One-Stage Correction of Tetralogy of Fallot, Pulmonary Atresia and Major Aortopulmonary Collateral Artery Associated with Aortopulmonary Window

(Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan)

Yuka Okubo Masashi Takahashi Shuichi Shiraishi
Maya Watanabe Masanori Tsuchida
A 4-year-old boy was born with cyanosis and was given a diagnosis of tetralogy of Fallot and pulmonary atresia. Echocardiography showed membranous atresia of the pulmonary trunk that was connected to the left side of the ascending aorta via an aortopulmonary window 3 mm in diameter. Four major aortopulmonary collateral arteries(MAPCAs)were detected by cardiac catheterization and computed tomography angiography prior to undergoing surgery at 4 years of age. We performed one-stage complete unifocalization and definitive repair via a median sternotomy. The MAPCA supplying the left lower lobe was anastomosed to the true left pulmonary artery and the pulmonary artery trunk was augmented with an autologous pericardium patch. We then reconstructed the right ventricular outflow tract using a transannular patch and simultaneously patch-closed the VSD. The right/left ventricle pressure ratio after weaning from cardiopulmonary bypass was 0.8. The postoperative course was uneventful and the patient was discharged 26 days later. Seven months after the procedure, the right/left ventricle pressure ratio was decreased to 0.56 on cardiac catheterization.
  Jpn. J. Cardiovasc. Surg. 42:297-301(2013)

Keywords:aortopulmonary window, tetralogy of Fallot, major aortopulmonary collaterals