Novel Approach to Construct Absent Intrapericardial Branch Pulmonary Arteries

Pourmoghadam, Kamal; Schwartz, Matthew C.; DeCampli, William M.; O’Brien, Morrough P.

doi:10.1016/j.athoracsur.2015.03.046

Cited by 4 publications

(3 citation statements)

References 6 publications

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“…The difficulty of directly connecting the hilar PA and the MPA is the substantial distance between the two stumps (22). A direct anastomosis would inevitably lead to excess tension on the anastomosis.…”

Section: Discussionmentioning

confidence: 99%

Surgical repair of unilateral absence of pulmonary artery in children with pulmonary hypertension: a single-center retrospective study

Yan¹,

Cen²,

Luo³

et al. 2022

Transl Pediatr

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Background: The early diagnosis of unilateral absence of pulmonary artery (UAPA) in children offers an opportunity for effective intervention. Due to the lack of clinical evidence, a consensus regarding surgical treatment has yet to be reported. The aim of this study is to evaluate the effectiveness and safety of pulmonary artery (PA) reconstruction with a "two-segment" technique to repair UAPA in patients with pulmonary hypertension.Methods: Intraoperatively, the ligamentum arteriosum connecting the innominate artery and distal PA was dissected and occluded. A conduit created by fresh autologous pericardium formed the first "segment" of the neo-PA. The second "segment" was a Gore vascular graft with integrated rings anastomosed between the proximal end of the pericardial conduit and the main pulmonary artery (MPA).Results: A total of five consecutive patients were included, and the absent PA was successfully reconstructed using the "two-segment" technique in all patients. Following revascularization, the direct measurement of the pressure in MPA during the operation showed that the average mean pulmonary artery pressure (mPAP) decreased from 31.3±16.0 to 16.8±4.2 mmHg (P=0.047). The average mPAP/radial mean arterial pressure (rMAP) ratio decreased from 0.59±0.27 preoperatively to 0.30±0.10 postoperatively (P=0.028). The mean follow-up period was 18.85±4.67 months. The median diameter of the reconstructed PA (pericardial segment) measured by transthoracic echocardiography (TTE) was 6.1 mm. One patient safely underwent a redo operation to repair relative stenosis in the neo-PA.Conclusions: Early PA reconstruction may effectively alleviate pulmonary hypertension in children with UAPA. The "two-segment" technique is safe and can facilitate potential redo pulmonary arterioplasty.Anticoagulation and antiplatelet therapy, as well as frequent follow-up, is required after the operation.

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Section: Discussionmentioning

confidence: 99%

Surgical repair of unilateral absence of pulmonary artery in children with pulmonary hypertension: a single-center retrospective study

Yan¹,

Cen²,

Luo³

et al. 2022

Transl Pediatr

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“…Due to the length of the lacking segment and few available blood vessel tissue, reconstruction of the connection between the LPA and the main pulmonary artery is a challenge for surgeons. Various techniques and reconstructive materials have been reported 9–13 . In our institute, different surgeons have different techniques and strategies.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary artery reconstruction and correction of tetralogy of Fallot combined with the absence of the mediastinal left pulmonary artery

Cui

Yang

Qiu

et al. 2022

Journal of Cardiac Surgery

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Objectives: Tetralogy of Fallot (TOF) is the most common deformity combined with the unilateral absence of the mediastinal pulmonary artery (UAMPA), and its treatment strategy remains controversial. In this study, we analyzed the effect of bilateral pulmonary reconstruction in patients with TOF combined with UAMPA. Methods: This was a single-center, retrospective review of 1713 patients with TOF between January 2009 and November 2021. Overall, eight patients were diagnosed with TOF combined with UAMPA. Among them, seven underwent surgery: three underwent one-stage TOF correction with bilateral pulmonary artery reconstruction; three patients underwent bilateral pulmonary artery reconstruction, followed by two-stage TOF correction after several months; and one patient underwent two procedures of left pulmonary artery reconstruction, and the ventral septal defect remained open. The left pulmonary arteries were reconstructed with a Goretex conduit in three cases, direct anastomosis in two cases, and the modified autologous tissue extension technique in two cases. Results: All seven patients survived during the postoperative follow-up and showed good cardiac function and normal oxygen saturation of >97%. During follow-up echocardiography, we noted that the left pulmonary arteries reconstructed with a Goretex conduit or direct anastomosis had thrombosis or stenosis. However, those reconstructed using the modified autologous tissue extension technique was unobstructed. Conclusions: In patients with TOF and UAMPA, if there is a pulmonary artery confluence in the affected hilum, it is feasible to implement bilateral pulmonary artery reconstruction for one-stage TOF correction. The use of the pulmonary artery extension technique and autologous tissue for bilateral pulmonary reconstruction could reduce the incidence of anastomotic stenosis.

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“…The primary treatment goal is to restore the pulmonary flow distribution as close to normal as possible, which can be achieved through surgical continuity. Previous studies have provided various surgical designs to correct UAPA, such as direct anastomosis of the affected pulmonary artery (PA) to the main pulmonary artery (MPA), reconstructing PA with autologous pericardial roll, pulmonary artery or prosthetic materials, creating a systemic-to-PA shunt, repairing absent PA with a contralateral PA autograft segment interposition, using an insitu pedicle of transverse sinus pericardium as a base for a conduit to reconstruct PA and so on (3)(4)(5)(6)(7). The right-sided UAPA, however, poses a significantly greater surgical challenge compared to the left-sided UAPA due to the relatively long distance between the right pulmonary artery (RPA) and the MPA.…”

Section: Introductionmentioning

confidence: 99%

Case report: Reconstruction of the long-gap unilateral absence of right pulmonary artery with contralateral pulmonary artery flap and autologous pericardial graft

Lu²,

Xiong³

et al. 2023

Front. Cardiovasc. Med.

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Unilateral absence of pulmonary artery (UAPA) is a rare type of congenital abnormality that may coexist with other congenital abnormalities or present as an isolated lesion, the latter form can be asymptomatic. Surgical procedure is usually carried out when UAPA was diagnosed with significant symptoms, and the aim of surgery is to restore the pulmonary flow distribution. The right-side UAPA is a considerable challenge for surgeons to process surgery, however, technical description of this type of UAPA are limited. Here we described a rare case of a two-month girl with absence of right pulmonary artery, we presented a technique that reconstructs this long-gap UAPA with contralateral pulmonary artery flap and autologous pericardial graft.

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Novel Approach to Construct Absent Intrapericardial Branch Pulmonary Arteries

Cited by 4 publications

References 6 publications

Surgical repair of unilateral absence of pulmonary artery in children with pulmonary hypertension: a single-center retrospective study

Surgical repair of unilateral absence of pulmonary artery in children with pulmonary hypertension: a single-center retrospective study

Pulmonary artery reconstruction and correction of tetralogy of Fallot combined with the absence of the mediastinal left pulmonary artery

Case report: Reconstruction of the long-gap unilateral absence of right pulmonary artery with contralateral pulmonary artery flap and autologous pericardial graft

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