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J Thorac Cardiovasc Surg 1997;114:406-412
© 1997 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

LAY-OPEN PULMONARY ARTERIOPLASTY FOR POSTOPERATIVE HILAR PULMONARY ARTERY STENOSIS

Received for publication Dec. 23, 1996; revisions requested Feb. 3, 1997; revisions received April 14, 1997; accepted for publication April 16, 1997. Address for reprints: Yukihiro Kaneko, MD, Department of Thoracic and Cardiovascular Surgery, Kanagawa Children's Medical Center, 2-138-4, Mutsukawa Minami-ku, Yokohama 232, Japan.

Abstract

Objective: Lay-open pulmonary arterioplasty, a novel surgical technique to enlarge postoperative stenosis at the hilar pulmonary artery, was evaluated. Methods: Lay-open arterioplasty, in which the enlarged hilar stenotic pulmonary artery is partially made up of previous surgical scar tissue instead of being covered by a patch, was performed on 10 patients whose ages ranged from 2.2 to 15.7 years. Surgical results were assessed by angiography. Results: All patients tolerated the procedure without bleeding or embolic complications associated with pulmonary arterioplasty. Nine patients underwent concomitant procedures including total repair (n = 5), central interposing shunt (n = 3), and right ventricular outflow tract reconstruction (n = 1). No deaths or life-threatening events occurred during the total follow-up period of 18 patient-years. The stenotic segment was significantly enlarged from the preoperative diameter of 0.9 ± 1.1 mm (mean ± standard deviation) to the postoperative diameter of 8.0 ± 1.3 mm, values which correspond to 7.0% ± 8.8% and 68.4% ± 11.5% of the normative values, respectively. A follow-up angiogram (n = 5) revealed an increase in the pulmonary artery diameter balanced with somatic growth (initial value, 65.2% ± 9.0% of normal; second value, 69.1% ± 7.7% of normal). No aneurysms or clinically significant restenoses were seen on the angiograms. Conclusions: Our initial midterm results with this method were promising. The pulmonary arteries subjected to this procedure grew in proportion to somatic growth.

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