Successful Total Correction Research Articles

Aortic Origin of the Right Pulmonary Artery

ince the original description of this anomaly by Fraentzel in 1868 [5], few cases of aortic origin of the right pulmonary artery have S been reported. Caro, Lermanda, and Lyons [2] attempted the first total surgical correction of this defect in 1957. The first successful total correction was performed by Armer, Shumacker, and Klatte [l] in 1961. In 1965, Redo et al. [8] reviewed 14 cases of this anomaly collected from the literature and reported the second successful total surgical correction. Winship, Beck, and Schrire [ 141 recently reported an unsuccessful attempt at total surgical correction utilizing cardiopulmonary bypass for anastomosis of the right pulmonary artery to the main pulmonary trunk. Other means of surgical management have consisted of ligation of an associated patent ductus arteriosus [4, 113 and ligation of the right pulmonary artery in addition to ligation of the patent ductus arteriosus [7, 10, 121. All of these patients died postoperatively. In three of the four attempts at total surgical correction [l, 2, 81, repair was performed by interposition of a prosthetic graft anterior to the aorta between the end of the right pulmonary artery and the side of the main pulmonary trunk. We have recently operated upon a patient with this anomaly and employed a different technique.

Correction of complete atrioventricular canal defect: In patients with previous pulmonary artery banding ∗

Two patients with complete atrioventricular canal defects who had pulmonary artery banding in infancy and subsequent successful total correction of this defect are presented. Despite the reported high mortality for pulmonary banding in patients with complete atrioventricular canals, our experience would indicate that significant palliation can be achieved in some of them. Pulmonary banding procedure should, therefore, be seriously considered in patients in severe heart failure not controlled by stringent medical therapy.

Successful total correction of ventricular septal defect, diverticulum of the left ventricle, and anomaly of the thoracoabdominal wall in an 11-year-old boy with cardiac dextroversion

Successful total correction of ventricular septal defect, diverticulum of the left ventricle, and anomaly of the thoracoabdominal wall in an 11-year-old boy with cardiac dextroversion

Pulmonary Artery Banding in Infants with Cardiac Anomalies Other Than Ventricular Septal Defects: Including an Evaluation of a New Technic for Determining a Critical Degree of Banding

Persistent truncus arteriosus is now correctable surgically in patients with favorable anatomy. Given pulmonary arteries of reasonable size arising from any source, successful correction is possible so long as irreversible pulmonary vascular disease has not occurred. Although the majority of children with this defect demonstrate increased pulmonary blood flow, systemic-pulmonary artery shunts can be used. Also, banding of the pulmonary artery, followed subsequently by successful total correction, has been described. Recent reports of a few successful total corrections in infancy, performed with the aid of deep hypothermia and circulatory arrest, may modify the current approach. Although the majority of the reported corrections have involved aortic homograft reconstruction of the pulmonary artery, we strongly favor a synthetic prosthesis containing a heterograft valve. Based upon our clinical experience and this review of the literature, a suggested management protocol is presented.

Anomalous drainage of entire pulmonary venous system into left innominate vein: clinical and surgical considerations.

Total anomalous drainage of pulmonary venous blood produces a severe circulatory disturbance. In the most common type of this category of lesions, the entire venous return from the lungs enters a common venous channel ascending in the left superior mediastinum where it connects with the innominate vein. Seven cases of this type are described. Successful total correction was possible in 4 of these patients in whom a special technic was used, which incorporated the pump oxygenator for temporary cardiopulmonary bypass. This technic provides optimum conditions for complete correction of this complicated anomaly.