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Correspondence

Anatomical Model at Risk of Coarctation of the Pulmonary Artery

^a Pediatric Cardiac Surgery Department, "Policlinico-Giovanni XXIII" Hospital, University of Bari, Piazza Giulio Cesare 11, Bari 70100, Italy
^b Department of Obstetric Gynecology and Neonatology, Section of Neonatal Cardiology, University of Bari, Piazza Giulio Cesare 11, Bari 70100, Italy

(Email: detroise{at}libero.it).

To the Editor:

We read with great interest the article by Shinkawa and colleagues [1] on the surgical treatment of coarctation of the pulmonary artery (CoPA) in neonates affected with complex congenital heart disease with pulmonary atresia.

We completely agree with the authors that these complications, once clinically evident, should be treated by aggressive surgery on pulmonary artery branches early in life. In fact, such strategy prevents growth failure of the pulmonary branches, which would impair optimal results at the time of definitive surgery and the completion of a Fontan strategy in the univentricular heart.

The CoPA represents the evolution of a process of migration of ductal tissue within the pulmonary tree [2], which may be clinically evident either soon after the weaning of Alprostadil (PGE1) or later after a modified Blalock-Taussig shunt (MBTS) procedure. Therefore, it would seem that the population of patients studied by Shinkawa and colleagues [1] belong to a selective subgroup who presented with ductal constriction of pulmonary artery branches at the time of the first surgical procedure.

A few years ago, in our department we analyzed a population of 53 neonates who underwent the MBTS procedure during a 5-year period in an attempt to define an anatomical model of patients at risk of developing CoPA [3]. In this subset of patients, the incidence of CoPA detected was 7.5%.We analyzed the anatomy of the patients affected and hypothesized that the patients at risk of CoPA were those with critical pulmonary outflow obstruction (not necessarily atretic) and a ventricular septal defect. We speculated that this kind of lesion was embryologically premature and perhaps had a greater predisposition to ductal migration in the pulmonary artery after birth.

For this reason, it is not advisable to patch all pulmonary artery branches of neonates who require the MBTS procedure or to leave the pulmonary artery branches of all patients who have the MBTS procedure open to the risk of evolution of the CoPA into coarctation or atresia of a pulmonary artery. Therefore we suggest that the subset of patients who are at risk of having CoPA develop will require constant follow-up with frequent outpatient controls, especially in the weeks immediately after the MBTS procedure. Awareness of this potential complication is important, and the vessels should be evaluated by Doppler flow studies of the pulmonary artery on the ductal side or by computed tomographic scan evaluation of the pulmonary artery branches if echocardiographic images are poor.

We agree with Shinkawa and colleagues [1] that once the lesion is detected, patients must be submitted to surgery, because from our point of view we believe that interventional catheterization may not be sufficiently radical to relieve the stenosis and eliminate the ductal tissue, which is universally accepted for the treatment of neonatal aortic coarctation.

	References

Top References

 

1. Shinkawa T, Yamagishi M, Shuntoh K, Miyazaki T, Hisaoka T, Yaku H. Pulmonary arterial reconstruction for pulmonary coarctation in early infancy Ann Thorac Surg 2007;83:188-192.[Abstract/Free Full Text]
2. Waldman JD, Karp RB, Gittenberger-de Groot AC, Agarwala B, Glagov S. Spontaneous acquisition of discontinuous pulmonary arteries Ann Thorac Surg 1996;62:161-168.[Abstract/Free Full Text]
3. Troise D, Vairo U, Tagliente MR, Arbues M, Arciprete P. Discontinuità acquisita delle arterie polmonari non correlata a shunt chirurgico succlavio-polmonare G Ital Cardiol 1996;26(Suppl 2):15.

This article has been cited by other articles:

				T. Shinkawa and M. Yamagishi Reply Ann. Thorac. Surg., April 1, 2008; 85(4): 1506 - 1506. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted 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): Dario E. Troise Paolo M. Arciprete Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Troise, D. E. Articles by de Luca Tupputi Schinosa, L. Search for Related Content PubMed PubMed Citation Articles by Troise, D. E. Articles by de Luca Tupputi Schinosa, L. Related Collections Congenital - cyanotic Related Article