scholarly journals Bilateral Pulmonary Arteries Reconstruction for Correction of Tetralogy of Fallot with Unilateral Absence of the Pulmonary Artery

2021 ◽  
Author(s):  
Hujun Cui ◽  
Yongchao Yang ◽  
Hailong Qiu ◽  
Jianzheng Cen ◽  
Shusheng Wen ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Tetralogy Of Fallot ◽  
Pulmonary Arteries ◽  
Left Pulmonary Artery ◽  
Autologous Tissue ◽  
One Stage ◽  
Direct Anastomosis ◽  
Pulmonary Artery Reconstruction ◽  
Artery Reconstruction

Background: Tetralogy of Fallot (TOF) is the most common combined the deformity of unilateral absence of the pulmonary artery (UAPA). The treatment strategy of TOF combined with UAPA is still very controversial. In this study, we analyzed the effect of the bilateral pulmonary reconstruction for patients with TOF combined with UAPA. Methods: A single-institution, retrospective review of all 1713 patients with TOF between January 2009 to November 2021. Eight patients were diagnosed with TOF combined with UAPA, and 7 patients underwent the surgery. Three patients 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. One patient underwent 2 procedures of left pulmonary artery reconstruction, and the VSD remained open. Results: All 7 patients survived during the postoperative follow-up and showed good cardiac function and normal oxygen saturation >97%. During the follow-up with echocardiograms, it was found that the left pulmonary arteries that were reconstructed with Goretex vessel or direct anastomosis had thrombosis or stenosis. The left pulmonary artery reconstructed with the modified autologous tissue extension technique was unobstructed. Conclusions: In patients with TOF and UAPA, if there is a pulmonary confluence in the affected hilum, it is feasible to implement bilateral pulmonary artery reconstruction for one-stage TOF correction. The use of pulmonary artery extension technique and autologous tissue to bilateral pulmonary reconstruct could reduce the incidence of anastomotic stenosis.

Intrapulmonary artery septation for unilateral absence of the pulmonary artery

2021 ◽  
pp. 021849232110139
Author(s):  
Junichi Koizumi ◽  
Tomoyuki Iwase ◽  
Shigeto Tsuji ◽  
Takuya Goto ◽  
Kotaro Oyama ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Tetralogy Of Fallot ◽  
Left Pulmonary Artery ◽  
Post Surgery ◽  
Pulmonary Artery Reconstruction ◽  
Artery Reconstruction ◽  
Absent Pulmonary Artery ◽  
Absent Left Pulmonary Artery ◽  
Tetralogy Of Fallot Repair ◽  
Blalock Taussig Shunt

We describe a seven-month-old boy with tetralogy of Fallot and an absent left pulmonary artery. Due to the diminutive size of the left pulmonary artery, we performed a native tissue left pulmonary artery reconstruction and intrapulmonary artery septation procedure with a left modified Blalock-Taussig shunt. After confirming left pulmonary artery growth, the patient underwent tetralogy of Fallot repair, removal of septation patch, and division of the Blalock-Taussig shunt. Nine months post-surgery, we confirmed his balanced lung perfusion (R/L ratio 6:4). The intrapulmonary artery septation procedure would be suitable for both the resuscitation and reconstruction of the hypoplastic absent pulmonary artery.

scholarly journals Tracheal development after left pulmonary artery reimplantation: an individual study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Xiaoyang Hong ◽  
Ruijie Li ◽  
Zhe Zhao ◽  
Jiangheng Guan ◽  
Hui Wang ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Arteries ◽  
Left Pulmonary Artery ◽  
Weaning Failure ◽  
Threatening Condition ◽  
Ventilation Weaning ◽  
Life Threatening ◽  
The Mean ◽  
Tracheal Carina

Abstract Pulmonary artery sling (PA sling) often presents as a life-threatening condition requiring urgent surgical correction. We reported 32 cases of PA sling in children who were followed up postoperatively in the past 6 years. All patients with PA slings who were admitted to the hospital from January 2012 to December 2017 and underwent surgery were retrospectively analyzed. The mean age of the 32 patients at repair was 16.97 months (range, 15 days to 128 months). Six patients required ventilator assistance for respiratory failure. All children underwent left pulmonary artery (LPA) reimplantation (n = 32), and 3 patients needed reimplantation slide tracheoplasty (n = 3) due to ventilation weaning failure. Four patients died, 27 patients survived until discharge, and 18 patients were followed up. Pulmonary computed tomography imaging and echocardiography were performed in 18 patients who were followed up. After LPA reimplantation, the tracheal carina area was significantly enlarged compared to that preoperation (p = 0.0002). In this follow-up cohort study, 75% of the patients who underwent LPA reimplantation survived until discharge. The survivors had subsequently well-developed pulmonary arteries and tracheas.

Primary repair of tetralogy of Fallot in infancy – the effect on growth of the pulmonary arteries and the risk for late reinterventions

2001 ◽  
Vol 11 (4) ◽  
pp. 391-398 ◽  
Author(s):  
Renate Kaulitz ◽  
Christian Jux ◽  
Harald Bertram ◽  
Thomas Paul ◽  
Gerhard Ziemer ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Tetralogy Of Fallot ◽  
Pulmonary Valve ◽  
Primary Repair ◽  
Pulmonary Arteries ◽  
Arterial System ◽  
Asymptomatic Patients ◽  
The Right ◽  
Normal Controls

We sought to analyse the long-term follow-up after primary repair of tetralogy of Fallot in infancy in the first year of life, paying particular attention to growth of the pulmonary arteries and the need for reintervention. We performed a combined retro- and prospective echocardiographic study, including measurements of the pulmonary valve and right and left pulmonary arteries, indexed to the square root of body surface area, in 62 patients prior to primary repair, 18 to 24 months after this event, and at the most recent follow-up, with a mean of 80.4 ± 24 months. Of these, 38 patients, with an age at operation of 5.0 ± 3.4 months, had presented preoperatively with hypoxic spells or increasing cyanosis. The remaining 24 patients had been asymptomatic, with adequate flow of blood to the lungs. Their age at elective operation was 7.4 ± 3.0 months. A transannular patch was needed in 37 patients (63%). There were 3 early postoperative deaths (4.8%).Cross-sectional echocardiography revealed a significantly smaller diameter for the pulmonary valve in patients who had been symptomatic preoperatively compared to the asymptomatic patients (1.09 versus 1.3 cm/BSA0.5; p = 0.019). The diameters of the right and left pulmonary arteries did not differ significantly between the groups. Examination of echocardiographic data obtained 18 to 24 months postoperatively in 43 patients revealed a significant increase in the diameter of the pulmonary arteries; 0.83 ± 0.17 cm/BSA0.5 versus 1.1 ± 0.26 cm/BSA0.5 for the diameter of the right pulmonary artery, 0.85 ± 0.2 cm/BSA0.5 versus 1.0 ± 0.25 cm/BSA0.5 for the left pulmonary artery. On comparison between individuals, 18.6% and 25.6% of the patients, respectively, did not show any change in the diameters of their right and left pulmonary arteries, whereas the increase in diameter reached or exceeded the measurements in normal controls in 55.8% and 46.5% of the patients, respectively. On recent follow-up, with a range from 56 to 147 months, no further increase in the indexed diameters of the pulmonaries could be documented in 21 of 33 patients. Of these, 9.1% and 18.2%, respectively, presented with small right and left pulmonary arteries compared with measurements obtained in normal controls. Moderate pulmonary incompetence was found on colour flow mapping in one-third. Of 56 longterm survivors, 8 (14%) had required reinterventions, which were surgical in 6 and achieved by transcatheter techniques in the other 2 patients. Thus, primary correction of tetralogy of Fallot in infancy, with restoration of normal pressures and flows, resulted in sustained increase in the diameters of the right and left pulmonary arteries. It allowed for early normal development of the proximal pulmonary arterial system in most patients regardless of their age and symptomatic status at operation. Patients with persistent subnormal diameter of the pulmonary arteries did not present with significantly elevated right ventricular pressure. Early one-stage repair of tetralogy of Fallot in infancy was associated with a low rate of reinterventions.

Arterial Duct Closure with Detachable Coils: Application in the Small Child

2002 ◽  
Vol 10 (2) ◽  
pp. 124-128 ◽  
Author(s):  
Ümrah Aydoğan
Keyword(s):  
Pulmonary Artery ◽  
Flow Velocity ◽  
Ductus Arteriosus ◽  
Main Pulmonary Artery ◽  
Pulmonary Arteries ◽  
Left Pulmonary Artery ◽  
Small Child ◽  
Coil Occlusion ◽  
Detachable Coils

Transcatheter closure of patent ductus arteriosus using controlled-release coils was performed in 16 patients weighing < 10 kg. No embolization occurred. Procedure-related complications occurred in 3 patients (18.8%): massive femoral hemorrhage in 1 and femoral artery thrombosis in 2. The ductus recanalized in 1 of them because of mechanical hemolysis caused by streptokinase treatment. This was the only patient who underwent another occlusion procedure. Complete occlusion was achieved in 7 patients (43.8%) immediately, in 13 (81.2%) the following day, and in all 15 patients who had completed the 6-month follow-up. During follow-up, flow velocities between the left and the main pulmonary arteries and between the descending and the ascending aortae did not differ significantly. Flow velocity was > 2 m·sec−1 in 3 patients in the left pulmonary artery and in 1 in the descending aorta. Protrusion of the coil was seen in 3 of these patients. Flow velocity was also high in the main pulmonary artery in the 4th patient. In conclusion, coil occlusion of ductus arteriosus is feasible in the small child, but no more than half a loop of the coil should be left at the pulmonary site. High flow velocity does not always mean obstruction.

scholarly journals Hidden pulmonary arteries in tetralogy of Fallot and pulmonary artery pressure in patients operated with a pulmonary artery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mohammadreza Edraki ◽  
Bahram Ghasemzadeh ◽  
Kambiz Keshavarz ◽  
Ahmadali Amirghofran ◽  
Hamid Mohammadi ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Tetralogy Of Fallot ◽  
Pulmonary Vein ◽  
Ductus Arteriosus ◽  
Pulmonary Arteries ◽  
Left Pulmonary Artery ◽  
Pulmonary Artery Hypertension ◽  
Surgical Correction ◽  
Right Pulmonary Artery ◽  
The Right

Abstract Introduction The absence of a pulmonary artery is a rare congenital anomaly that occurs isolated or with other congenital cardiac disorders, particularly tetralogy of Fallot (TOF); meanwhile, a hidden pulmonary artery might exist and originate from a closed ductus arteriosus (DA), which can be stented to reach the artery. Material and methods This prospective study describes cardiac catheterization of nine TOF patients diagnosed with the absence of the left pulmonary artery before the operation. The patients were stratified into three groups: group one, whose closed DA was found and connected to the hidden pulmonary artery with a stent; group two, whose hidden pulmonary arteries were found via the pulmonary vein angiography; and group three, for whom we could not find the remnant of the DA, or our attempt to stent the DA to the hidden pulmonary artery was not successful. We also evaluated outcomes of six other surgically-corrected TOF patients who were operated with the absent left pulmonary artery. Results The first group included the patients aged 1, 24, and 30 months, whose CT angiography 6–9 months after stenting showed acceptable left pulmonary artery diameter for surgical correction, and the pulmonary vein angiography of the second group showed a hidden left pulmonary artery with a suitable diameter for surgical correction. However, we were unable to find or stent the DA of group three patients, aged 12, 38, 60, and 63 months. Earlier Angiography might have increased the chance of access to the hidden vessel. Apart from these three groups, follow-ups of six other patients previously corrected with only the right pulmonary artery revealed pulmonary artery hypertension in all patients. Conclusion The concealed pulmonary artery might be found, and stenting of the closed DA to it might be performed to improve the diameter of the diminutive pulmonary artery. This procedure may allow TOF total surgical correction with two pulmonary arteries. Besides, pulmonary vein angiography can reveal the hidden pulmonary artery.

scholarly journals Existence of Hidden Pulmonary Arteries in Tetralogy of Fallot and pulmonary artery hypertension in patients Operated with one Pulmonary Artery

2020 ◽  
Author(s):  
Mohammadreza Edraki ◽  
Bahram Ghasemzadeh ◽  
Kambiz Keshavarz ◽  
Ahmadali Amirghofran ◽  
Hamid Mohammadi ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Tetralogy Of Fallot ◽  
Pulmonary Vein ◽  
Ductus Arteriosus ◽  
Pulmonary Arteries ◽  
Left Pulmonary Artery ◽  
Pulmonary Artery Hypertension ◽  
Surgical Correction ◽  
Right Pulmonary Artery ◽  
The Right

Abstract Introduction: The absence of a pulmonary artery is a rare congenital anomaly that occurs isolated or with other congenital cardiac disorders, particularly tetralogy of Fallot (TOF); meanwhile, a hidden pulmonary artery might exist and originate from a closed ductus arteriosus (DA), which can be stented to reach the artery.Material and methods: This prospective study describes cardiac catheterization of nine TOF patients diagnosed with the absence of the left pulmonary artery before the operation. The patients were stratified into three groups: group one, whose closed DA was found and connected to the hidden pulmonary artery with a stent; group two, whose hidden pulmonary arteries were found via the pulmonary vein angiography; and group three, for whom we could not find the remnant of the DA, or our attempt to stent the DA to the hidden pulmonary artery was not successful.We also evaluated outcomes of six other surgically-corrected TOF patients who were operated with the absent left pulmonary artery.Results: The first group included the patients aged 1, 24, and 30 months, whose CT angiography 6-9 months after stenting showed acceptable left pulmonary artery diameter for surgical correction, and the pulmonary vein angiography of the second group showed a hidden left pulmonary artery with a suitable diameter for surgical correction.However, we were unable to find or stent the DA of group three patients, aged 12, 38, 60, and 63 months. Earlier Angiography might have increased the chance of access to the hidden vessel. Apart from these three groups, follow-ups of six other patients previously corrected with only the right pulmonary artery revealed pulmonary artery hypertension in all patients.Conclusion: The concealed pulmonary artery might be found, and stenting of the closed DA to it might be performed to improve the diameter of the diminutive pulmonary artery. This procedure may allow TOF total surgical correction with two pulmonary arteries. Besides, pulmonary vein angiography can reveal the hidden pulmonary artery.

scholarly journals Hidden Pulmonary Arteries in Tetralogy of Fallot and Pulmonary Artery Pressure in Patients Operated with a Pulmonary Artery

2020 ◽  
Author(s):  
Mohammadreza Edraki ◽  
Bahram Ghasemzadeh ◽  
Kambiz Keshavarz ◽  
Ahmadali Amirghofran ◽  
Hamid Mohammadi ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Tetralogy Of Fallot ◽  
Pulmonary Vein ◽  
Ductus Arteriosus ◽  
Pulmonary Arteries ◽  
Left Pulmonary Artery ◽  
Pulmonary Artery Hypertension ◽  
The Other ◽  
Right Pulmonary Artery ◽  
Cardiac Disorders

Abstract Introduction: The absence of a pulmonary artery is a rare congenital anomaly that occurs on its own or with some congenital cardiac disorders, particularly tetralogy of Fallot (TOF), while the hidden pulmonary artery might originate from a closed ductus arteriosus (DA) that can be stented to reach the artery.Material and methods: This prospective study describes cardiac catheterization of our nine TOF patients who had the absence of the left pulmonary artery before the operation. The patients were stratified in three groups: group one, whose closed DA were found and stented successfully to the hidden pulmonary artery; group two, whose hidden pulmonary arteries were found via the pulmonary vein angiography; and group three, for whom we could not find the remnant of the DA, or our attempt to stent the DA to the hidden pulmonary artery was not successful.We also evaluated outcomes of the other surgically-corrected TOF patients who were operated with the absent left pulmonary artery.Results: The first group included patients aged 1, 24, and 30 months, whose CT angiography 6-9 months after stenting showed acceptable left pulmonary artery diameter for surgically correction, while the pulmonary vein angiography of the group two patients showed a hidden left pulmonary artery with a suitable diameter for surgical correction.However, we were unable to find or stent the DA of the group three patients, aged 12, 38, 60, and 63 months. Moreover, evaluation of the other six previously corrected patients who were operated with a right pulmonary artery revealed pulmonary artery hypertension of the entire patients.Conclusion: The concealed pulmonary artery might be found, and stenting of the closed DA to it might be performed to improve the diameter of the diminutive pulmonary artery. This procedure may allow TOF total surgical correction with two pulmonary arteries. Besides, pulmonary vein angiography can reveal the hidden pulmonary artery.

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