Rd. Curran et al., ASCENDING AORTIC EXTENSION FOR RIGHT PULMONARY-ARTERY STENOSIS ASSOCIATED WITH VENTRICULAR-TO-PULMONARY ARTERY CONDUIT REPLACEMENT, Journal of cardiac surgery, 12(6), 1997, pp. 372-379
Background: Ventricular-to-pulmonary artery conduits in growing patien
ts with congenital heart disease will require replacement from time to
time due to somatic growth, neointimal hyperplasia, and pulmonary art
ery stenosis, The purpose of this article is to review our experience
with ascending aortic extension for significant long-segment pulmonary
artery stenosis in patients undergoing reoperation for Fight ventricu
lar-to-pulmonary artery conduit replacement. Methods: From 1989 to 199
7, 8 patients had aortic transection, right pulmonary artery augmentat
ion arterioplasty, and aortic interposition graft (Hemashield in 7 and
Gore-tex in 1) in association with right ventricular-to-pulmonary art
ery conduit replacement in 7 patients and completion Fontan operation
in 1 patient. Aortic cross-clamp time was 90 +/- 34 minutes, and the c
ardiopulmonary bypass time was 205 +/- 37 minutes. Results: All patien
ts survived. In those 7 patients who had conduit replacement, the RV/L
V ratio declined from 0.78 +/- 0.15 to 0.45 +/- 0.05 postoperatively (
P < 0.05), Average length of stay was 8.9 +/- 7.2 days. Follow-up rang
e is 18 months to 8 years (mean 4 years). Two complications included c
ardiac transplantation for pre-existing poor left ventricular function
and accelerated conduit stenosis leading to conduit re-replacement. C
onclusion: Ascending aortic extension facilitates long-segment pulmona
ry artery augmentation arterioplasty and enlarges the retroaortic spac
e, preventing future compression restenosis.