Operative treatment of tetralogy of Fallot with concomitant correction of anomalous origin of the left pulmonary artery from Kommerell’s diverticulum

Abstract

Anomalies in development of the pulmonary valve, pulmonary trunk and peripheral pulmonary arteries are typical accompanying pathologies in patients with tetralogy of Fallot (ToF). Demanding for diagnostics and borderline for treatment is a condition colloquially called “discontinuous pulmonary arteries”, while the main branches are supplied with systemic blood from the ascending aorta, aortic arch or descending thoracic aorta.We present a case of a one-year-old girl with ToF and anomalous origin of the left pulmonary artery (LPA) from Kommerell's diverticulum who underwent two-stage surgical therapy with the support of interventional cardiology.We conclude that early diagnosis of discontinuous pulmonary artery is crucial for choosing the optimal operative strategy. In our opinion, simultaneous anatomic intracardiac correction with direct pulmonary reconstruction seems reasonable and effective, particularly when the result is achieved after joint efforts of cardiac surgery and interventional cardiology.

Staged interventional and surgical treatment of tetralogy of Fallot with critical stenosis of proximal aortic arch in premature hypotrophic newborn

“…In the present case, an adequate shunt flow did not protect the baby from cyanotic spells, which could be related to additional comorbidities (prematurity, low gestational age, bronchopulmonary dysplasia, low body weight) [ 5 ].…”

Alternative hybrid and staged interventional treatment of congenital heart defects in critically ill children with complex and non-cardiac problems.

“…The anomalous origin of the pulmonary artery branch needs to be anatomically corrected upon surgical intracardiac repair of ToF, while initial cardiology interventional treatment could be beneficial with the aim of recruiting (direct stenting), or widening (balloon angioplasty) pulmonary arteries. We used the percutaneous technique to widen an anomalous pulmonary artery origin, narrowed LPA from the aorta, and for direct stenting of the Kommerell's diverticulum that gave rise to the LPA [ 16 ]. We preferred percutaneous stent deployment in contrast to the report of Menon and co-workers, who implanted intraoperatively 27 stents in 24 patients, medium age 15 years, who were initially treated because of pulmonary atresia (PA – 9 cases) and ToF (7 cases) [ 17 ].…”