Hyungtae Kim1, Si Chan Sung2, Yun Hee Chang3, Hyoung Doo Lee4, Ji Ae Park4. 1. Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Gyeongsangnam-do, Republic of Korea. 2. Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Gyeongsangnam-do, Republic of Korea. Electronic address: scsung21@hanmail.net. 3. Department of Thoracic and Cardiovascular Surgery, Catholic University St Mary's Hospital, Seoul, Republic of Korea. 4. Department of Pediatrics, Pusan National University Yangsan Hospital, Gyeongsangnam-do, Republic of Korea.
Abstract
OBJECTIVES: Postoperative left pulmonary artery (LPA) kinking is problematic in repair of tetralogy of Fallot (TOF). We used angioplasty of the proximal LPA with an anterior wall flap of the main pulmonary artery (MPA) to prevent this problem. METHODS: We have used an anterior wall of the MPA as a flap for LPA angioplasty in 42 patients with TOF and pulmonary stenosis (26 males and 16 females) since February 2007. During the same period, 116 patients underwent total repair of TOF with pulmonary stenosis. The median age was 7.1 months (range, 3-88.8), and the median weight was 8.4 kg (range, 5-27). The indications for LPA angioplasty were acute-angle proximal LPA in 17 (40.5%), proximal LPA stenosis in 6 (14.3%), acute-angle and stenotic proximal LPA in 18 (43%), and short and small distal MPA in 1 patient. The patches used for MPA and LPA reconstruction were glutaraldehyde-treated autologous pericardium in 34 and bovine pericardium in 8 patients. RESULTS: No operative or late death occurred. The mean follow-up duration after surgery was 26.4 ± 18.6 months (range, 0.5-67). During the follow-up period, reoperation for LPA stenosis or kinking was not required in any patient; however, balloon angioplasty was performed with good results in 4 patients (9.5%). No postoperative kinking of the proximal LPA occurred. Echocardiography or computed tomography angiography at the recent follow-up visit demonstrated good branch pulmonary arteries in all patients. CONCLUSIONS: Angioplasty of the proximal LPA using an anterior wall flap of the MPA in the patients with TOF and pulmonary stenosis is an effective method in the management of acute angle and/or stenosis of LPA without postoperative kinking.
OBJECTIVES:Postoperative left pulmonary artery (LPA) kinking is problematic in repair of tetralogy of Fallot (TOF). We used angioplasty of the proximal LPA with an anterior wall flap of the main pulmonary artery (MPA) to prevent this problem. METHODS: We have used an anterior wall of the MPA as a flap for LPA angioplasty in 42 patients with TOF and pulmonary stenosis (26 males and 16 females) since February 2007. During the same period, 116 patients underwent total repair of TOF with pulmonary stenosis. The median age was 7.1 months (range, 3-88.8), and the median weight was 8.4 kg (range, 5-27). The indications for LPA angioplasty were acute-angle proximal LPA in 17 (40.5%), proximal LPA stenosis in 6 (14.3%), acute-angle and stenotic proximal LPA in 18 (43%), and short and small distal MPA in 1 patient. The patches used for MPA and LPA reconstruction were glutaraldehyde-treated autologous pericardium in 34 and bovine pericardium in 8 patients. RESULTS: No operative or late death occurred. The mean follow-up duration after surgery was 26.4 ± 18.6 months (range, 0.5-67). During the follow-up period, reoperation for LPA stenosis or kinking was not required in any patient; however, balloon angioplasty was performed with good results in 4 patients (9.5%). No postoperative kinking of the proximal LPA occurred. Echocardiography or computed tomography angiography at the recent follow-up visit demonstrated good branch pulmonary arteries in all patients. CONCLUSIONS: Angioplasty of the proximal LPA using an anterior wall flap of the MPA in the patients with TOF and pulmonary stenosis is an effective method in the management of acute angle and/or stenosis of LPA without postoperative kinking.