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J Thorac Cardiovasc Surg 2005;130:e1-e2
© 2005 The American Association for Thoracic Surgery

Brief Communication

Main pulmonary artery to innominate artery shunt during hybrid palliation of hypoplastic left heart syndrome

Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.

Received for publication May 10, 2005; revisions received May 30, 2005; accepted for publication June 7, 2005.

^_* Address for reprints: Christopher Caldarone, MD, Division of Cardiovascular Surgery, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario M5G 1X8, Canada. (Email: christopher.caldarone@sickkids.ca).

The first 20% of the full text of this article appears below.

Bilateral pulmonary artery banding with ductal stenting (PAB-DS) hybrid procedures represent an evolving management strategy for neonates requiring single ventricle palliation. ¹ A concern with this strategy is the possibility of immediate or delayed obstruction in the aortic isthmus after stent deployment, which in patients with aortic atresia can lead to acute coronary and cerebral hypoperfusion. ² Obstruction can occur immediately as a result of stent maldeployment, within a few hours from ductal remodeling after discontinuation of prostaglandins, or late as a result of fibrosis in the distal stent. ^1,3,4 A potential solution to this problem is the placement of a main pulmonary artery–to–innominate artery (MPA-IA) shunt, which is analogous to a reversed modified Blalock-Taussig shunt (Figure 1).

View larger version (39K): [in this window] [in a new window]   Figure 1. Hypoplastic left heart syndrome with aortic atresia is depicted after bilateral pulmonary artery banding (stippled areas) and ductal stenting (crosshatched area). MPA-IA shunt provides source of blood flow to aortic arch (small arrows) in patients in whom retrograde flow across aortic isthmus is obstructed (large . . . [Full Text of this Article]

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