralogy of Fallot . J Thorac Cardiovasc Surg 1966;;52:502-513.
Williams GD, Dungan WT, Campbell GS:  Surgical treatment of tetralogy of Fallot with unilateral absence of a pulmonary artery . Ann Thorac Surg 1972;;14:483-493.
Donahoo JS, Brawley RK, Haller JA, et al:  Correction of tetralogy of Fallot in patients with one pulmonary artery in continuity with the right ventricular outflow tract . Surgery 1973;;74:887-893.
Bristow JD, Adrouny ZA, Porter GA, et al:  Hemodynamic studies after total correction of tetralogy of Fallot . Am J Cardiol 1962;;9:924-932.
Findlay CW Jr, Maier HC:  Anomalies of the pulmonary vessels and their surgical significance . Surgery 1951;;29:604-641.
Pool PE, Vogel JHK, Blount SGJr:  Congenital unilateral absence of a pulmonary artery . Am J Cardiol 1962;;10:706-732.
Doty DB, Kouchoukos NT, Kirklin JW, et al:  Surgery for pseudotruncus arteriosus with pulmonary blood flow originating from upper descending thoracic aorta . Circulation 1972;;45/46( (suppl 1) ):121-129.
Murphy DA, Sridhara KS, Nanton MA, et al:  Surgical correction of pulmonary atresia with multiple large systemic-pulmonary collaterals . Ann Thorac Surg 1979;;27:460-464.
Bowman FO Jr: Approach to 'type IV truncus arteriosus.' Read before the symposium on current controversies and techniques in congenital heart surgery, Baltimore, May 8-9, 1981.
Rudolph AM: Congenital Diseases of the Heart . Chicago, Year Book Medical Publishers, 1974;, p 125.
Bjork VO:  Surgical treatment of tetralogy of Fallot with right pulmonary artery reconstruction after previous end-to-end anastomosis of systemic artery to pulmonary artery . J Thorac Cardiovasc Surg 1965;;49: 635-639.
Jefferson K, Rees S, Somerville J:  Systemic arterial supply to the lungs in pulmonary atresia and its relation to pulmonary artery development . Br Heart J 1972;;34:418-427.

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Kouchoukos NT, Barcia A, Bargeron LM, et al:  Surgical treatment of congenital pulmonary atresia with ventricular septal defect . J Thorac Cardiovasc Surg 1971;;61:70-84.
Danielson GK, Wallace RB, McGoon DC: Pulmonary atresia: Surgical considerations and results of definitive repair. Proceedings of the US-USSR Joint Symposium on Congenital Heart Disease, 1977, pp 251-267.
Bailey WW, Kirklin JW, Bargeron LM Jr, et al:  Late results with synthetic valved conduits from venous ventricle to pulmonary arteries . Circulation 1977;;56( (suppl 2) ):73-79.
Norwood WI, Freed MO, Rocchini AP, et al:  Experience with valved conduits for repair of congenital cardiac lesions . Ann Thorac Surg 1977;;24: 223-232.
Alfieri O, Blackstone EH, Kirklin JW, et al:  Surgical treatment of tetralogy of Fallot with pulmonary atresia . J Thorac Cardiovasc Surg 1978;;76:321-335.
Berry BE, McGoon DC, Ritter DG, et al:  Absence of anatomic origin from heart of pulmonary arterial supply . J Thorac Cardiovasc Surg 1974;;68:119-125.
Ebert PA, Robinson SJ, Stanger P, et al:  Pulmonary artery conduits in infants younger than 6 months of age . J Thorac Cardiovasc Surg 1976;;72: 351-356.
Mistrot JJ, Bernhard WF, Rosenthal A, et al:  Tetralogy of Fallot with a single pulmonary artery: Operative repair . Ann Thorac Surg 1977;;23:249-253.
Malm JR, Blumenthal S, Bowman FO Jr, et al:  Factors that modify hemodynamic results in total correction of tetralogy of Fallot . J Thorac Cardiovasc Surg 1966;;52:502-513.
Williams GD, Dungan WT, Campbell GS:  Surgical treatment of tetralogy of Fallot with unilateral absence of a pulmonary artery . Ann Thorac Surg 1972;;14:483-493.
Donahoo JS, Brawley RK, Haller JA, et al:  Correction of tetralogy of Fallot in patients with one pulmonary artery in continuity with the right ventricular outflow tract . Surgery 1973;;74:887-893.
Bristow JD, Adrouny ZA, Porter GA, et al:  Hemodynamic studies after total correction of tetralogy of Fallot . Am J Cardiol 1962;;9:924-932.
Findlay CW Jr, Maier HC:  Anomalies of the pulmonary vessels and their surgical significance . Surgery 1951;;29:604-641.
Pool PE, Vogel JHK, Blount SGJr:  Congenital unilateral absence of a pulmonary artery . Am J Cardiol 1962;;10:706-732.
Doty DB, Kouchoukos NT, Kirklin JW, et al:  Surgery for pseudotruncus arteriosus with pulmonary blood flow originating from upper descending thoracic aorta . Circulation 1972;;45/46( (suppl 1) ):121-129.
Murphy DA, Sridhara KS, Nanton MA, et al:  Surgical correction of pulmonary atresia with multiple large systemic-pulmonary collaterals . Ann Thorac Surg 1979;;27:460-464.
Bowman FO Jr: Approach to 'type IV truncus arteriosus.' Read before the symposium on current controversies and techniques in congenital heart surgery, Baltimore, May 8-9, 1981.
Rudolph AM: Congenital Diseases of the Heart . Chicago, Year Book Medical Publishers, 1974;, p 125.
Bjork VO:  Surgical treatment of tetralogy of Fallot with right pulmonary artery reconstruction after previous end-to-end anastomosis of systemic artery to pulmonary artery . J Thorac Cardiovasc Surg 1965;;49: 635-639.
Jefferson K, Rees S, Somerville J:  Systemic arterial supply to the lungs in pulmonary atresia and its relation to pulmonary artery development . Br Heart J 1972;;34:418-427.

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