Unifocalization of major aortopulmonary collaterals in single-ventricle patients.
BACKGROUND
Unifocalization of major aortopulmonary collateral arteries (MAPCAs) in pulmonary atresia with ventricular septal defect and intracardiac repair has become the standard of care. However, there are no reports addressing unifocalization of MAPCAs in single-ventricle patients. It is unknown whether their pulmonary vascular bed can be reconstructed and low enough pulmonary vascular resistance achieved to allow for superior or total cavopulmonary connections.


METHODS
We reviewed data on all patients with functional single ventricles and unifocalization procedures of MAPCAs. From 1997 to 2005, 14 consecutive children with various single-ventricle anatomies were operated on.


RESULTS
Patients had a median of three surgical procedures (range, 1 to 5). Two patients had absent, all others diminutive central pulmonary arteries, with an average of 3.5 +/- 1.2 MAPCAs. Seven patients (50%) had bidirectional Glenn procedures, and 3 of these had Fontan procedures. Median postoperative pulmonary artery pressures measured 12.5 mm Hg (Glenn) and 14 mm Hg (Fontan), respectively. Six patients are alive today (46%), with 1 patient lost to follow-up. Three patients died early and 3 late after initial unifocalization to shunts. One other patient survived unifocalization, but was not considered a candidate for a Glenn procedure and died after high-risk two-ventricle repair. Another patient with right-ventricle-dependent coronary circulation died of sepsis late after Glenn.


CONCLUSIONS
In selected patients with functional single ventricles and MAPCAs, the pulmonary vascular bed can be reconstructed sufficiently to allow for cavopulmonary connections. Venous flow to the pulmonary vasculature decreases cardiac volume load and is likely to increase life expectancy and quality of life for these patients.
Reinhartz
Olaf
O
Department of Cardiothoracic Surgery, Division of Pediatric Cardiac Surgery, Stanford University, Stanford, California 94305, USA. orx@stanford.edu
Reddy
V Mohan
VM
Petrossian
Edwin
E
Suleman
Sam
S
Mainwaring
Richard D
RD
Rosenthal
David N
DN
Feinstein
Jeffrey A
JA
Gulati
Raj
R
Hanley
Frank L
FL
D000015:Abnormalities, Multiple; D001013:Aorta, Thoracic / Q000601:surgery*; D001166:Arteriovenous Shunt, Surgical; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D003097:Collateral Circulation; D005260:Female; D018729:Fontan Procedure; D006352:Heart Ventricles / Q000002:abnormalities* / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000401:mortality; D011651:Pulmonary Artery / Q000601:surgery*; D018633:Pulmonary Atresia / Q000601:surgery*; D011652:Pulmonary Circulation; D014656:Vascular Surgical Procedures; D014683:Vena Cava, Superior / Q000601:surgery