ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Modified aortopulmonary window technique for the first-stage treatment of patients with pulmonary atresia
Murat Uğurlucan 1, Ömer Ali Sayın 1, Tarhan Çınar 1, Kemal Nişli2 Ümrah Aydoğan, Emin Tireli 1, Enver Dayıoğlu1
1İstanbul Üniversitesi İstanbul Tıp Fakültesi, 1Kalp ve Damar Cerrahisi Anabilim Dalı, İstanbul
2İstanbul Üniversitesi İstanbul Tıp Fakültesi,Pediatrik Kardiyoloji Anabilim Dalı, İstanbul
Background: Palliative shunt operations represent the initial stage of treatment for patients with pulmonary atresia and hypoplastic pulmonary arteries. Among various shunt models, one is placed between the ascending aorta and the pulmonary artery using a polytetrafluoroethylene (ePTFE) graft. In this study, we presented a modification of this technique performed at our institution, which is a kind of modified aortopulmonary window creation.

Methods: Four newborns (2 boys, 2 girls; mean age 8.5 days; range 1 to 15 days) with pulmonary atresia and associated cardiac pathologies underwent a modified central shunt operation between the ascending aorta and the main pulmonary artery using an ePTFE graft. All the patients had hypoplastic pulmonary arteries whose diameters ranged between 1 and 2 millimeters. The graft was anastomosed end-to-end to the main pulmonary artery following total transection from the right ventricle, and its proximal end was anastomosed side-to-side to the ascending aorta. The proximal open end of the graft was sutured primarily.

Results: Following the operation, diastolic blood pressure decreased by 3 mmHg to 6 mmHg and arterial oxygen saturation increased by 5% to 10%. One patient died in the early postoperative period due to a noncardiac and nonsurgical cause. The remaining patients were discharged after 8 to 12 days without any surgical complications and were monitored with periodic echocardiographic controls for one to four months. Total correction was planned when the pulmonary arteries reached sufficient growth.

Conclusion: Considering the potential risks of the classical aortopulmonary window method and central shunt operations with graft use, our modified aortopulmonary window technique prevents overflow to the pulmonary circulation and minimizes arterial distortion.

Keywords : Cardiovascular surgical procedures/methods; pulmonary artery/surgery; pulmonary atresia/surgery; pulmonary circulation
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