Persistent stenosis and deformity of the right pulmonary artery after correction of the Waterston anastomosis.

Between July, 1975, and July, 1979, 16 patients with cyanotic heart disease and previously constructed ascending aorta-right pulmonary artery (AA-RPA) shunts underwent subsequent operations. Fourteen of the 16 had significant physiological and anatomic problems associated with the shunts. Eight had kinking and preferential flow to the right pulmonary artery (RPA), four had preferential flow without kinking, and two had small pulmonary arteries bilaterally. Various techniques were used to close the RPA after Waterston takedown: direct suture in four, pericardial patch in five, prosthetic patch in four, and conduit in three. Five patients required reoperation 3 months to 3 years after Waterston dismantling because of persistent deformity of the RPA. Four patients had pericardial patch reconstruction of the RPA and one had direct closure of the opening in the RPA when the Waterston shunt was dismantled. All five patients received prosthetic patch enlargment of the RPA either alone or with a conduit. The four surviving patients are doing well 7 to 15 months following repair. Three have been studied angiographically and have been found to have no pulmonary artery deformity.