The cause of kinking of the right pulmonary artery in the Waterston anastomosis. A growth phenomenon.

The case is presented of an infant, referred at the age of 8 hours, who underwent a Waterston anastomosis for pulmonary atresia with intact ventricular septum and a hypoplastic right ventricle. Angiographic studies performed 3 days and 12 months after the Waterston anastomosis clearly demonstrated that kinking was not present soon after the operation but developed later. Kinking of the right pulmonary artery is a widely recognized complication of the Waterston anastomosis. Data from other workers show that severe kinking occurs more frequently in infants operated during the first year of life than in those treated after 1 year of age. These data and the case herein presented support the hypothesis that the kinking occurring after the Waterston anastomosis develops because of growth and realignment of the great arteries. Because of this and other problems encountered after the Waterston anastomosis, it is recommended that either primary correction or, in case of an uncorrectable cardiac defect, a Blalock-Taussig shunt should be performed.