Objective In order to correct left pulmonary artery (LPA) stenosis in tetralogy of Fallot (TOF), a technique for LPA reconstruction by widening pulmonary arterial posterior wall was devised. To evaluate its surgical technique as well as postoperative outcome.
Methods From January 2008 through August 2014 year, 1 142 consecutive patients underwent repair of TOF including 44 patients with TOF and LPA stenosis in our hospital. We used widening pulmonary arterial posterior wall for LPA reconstruction in 21 patients. The median age was 22.8 months (range, 1 month to 11 years), and the median weight was 9.1 kg (range, 3.8-29 kg).
Results There was one operative death. No death occurred during the follow-up period in the other 20 patients. There were 4 patients with complicate unbalanced pulmonary perfusion postoperatively. Echocardiography at 3-72 months follow-up demonstrated no obvious stenosis was found at LPA in 14 patients, and mild stenosis (32.8±12.7 mm Hg) in 6 patients. Only 1 patient required further interventions because of restenosis of LPA.
Conclusions LPA reconstruction by widening pulmonary arterial posterior wall is an effective method in the management of stenosis of LPA in the patients with TOF. We emphasize division of the arterial duct or ligamentum completely because it will tether and kink the LPA. This procedure retains the better growth potential by increasing autogenous tissue of native tissue.
Citation：
LIUXiao-bing, CHENJi-mei, CENJian-zheng, DINGYi-qun, XUGang, WENShu-sheng, ZHUANGJian. Widening Pulmonary Arterial Posterior Wall for Tetralogy of Fallot Repair Patients Complicated with Left Pulmonary Artery Stenosis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(8): 800-803. doi: 10.7507/1007-4848.20160192
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Chaturvedi RR, Kilner PJ, White PA, et al. Increased airway pressure and simulated branch pulmonary artery stenosis increase pulmonary regurgitation after repair of tetralogy of Fallot:real-time analysis with a conductance catheter technique. Circulation, 1997, 95(3):643-649.
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Oechslin EN, Harrisson DA, Harris L, et al. Reoperation in adults with repair of tetralogy of Fallot:indications and outcomes. J Thorac Cardiovasc Surg, 1999, 118(2):245-251.
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Shinkawa T, Yamagishi M, Shuntoh K, et al. Pulmonary arterial reconstruction for pulmonary coarctation in early infancy. Ann Thorac Surg, 2007, 83(1):188-192.
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McElhinney DB, Parry AJ, Reddy VM, et al. Left pulmonary artery kinking caused by outflow tract Dilatation after transannular patch repair of tetralogy of Fallot. Ann Thorac Surg, 1998, 65(4):1120-1126.
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| 9. |
Kim H, Sung SC, Chang YH, et al. Early and midterm outcomes of left pulmonary artery angioplasty using an anterior wall flap of the main pulmonary artery in tetralogy of Fallot repair. J Thorac Cardiovasc Surg, 2014, 148(6):2597-2601.
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- 1. Kouchoukos NT, Blackstone EH, Hanley FL, et al. Kirklin/Barratt-Boyes Cardiac Surgery:Morphology, Diagnostic Criteria, Natural History, Techniques, Results, and Indications. 4th edition. Philadel-phia:Elsevier Medicine, 2012. 1359-1467.
- 2. Faidutti B, Christenson JT, Beghetti M, et al. How to diminish reop-eration rates after initial repair of tetralogy of Fallot? Ann Thorac Surg, 2002, 73(1):96-101.
- 3. Sheikh AM, Kazmi U, Syed NH. Variations of pulmonary arteries and other associated defects in tetralogy of Fallot. Springerplus, 2014, 3:467.
- 4. Elzenga NJ, Suylen RJ, Frohn-Mulder I, et al. Juxtaductal pulmonary artery coarctation:an underestimated cause of branch pulmonary artery stenosis in patients with pulmonary atresia or stenosis and a ventricular septal defect. J Thorac Cardiovasc Surg, 1990, 100(3):416-424.
- 5. Chaturvedi RR, Kilner PJ, White PA, et al. Increased airway pressure and simulated branch pulmonary artery stenosis increase pulmonary regurgitation after repair of tetralogy of Fallot:real-time analysis with a conductance catheter technique. Circulation, 1997, 95(3):643-649.
- 6. Oechslin EN, Harrisson DA, Harris L, et al. Reoperation in adults with repair of tetralogy of Fallot:indications and outcomes. J Thorac Cardiovasc Surg, 1999, 118(2):245-251.
- 7. Shinkawa T, Yamagishi M, Shuntoh K, et al. Pulmonary arterial reconstruction for pulmonary coarctation in early infancy. Ann Thorac Surg, 2007, 83(1):188-192.
- 8. McElhinney DB, Parry AJ, Reddy VM, et al. Left pulmonary artery kinking caused by outflow tract Dilatation after transannular patch repair of tetralogy of Fallot. Ann Thorac Surg, 1998, 65(4):1120-1126.
- 9. Kim H, Sung SC, Chang YH, et al. Early and midterm outcomes of left pulmonary artery angioplasty using an anterior wall flap of the main pulmonary artery in tetralogy of Fallot repair. J Thorac Cardiovasc Surg, 2014, 148(6):2597-2601.
