Surgery: Pulmonary atresia - VSD, MAPCAs, Unifocalization

Staged repair of tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries. Duncan, BW., Mee, RBB, et al. JTCVS 2003;126:694-702.

Bill Brawn group: JTCVS 2004;127:251-8
Treatment algorithm:

Survival after first surgery:

Freedom from reintervention (surgery or cath) after complete repair:

Frank Hanley group re: Surgical creation of "A-P window"
Rodefeld, MD. et al. JTCVS 2002;123:1147-54.
Selection criteria for surgical creation of A-P window:
1) Presence of centrally confluent pulmonary arteries (1 - 2.5 mm in diameter with well-developed peripheral arborization)
2) Multiple, hypoplastic AP collaterals that communicated with true pulmonary artery system
3) Presence of marked cyanosis
Avoid this procedure in the following situations:
1) High flow from MAPCAs
2) Isolated supply from MAPCAs (indicates native PAs do not have good peripheral arborization...to stand the high flow-high pressure from aorta)
3) Native PAs > 2.5 mm and
4) non-confluent native PAs.

Frank Hanley group: (Circulation 2000)
V. Mohan Reddy et al. Circulation 2000;101:1826-32
Early and Intermediate outcomes after repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries.
Treatment algorithm

Also see:

Journal Club: PA-VSD, MAPCAs, Unifocalization


Preop Evaluation of PAs in PA-VSD

No comments: