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J Thorac Cardiovasc Surg 2005;130:1717-1718
© 2005 The American Association for Thoracic Surgery

Brief Communications

One-stage intracardiac repair in combination with external stenting of the trachea and right bronchus for tetralogy of Fallot with an absent pulmonary valve and tracheobronchomalacia

^a Departments of Cardiovascular Surgery
^b Pediatric Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
^c Divisions of Cardiovascular Surgery
^d Neonatology, Matsudo Municipal Hospital, Chiba, Japan

Received for publication July 2, 2005; accepted for publication August 3, 2005.

^_* Address for reprints: Takahiko Sakamoto, MD, Division of Cardiovascular Surgery, Kanagawa Children's Medical Center, 2-138-4, Mutsukawa,Minami-ku, Yokohama-city, Kanagawa 232-8555, Japan (Email: takasakamoto@yahoo.co.jp).

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

Drs Sakamoto and Kurosawa

Clinical Summary

The patient was noted to be cyanotic immediately after birth. Echocardiography revealed tetralogy of Fallot with an absent pulmonary valve. He showed severe respiratory dysfunction 1 month later and was intubated because of the appearance of apnea. Cardiac catheterization showed left ventricular end-diastolic volume of 88% of normal, left ventricular ejection fraction of 58%, right ventricular end-diastolic volume of 188% of normal, right ventricular ejection fraction of 53%, pulmonary/systemic flow ratio of 2.7, and pulmonary artery (PA) index of 1290 mm²/m². Repeated inadequate ventilation required a careful examination, and bronchoscopy elucidated a narrowing of the trachea and a flat shape of the right bronchus with granulations. High positive end-expiratory pressure ventilation therapy for 2 weeks under deep sedation was scheduled to cure the granulations, and definitive surgical intervention was performed at the age of 3 months.

Through a median sternotomy, the trachea and right bronchus were dissected carefully. Ringed expanded polytetrafluoroethylene (ePTFE) grafts (14 mm) were trimmed to a circumference of 12 mm. They . . . [Full Text of this Article]

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