CARDIOVASCULAR ENGINEERING Journal for Extracorporeal Circulation, Assist Devices,Transplantation and Artificial Organs
	Volume 4, 1999, No 1

The Effect of a Central Aortopulmonary Shunt in Staged Repair of Pulmonary Atresia, Ventricular Septal Defect and Systemic-Pulmonary Collateral Arteries
P. L. de Jong, P. C. van de Woestijne, M. Witsenburg, A. J. J. C. Bogers

Background: In pulmonary atresia (PA) with ventricular septal defect (VSD) and systemic-pulmonary collateral arteries (SPCA) unifocalization and adequate size of confluent pulmonary arteries are a prerequisite for repair. In this regard we report our results of a direct central aortopulmonary shunt on pulmonary artery size and the need for further interventions.

Methods: In 6 patients with a mean age of 15 months (range 1-39) a direct anastomosis of the central pulmonary artery was made to the ascending aorta. Angiographies were made preoperatively and after a mean of 11 months (range 7-17) follow up.

Results: The preoperative Nakata index was 72 mm2/m2 (range 21-143). The follow up Nakata index was 135 mm2/m2 (range 72-250). In all 6 patients further surgical incorporation of SPCAs by lateral thoracotomies was necessary. One patient is awaiting final correction. One patient is not further correctable. In the other 4 patients further augmentation of the confluent pulmonary arteries was necessary during repair. Repair was successful in 3 patients, 1 patient needed a takedown.

Conclusion: A direct central aortopulmonary shunt as a first step in staged repair of PA, VSD and SPCAs results only in a limited increase in pulmonary artery size. It does not preclude the need for further unifocalization and central augmentation of the pulmonary arteries to allow final repair.

Key words: pulmonary atresia, ventricular septal defect, systemic-pulmonary collateral arteries, central aortopulmonary shunt, unifocalization

Address for Correspondence:
Peter L. de Jong, M.D.
Department of Cardiothoracic Surgery
University Hospital Rotterdam
PO box 2040
NL-3000 CA Rotterdam
The Netherlands
E-mail: klomp@thch.azr.nl

Reference:
(CVE. 1999; 4 (1): 27-29)

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