![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgraG56oRzLNOAW0bSWcGNilKFn5AWuOX4tpCzCD2J560PZR-2qbHZrW-hyTQtGNTIVsYuPbVvhDKjuArYRnZYTjzlVGZ6JU34A64J3Ur2KxgZx0mflzXoOmdlmdSofzbiBYVhuXw/s400/DuncanMeeShuntFig.gif)
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHrHvoO_88FfrFIF5yhuXHSeOtJW26HBWhhrCRL4D2PXwV26QA_QEP3ARmMAuHlr9TBp-YdZTzehC7QbppxhfZXQnKmT_VKa_qvazVDL7WPL8SEEtqrhaUfizSdTBEd9prw5Ueow/s400/DuncanMeeTreatmentAlgori1Fig.gif)
Treatment algorithm:
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbb4AsLzzGy_PDN2IRenz6wOHrFBfBEDmnMtPH9o9CAxt-sbRD0bcRluFcndgQ68P00U-6hzXI5Xe1yfHRp7OZxC4oYJYNnSnMPt-8Ku4uOOxjhZd1VvXuF4ZeVZcRMtZI-cYfWw/s400/BrawnPA-VSDTreatmentAlgoriJTCS2004.gif)
Survival after first surgery:
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjXmfau5-VjRcvKV6ov1CYqDwnGp8du3dfMTVrW0dLlExrrD4aUGgMoMAYpjcXIK2AYAcuKPEYRQk37N1f26iWL_NFKpN500PmOtZTiOXdr272uVxWJtHFl3fwDaeOyYFguK3roVg/s400/BrawnPA-VSDsurvivalAfterFirstOpPerNPAmorphoJTCVS2004.gif)
Freedom from reintervention (surgery or cath) after complete repair:
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0JhTpTftXQLRwcOl7Cn_hh-jzMcRhemWH9zrZTTQ6gEHMQFJsF6JqBfY7alQsSquCs8afzMWL7OV7DkX82phZ5bYFG3XPxNFFYTOW1hd4QU9LX6W3rP70UuzNnGDd3InxCkkQYQ/s400/BrawnPA-VSDfreedomFromCathIntervPerNPAanatJTCVS2004.gif)
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.![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEge5fWDjsBQ_EgDZ7UBtJLEt_Fq0mSHh2dFDFlLatUlikojq0OlpkF7xwRJpzVuxFiF5Yi9vOZpDxN0QRR0POyQ09uwXb-7xizWqAojvakX4CHDxV8ELWlq8420dLjktr1rMDYehQ/s400/PA-VSDCreationAPwindowHanleyfig1.gif)
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7QYN0SCRWtgrrnsL5KiIjyLr-a0XdyvNAdtCuzLWHzudAfePc7qb1-aDDNojN1P1fqFEMJtaxnGddV4nbejvRby-1gKViQfVqF3Cbh6Lb8zaOwtCp4ssjjgtnT23luBR93OXanA/s400/PA-VSDCreationAPwindowHanleyfig2.gif)
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfgYRq1kZnaFCYlprFZnpoXaDidqQ6ZeMpctVQzBGSQ2x1wCRscvpDTYisjs8C3Gwu813oj1DEERa7bG7OCG_wcxA4VgZZRyO8vqwAKAf9Zqpu45Td8K8krxrrYf1-iY0MYTkMjA/s400/PA-VSDCreationAPwindowHanleyfig3.gif)
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifLVCYh-PsnDA7F-k7z-NulmqQcaIom7TZOKOJupw4iwj800R3nXqJcT2YybnfV2HfHg6dg6Y2TO7F4ytDFHsToQ_rrTuE1Z8BfB7_5qUkf1xLlXPkCgPVbqzj-xTg1ElaQnc23A/s400/PA-VSDCreationAPwindowHanleyfig4.gif)
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEge5fWDjsBQ_EgDZ7UBtJLEt_Fq0mSHh2dFDFlLatUlikojq0OlpkF7xwRJpzVuxFiF5Yi9vOZpDxN0QRR0POyQ09uwXb-7xizWqAojvakX4CHDxV8ELWlq8420dLjktr1rMDYehQ/s400/PA-VSDCreationAPwindowHanleyfig1.gif)
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7QYN0SCRWtgrrnsL5KiIjyLr-a0XdyvNAdtCuzLWHzudAfePc7qb1-aDDNojN1P1fqFEMJtaxnGddV4nbejvRby-1gKViQfVqF3Cbh6Lb8zaOwtCp4ssjjgtnT23luBR93OXanA/s400/PA-VSDCreationAPwindowHanleyfig2.gif)
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfgYRq1kZnaFCYlprFZnpoXaDidqQ6ZeMpctVQzBGSQ2x1wCRscvpDTYisjs8C3Gwu813oj1DEERa7bG7OCG_wcxA4VgZZRyO8vqwAKAf9Zqpu45Td8K8krxrrYf1-iY0MYTkMjA/s400/PA-VSDCreationAPwindowHanleyfig3.gif)
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifLVCYh-PsnDA7F-k7z-NulmqQcaIom7TZOKOJupw4iwj800R3nXqJcT2YybnfV2HfHg6dg6Y2TO7F4ytDFHsToQ_rrTuE1Z8BfB7_5qUkf1xLlXPkCgPVbqzj-xTg1ElaQnc23A/s400/PA-VSDCreationAPwindowHanleyfig4.gif)
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:
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