Challenging Pulmonary Arterial Reconstruction: Pulmonary Arterioplasty Post-Arterial Switch

This case involves a ten-month-old infant who underwent an arterial switch as a neonate for transposition of the great arteries. He went on to develop progressive severe branch pulmonary artery stenoses and hypoplasia in addition to supravalvular main pulmonary artery stenosis. This resulted in systemic or suprasystemic right ventricular pressure on his cardiac catheterization.

A repeat median sternotomy was performed and cardiopulmonary bypass was initiated via central aortic and right atrial cannulation. The procedure was performed on a beating heart and at normothermia.

Multiple decellularized pulmonary homograft patches were used to augment the left and right main branch pulmonary arteries down to their lobar branches. Two of sinuses of Valsalva of the pulmonary root were augmented as well in the same fashion. Repeat direct right ventricular pressure measurement showed a near normal right ventricular pressure.

The patient was weaned off cardiopulmonary bypass without difficulty and he was extubated in the operating room. He received no transfusions and was discharged on the sixth postoperative day.

He continued to do well during his follow-up and a repeat CT scan showed widely patent right ventricular outflow tract and pulmonary arteries.

Reference(s)

1. Sobczak-Budlewska K, Łubisz M, Moll M, Moszura T, Moll JA, Korabiewska-Pluta S, Moll JJ, Michalak KW. 30 years' experience with the arterial switch operation: risk of pulmonary stenosis and its impact on post-operative prognosis. Cardiol Young. 2022 Aug 30:1-6

2. Martens T, Claeys G, De Groote J, Kanakis M, Kostolny M, Tsang V, Hughes M. Quantification of Pulmonary Artery Configuration after the Arterial Switch Operation: A Pilot Study. Diagnostics (Basel). 2022 Oct 30;12(11):2629