A NEW CONCEPT IN CARDIAC SURGERY: UNIFOCALIZATION

Cevahir HABERAL, * Emin TİRELİ, * Enver DAYIOĞLU, * Ertan ONURSAL

Koşuyolu Kalp ve Araştırma Hastanesi, İSTANBUL
^*İ.Ü. İstanbul Tıp Fakültesi Göğüs, Kalp ve Damar Cerrahisi Anabilim Dalı, İSTANBUL

Pulmonary atresia with ventricular septal defect (VSD) hawing major aortopulmonary collateral arteries is a rare congenital cardiac disease. These cases differ from type IV Truncus arteriosus for having central pulmonary arteries and from pseudotruncus for having MAPCAs and they are classified as VSD+PA+MAPCA in new surgical concept.

Seven VSD+PA+MAPCA cases were admitted to the department of Thoracic and Cardiovascular Surgery, Istanbul Medical Faculty, University of Istanbul. Six cases had hypoplastic confluent pulmonary arteries and 2 cases had no native pulmonary artery. Out of 21 MAPCAs, only 1 MAPCA had a communication with the native pulmonary artery. Five cases had right arcus aorta. Patients had average 3 MAPCAs, ranging between 2, 6. Two cases had right unifocalization through right thoracotomy, 2 cases had left unifokalization through left thoracotomy, 2 cases had bilateral unifokalization through median sternotomy and 2 cases were considered to be inoperable. MAPCAs were unifocalized using polytetrafluoroethylene graft in 1 case and in 7cases, MAPCAs were unifocalized with direct anastomosis. There was no mortality.

Although unifocalization for VSD+PA+MAPCA cases are limited today, we think that staged surgical repairs are suitable for these cases.

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