Relief of airway compression by enlarged pulmonary artery--modified palliative suspension of the artery after plication.

A new modification of the technique for plication and suspension of the pulmonary artery in critically ill infants and children is described. The technique consists of (1) left lobe thymectomy, (2) insertion of a polytetrafluoroethylene sheet to provide complete coverage of pericardium, (3) plication of dilated pulmonary artery and (4) suspension of plicated pulmonary artery to the left side of the anterior chest wall. We employed this technique in 7 patients with respiratory distress due to tracheal and/or broncheal compression with massive left-to-right shunt (5 patients) and with absent pulmonary valve (2 patients). Five of these patients (71%) could be weaned from the respirator in the postoperative phase with this surgery. Although this procedure is palliative, this simple technique might be one of the choices for critically ill infants and children.