One-stage Midline Unifocalization with Complete Repair of Pulmonary Atresia, VSD and MAPCA's.mov (1.18 GB)

One-Stage Midline Unifocalization With Complete Repair of Pulmonary Atresia, Ventricular Septal Defect, and Major Aortopulmonary Collaterals

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posted on 2020-06-29, 21:02 authored by Gamal Marey, Gustavo Orellana, Sameh M. Said

The patient was a 5-month-old, 4.7 kg Infant with pulmonary atresia, ventricular septal defect (VSD), and absent native intra-pericardial pulmonary arteries. All bronchopulmonary segments were supplied by four large major aortopulmonary collaterals (MAPCA). Associated defects were severe ascending aorta dilation, mild bicuspid aortic valve stenosis, right aortic arch with mirror image branching, and multiple thoracic hemivertebral anomalies.

Preoperative evaluation included transthoracic echocardiography, cardiac computed tomography (CT) scan, and cardiac catheterization to demonstrate her complete anatomy. Through a median sternotomy, complete unifocalization of all MAPCAs were performed followed by completion of the repair with patch closure of the ventricular septal defect, suture closure of the patent foramen ovale, and establishment of right ventricular to neopulmonary confluence using a decllularized valved aortic homograft. She remained in normal sinus rhythm and was weaned off cardiopulmonary bypass without difficulty. She was extubated on postoperative day two and required a subxiphoid pericardial window for drainage of pericardial effusion. She was dismissed a month later on aspirin.

Follow-up echocardiography showed good biventricular function, widely patent biventricular outflow tracts, tiny residual ventricular level shunt, and good flow in the pulmonary conduit and main branches. CT scan showed the reconstructed pulmonary vascular bed. Her right ventricular pressure was 40% of the systemic blood pressure. She continued to do well at her last follow-up.


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