Ann Thorac Surg 2005;80:1160
© 2005 The Society of Thoracic Surgeons
Correspondence
Repair of Anomalous Origin of Right Pulmonary Artery From Ascending Aorta: Double Trap-Door or Double-Flap?
Khanh H. Nguyen, MD
Department of Cardiothoracic Surgery, Mount Sinai Medical Center, 1190 5th Ave, Box 1028, New York, NY 10029
(Email: khanh.nguyen{at}mountsinai.org).
To the Editor:
We appreciate Dr Pritfti and colleagues for their comments on our article [1]. In their opinion, the double trapdoor technique [2] that we employed to repair an anomalous right pulmonary artery from the aorta might enlarge the anastomosis area but would not adequately increase tissue length. He also raised the concern that the reconstituted aorta would have caused late compression of the right pulmonary artery (RPA) if it were placed posterioly. His technique of using a segment of the aorta and placement of the RPA anterior to the aorta deserves consideration [3]. However, as experience gained from procedures such as the arterial switch operation, a thorough mobilization of both branch pulmonary arteries can provide significantly extra length to the arteries. In this case we did find very adequate length of tissue for the right pulmonary anastomosis. The tissue removed at the aorta in our technique is clearly much less than the one described by Pritfti and colleagues [1], which calls for removal of a ring of the ascending aorta 1.5 times more than the diameter of the RPA. In our case, with extensive mobilization of the brachiocephalic vessels, the aorta was anastomosed with no tension. Therefore, we do not think that placement of the right pulmonary branch anteriorly would be necessary.
Again, we have found the technique described in our article works well for its intended purpose. The patient was seen recently more than 2 years after the repair. The transthoracic echocardiography confirmed normal growth of the right pulmonary artery with no obstruction.
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References
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- Prifti E, Bonacchi M, Vanini V, Bartolozzi F. Double-flap technique for repair of anomalous origin of right pulmonary artery from ascending aorta Ann Thorac Surg 2004;78:1883-1884.[Free Full Text]
- 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]
- 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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