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Original Articles: Pediatric Cardiac

Surgical Treatment of Anomalies With Discontinuity Between the Right Ventricle and the Pulmonary Arteries Without Use of an Extracardiac Conduit

^a Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
^b Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
^c Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
^d Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan
^e Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
^f Mackay Medicine, Nursing and Management College, Taipei, Taiwan
^g Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan

Accepted for publication December 24, 2009.

^_* Address correspondence to Dr Chiu, Department of Surgery, National Taiwan University Hospital, No. 7 Chung-Shan S. Rd, Taipei, 100, Taiwan (Email: ingsh{at}ntu.edu.tw).

Presented at the Fifty-fifth Annual Meeting of the Southern Thoracic Surgical Association, Austin, TX, Nov 5–8, 2008.

Background: Reoperation is usually inevitable for congenital cardiac patients after insertion of an extracardiac valved conduit. We sought to verify that a transannular patch on the autologous posterior wall with the common wall between the aorta and pulmonary artery can replace the conventional operation using an extracardiac conduit.

Methods: From August 1997 to October 2007, 31 patients (age 15 days to 19.3 years) underwent a procedure of autologous pulmonary floor with common wall between the great arteries and transannular patch to correct a right ventricle to pulmonary artery discontinuity at our hospital. The posterior pulmonary pathways were reconstructed by direct or indirect ventriculoarterial connection using tissue in situ or donated from the dominant aorta or truncus in all cases. The aorta or truncus was tailored transversely or longitudinally to donate the inner or outer wall to the pulmonary pathway as needed.

Results: There was no surgical mortality, and late noncardiac death occurred in 1 patient (3%). The postoperative systolic right ventricular to aortic pressure ratio was 0.48 ± 0.11 in the operating theater, and the central venous pressure was 9 ± 2 mm Hg. The follow-up duration was 5.5 ± 3.3 years (range, 6 months to 10.6 years). In the follow-up echocardiography, significant pulmonary stenosis (pressure gradient > 40 mm Hg) was noted in 4 patients (13%). Follow-up computerized tomograms (n = 9) showed growth of the common wall.

Conclusions: The tissue deficiency of the pulmonary outflow tract could be recruited from the outer wall or inner wall of the large aorta or truncus in this disease category. We recommend such an operation to correct a right ventricle to pulmonary artery discontinuity without using an extracardiac conduit.