Long-term results of pulmonary artery rehabilitation in patients with pulmonary atresia, ventricular septal defect, pulmonary artery hypoplasia, and major.

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Long-term results of pulmonary artery rehabilitation in patients with pulmonary atresia, ventricular septal defect, pulmonary artery hypoplasia, and major aortopulmonary collaterals Andreea Dragulescu, MD, PhD, Issam Kammache, MD, Virginie Fouilloux, MD, Pascal Amedro, MD, Dominique Métras, MD, Bernard Kreitmann, MD, PhD, Alain Fraisse, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 142, Issue 6, Pages 1374-1380 (December 2011) DOI: 10.1016/j.jtcvs.2011.05.010 Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Initial angiogram through a right-sided MAPCA in an 11-month-old infant showing hypoplasia (Nakata index at 34 mm2/m2) of native PA (A), with pulmonary arterial blood flow mainly dependent on the MAPCAs in the aortogram (B). Twelve months after right-ventricle to PA surgical connection and 3 months after the last transcatheter rehabilitation with left PA stenting, the native PA bed achieved appropriate growth with a Nakata index of 187 mm2/m2(C), and all the MAPCAs have been occluded proximally (D), allowing subsequent surgical repair. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1374-1380DOI: (10.1016/j.jtcvs.2011.05.010) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 RV to PA connection using pericardial patch, through median sternotomy as the first step of the rehabilitation strategy. Ao, Aorta; PA, pulmonary artery; RV, right ventricle. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1374-1380DOI: (10.1016/j.jtcvs.2011.05.010) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Nakata index increase of native PAs during rehabilitation process. The initial Nakata index was 26 ± 14 mm2/m2, increased at 208 ± 85 mm2/m2 after the second step of transcatheter rehabilitation and before surgical repair, with a further increase up to 330 ± 89 mm2/m2 at the last catheterization. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1374-1380DOI: (10.1016/j.jtcvs.2011.05.010) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions