The double shunt technique as a bridge to heart transplantation in a patient with pulmonary atresia with intact septum and right ventricular-dependent coronary circulation

Commentary: Another way to skin a rare and dangerous cat

“…In the present report, Said and colleagues 7 described, in a similar patient, modifications of this approach, which provided bridge to transplant, albeit not without interval complications (2 separate courses of extracorporeal membrane oxygenation). Their modifications included anastomosis of the ARVS to the tricuspid annulus (after valvectomy) via the right atrium, and employment of allograft saphenous vein as conduits for both the ARVS and the SPS.…”

Impact of decompression of the right ventricle on the sinusoidal communications in pulmonary atresia and intact ventricular septum

“…For patients with RVDCC with total coronary atresia with progressive myocardial ischemia, that is, ST change with or without hemodynamic instability and arrhythmia, aortic to RV shunt has been previously described. 31,32 intervention. Aortic to RV shunt with either direct anastomosis to RV 31 or anastomosis to tricuspid valve 32 prevents coronary ischemia and works as a bridge to heart transplantation or the Fontan pathway.…”

“…31,32 intervention. Aortic to RV shunt with either direct anastomosis to RV 31 or anastomosis to tricuspid valve 32 prevents coronary ischemia and works as a bridge to heart transplantation or the Fontan pathway. For those without any evidence of myocardial ischemia, even RVDCC with total coronary atresia, the indication for aortic to RV shunt is not well discussed.…”

Commentary: Despite best intentions: Developing better strategies for patients with pulmonary atresia with intact ventricular septum

“…For patients with ongoing risk of myocardial ischemia or infarction, the use of ventricular assist devices has also been described, 4,5 as well as the use of aorto-RV shunts. 6 Larger multi-institutional studies are required to delineate the influence of aortocoronary connections, coronary anatomy considerations, and thresholds of myocardium at risk to aid clinical decision making in this high-risk cohort.…”