Kawada M

Truncus arteriosus with interrupted aortic arch: Successful correction using autologous flap

A newborn baby with type II truncus arteriosus and type B interrupted aortic arch was successfully treated by creating a pulmonary tract using autologous flap made from truncal wall without excision of the pulmonary artery and by reconstructing the aortic arch with direct anastomosis. This method provided excellent hemodynamics with wide reconstruction of the pulmonary tract without conduit.

Assessment of left ventricular function before and after Fontan's operation for the correction of tricuspid atresia

SummaryFunctional change in the left ventricle was studied in the light of changes in the left ventricular (LV) volume preload before and after Fontans operation. Six cases with tricuspid atresia (TA) were studied, and they had either types Ib or IIb. The preoperative LV end-diastolic volume index (LVEDVI) was 123±44 ml/m2, which corresponds to 166%±45% of normal values. This suggests that in TA the preload of the LV volume is increased because of its peculiar hemodynamic situation. After Fontans operation, the LVEDV decreased by 24.6% to 119.6±87.7 ml (P=0.01), which corresponds to 120%±50.9% of normal values. Presenting a striking contrast to the decrease in LVEDV, the postoperative reduction in LV end-systolic volume (LVESV) was approximately 8%. Preoperative and postoperative values for LVESV were 67.1±50.8 ml and 62±45.6 ml, thus, the systolic volume was decreased. Because of the small change in LVESV, the ejection fraction (EF) of the left ventricle significantly decreased from 0.61±0.1 preoperatively to 0.48±0.1 postoperatively. The cardiac index (CI) remained in the range of 1.9–2.5 1/min/m2 with a mean of 2.2±0.2 1/min/m2 at 1 month after operation. But, later, improvement in EF was observed in one case, in which the CI increased from 2.5 to 3.2 1/min/m2. In cases with TA in which function of the left ventricle is damaged by chronic LV volume overload and longstanding hypoxemia, important factors for long-term survival after Fontans operation are the degree of postoperative improvement in LV function and the maximal limit of LV function, which could be affected by compromised function of the right heart.

Anterior pulmonary translocation without conduit for the repair of truncus arteriosus

A technique with autologous tissue for the correction of type III truncus arteriosus is described. The truncal root was excised as a cylinder that incorporated pulmonary arteries and that was translocated anterior to the ascending aorta. The proximal section of the cylinder was closed and the pulmonary tract was reconstructed with anastomosis of a widely opened distal section to the right ventricle. Autologous pericardium was sutured to the entire surface of the pulmonary tract.

Obstruction of the proximal pulmonary artery branches after banding of the pulmonary trunk.

Abstract Most of the pulmonary branch obstruction that occurs after banding may be the result of dislocation or placement of the band very near the bifurcation during surgery rather than progressive migration of the band. Two-dimensional and Doppler echocardiography are useful noninvasive techniques for evaluating pulmonary branch size and stenosis after banding.