The Annals of Thoracic Surgery, Vol 40, 593-598, Copyright © 1985 by The Society of Thoracic Surgeons
Management of large aortopulmonary collateral arteries in patients with ventricular septal defect and pulmonary atresia: simultaneous ligation through median sternotomy during intracardiac repair
H Matsuda, H Hirose, S Nakano, Y Shimazaki, H Kishimoto, J Kobayashi, J Arisawa and Y Kawashima
Nine consecutive patients with ventricular septal defect (VSD) and
pulmonary atresia associated with large aortopulmonary collateral arteries
underwent primary repair with simultaneous ligation of these collateral
arteries. The patients ranged from 1 year to 20 years old (average, 8.0
years). The average number of large aortopulmonary collateral arteries was
1.9 per patient. Arborization abnormality was found in 5 patients. The
aortopulmonary collateral arteries were reached solely through a median
sternotomy, with dissection of the posterior pericardium or anterior
mediastinal pleura before or after the initiation of cardiopulmonary
bypass. The immediate postoperative peak pressure ratio between the right
and left ventricles was higher in patients with an arborization
abnormality, but all ratios ranged from 0.60 to 0.87. There was 1 operative
death. Postoperative transcatheter embolization for a residual large
aortopulmonary collateral artery was required in 1 patient and pulmonary
infarction of mild degree developed with spontaneous recovery in another.
These results indicate the usefulness and safety of simultaneous ligation
of large aortopulmonary collateral arteries through median sternotomy, even
with an associated arborization abnormality.