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Ann Thorac Surg 2004;78:1883-1884
© 2004 The Society of Thoracic Surgeons

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Correspondence

Double-Flap Technique for Repair of Anomalous Origin of Right Pulmonary Artery From Ascending Aorta

Department of Pediatric Cardiac Surgery, G. Pasquinucci Hospital, CREAS-IFC-CNR, Via Aurelia Sud, 54100, Massa, Italy

Fabio Bartolozzi, MD

Cardiothoracic Department, St. James's Hospital, Dublin, Ireland

edvinprifti{at}hotmail.com

To the Editor:

We read with interest the report by McMurtry and co-workers [1] regarding surgical correction of anomalous origin of the right pulmonary artery (RPA) from the ascending aorta. When the RPA arises from the ascending aorta, direct implantation is difficult because of the distance between the anomalous RPA and the main pulmonary artery (MPA). Consequently, a synthetic graft, a homograft, or a pericardial patch must be used. Direct implantation of the anomalous RPA does not seem to be the best procedure for several reasons: tension at the anastomosis, stretching of the RPA, stricture at the anastomosis itself, and reduced growth at the anastomotic site [2]. To reduce these potential complications, McMurtry and colleagues suggested use of an aortic cuff and construction of two trapdoors at the MPA with connection to aortic flaps surrounding the RPA. Van Son and Hanley [3] first reported placement of an aortic cuff and creation of a small anterior pulmonary flap to reach the posterior aortic flap for relocation of the RPA using autologous tissue, a method similar to the technique of McMurtry and associates.

In our opinion, the modification suggested by McMurtry and coauthors might enlarge the anastomotic area but would not adequately increase tissue length compared with the technique of Van Son and Hanley. The technique reported by McMurtry and co-workers seems inadequate to provide enough tissue length to permit placement of the newly created RPA anterior to the ascending aorta. An end-to-end anastomosis of the ascending aorta will cause it to retract more posteriorly, and the resulting aortic compression could cause later obstruction of the newly created RPA placed posterior to the aorta [2]. Therefore, reconstruction of the RPA using the "single aortic flap technique" [4] (Fig 1) and the "double-flap technique" proposed by our team [5] (Fig 2) may be advantageous in allowing extra tissue length. This new communication between the MPA and RPA is autologous, viable tissue, which will grow in neonates. The double-flap technique we propose offers the possibility of less tension at the anastomotic site, placement of the newly created RPA anterior to the ascending aorta, and reduced risk of kinking or stenosis of either branch of the pulmonary artery.

View larger version (27K): [in this window] [in a new window]   Fig 1. (A, B) Single aortic flap technique using an aortic ring.

View larger version (25K): [in this window] [in a new window]   Fig 2. (A-C) Double–flap technique. After preparation of the aortic and pulmonary flaps, the aorta (AO) is closed. The aortic flap is sutured to the main pulmonary artery (MPA), and the new communication between the anomalous right pulmonary artery (RPA) and MPA is placed anterior to the ascending aorta. (LPA = left pulmonary artery.)

1. McMurtry K, Srivastava S, Nguyen KH. Description of a new technique for reimplanting the anomalous right pulmonary artery. Ann Thorac Surg. 2003;76:628–630[Abstract/Free Full Text]
2. Prifti E, Crucean A, Bonacchi M, et al. Postoperative outcome in patients with anomalous origin of one pulmonary artery branch from the aorta. Eur J Cardio-thorac Surg. 2003;24:21–27[Abstract/Free Full Text]
3. Van Son JA, Hanley FL. Use of autogenous aortic and main pulmonary artery flaps for repair of anomalous origin of the right pulmonary artery from the ascending aorta. J Thorac Cardiovasc Surg. 1996;111:675–676[Free Full Text]
4. Gybels Y, Grapow MTR, Todorov A, Wagner G, Zerkowski H-R. Aberrant right pulmonary artery and double outlet ventricle: one-stage repair. Ann Thorac Surg. 2000;69:630–632[Abstract/Free Full Text]
5. Prifti E, Frati G, Crucean A, Vanini V. A modified technique for repair of the anomalous origin of the right pulmonary artery from the ascending aorta. Eur J Cardiothorac Surg. 2002;22:148–150[Abstract/Free Full Text]

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				K. H. Nguyen Repair of Anomalous Origin of Right Pulmonary Artery From Ascending Aorta: Double Trap-Door or Double-Flap? Ann. Thorac. Surg., September 1, 2005; 80(3): 1160 - 1160. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Edvin Prifti Massimo Bonacchi Vittorio Vanini Fabio Bartolozzi Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Prifti, E. Articles by Bartolozzi, F. Search for Related Content PubMed PubMed Citation Articles by Prifti, E. Articles by Bartolozzi, F.