Ann Thorac Surg 2000;70:1506
© 2000 The Society of Thoracic Surgeons
Discussion
Discussion
Discussion
DR MARSHALL L. JACOBS (Philadelphia, PA): I noted your conclusion about coronary abnormalities and the recommendation that they be managed by gradual decompression of the right ventricle, but didn’t really see in the data a description of the presence of coronary abnormalities. Certainly in the spectrum of this very challenging disease there are some patients who have a right ventricular infundibulum but have marked abnormalities of the coronaries with stenoses or interruption of the native vessels and right ventricular dependence. I wonder if you encountered that and, in that circumstance, if you would still recommend establishment of antegrade flow by pulmonary valvotomy?
And then, in addition, you mentioned nine tricuspid valve repairs. I wonder if you could elaborate briefly on that.
DR SANO: Thank you for your comment. As I mentioned in the slide, out of 19 patients with pulmonary atresia with intact ventricular septum, we had 8 patients with sinusoidal–coronary communication. Only 1 of these seemed to be significant, resulting in right ventricle–dependent coronary circulation. The other 7 patients had only a fistula or minor communication, not the interrupted coronary artery. Therefore, we decided to perform a multistage palliation to decompress the right ventricle gradually. During that time we found, in many patients, that sinusoidal–coronary communication or coronary fistula disappeared gradually and that it didn’t cause much of a problem postoperatively.
