Successful Staged Repair of an Anomalous Origin of the Right Pulmonary Artery from the Ascending Aorta / 日本心臓血管外科学会雑誌

We report a successful staged repair of anomalous origin of right pulmonary artery from the ascending aorta in a neonate. A two-day-old girl, who suffered from severe circulatory failure, was admitted. In spite of all medical treatment, acidosis and systemic hypotension developed. Right pulmonary artery banding was performed in an emergency procedure, resulting in immediate elevation of systemic blood pressure. Definitive operation was subsequently performed on the 48th day after birth. The right pulmonary artery, which was de-banded and divided from aorta, was anastomosed directly to the pulmonary trunk in a side-to-end manner. The postoperative course was uneventful and the pulmonary artery pressure was within the normal range.

The Cases of Total Correction for Corrected Transposition of the Great Arteries after the Reconstruction of the Left Pulmonary Artery Using Heterologous Pericardial Conduit / 日本心臓血管外科学会雑誌

We report two surgical cases with corrected transposition of the great arteries associated with ventricular septal defect and pulmonary atresia undergoing total correction including reconstruction of the central pulmonary artery after reconstruction of the left pulmonary artery for non-confluent pulmonary arteries. Both patients underwent reconstruction of the left pulmonary artery using 13 or 12mm diameter heterologous pericardial conduit at age of 5 year, respectively. At surgery, after the left pulmonary artery was exposed between the upper and lower lobe of the left lung, the conduit was connected with the left pulmonary artery along the pericardium. Continuity between the conduit and the left subclavian artery or the ascending aorta was established with 5 or 6mm diameter Micronit grafts, respectively. Total correction was performed at 2 years and 10 months after the initial surgery, respectively. In a patient with {I, D, D} type corrected transposition of the great arteries, the central pulmonary artery was established with another 16mm diameter heterologous pericardial conduit, which ran in front of the left superior vena cava. The ventricular septal defect was closed via the right atrium. In another patient with {S, L, L}, the central pulmonary artery was established with the reconstructed conduit of the left pulmonary artery, which ran behind the left phrenic nerve. The ventricular septal defect was closed via the right atrium with the De Leval procedure. In both patients, continuities between the left ventricle and the central pulmonary artery were established with tricuspid valved porcine pericardial conduit and equine pericardial conduit. Postoperatively both patients had uneventful recovery with left ventricular/right ventricular systolic pressure ratios of 0.4 and 0.35, respectively.