Surgical results of anomalous origin of the right pulmonary artery from the ascending aorta including reoperation for infrequent complications.
BACKGROUND
We evaluated the results of surgery for an anomalous origin of the right pulmonary artery from the ascending aorta.


METHODS
From August 1986 to December 2005, 8 children (6 neonates) aged 7 to 180 days (mean, 35 +/- 59 days) with anomalous origin of the right pulmonary artery from the ascending aorta underwent surgical repair at our institute. All except one child, who had the distal form, had the proximal form. Cardiac catheterization showed that the left pulmonary artery to systemic pressure ratio was 1.0 or more. Surgery was performed by direct anastomosis in 7 patients and by graft interposition in 1.


RESULTS
There were no operative or late deaths. All patients postoperatively underwent cardiac catheterization that showed decreased left pulmonary artery to systemic pressure ratio ranging from 0.2 to 0.6. Follow-up periods ranged from 2 months to 13 years. We undertook reoperations for two infrequent postoperative causes. One patient exhibited significant supravalvar aortic stenosis and required patch enlargement of the ascending aorta 3 years after operation. The other patient (with the distal form) needed a reoperation after 1 month because of progressive stenosis at the anatomic site. Graft interposition was performed, and histopathologic examination showed that the tissue from the stenotic region looked like that of a ductus.


CONCLUSIONS
We undertook surgical repair for anomalous origin of the right pulmonary artery from the ascending aorta. Pulmonary hypertension was improved in all patients. Careful follow-up was necessary to detect supravalvar aortic and anastomotic stenosis early and late after operation.
Kajihara
Noriyoshi
N
Department of Cardiovascular Surgery, Kyushu Koseinenkin Hospital, Kitakyushu, Japan. n-c.kaji@f6.dion.ne.jp
Imoto
Yutaka
Y
Sakamoto
Masato
M
Ochiai
Yukie
Y
Kan-o
Meikun
M
Joo
Kunitaka
K
Watanabe
Mamie
M
Yuge
Tetsuji
T
Asou
Toshihide
T
Takeda
Yuko
Y
Sese
Akira
A
D000792:Angiography / Q000379:methods; D001013:Aorta, Thoracic / Q000002:abnormalities*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D002315:Cardiopulmonary Bypass; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000401:mortality; D011300:Preoperative Care / Q000379:methods; D011651:Pulmonary Artery / Q000002:abnormalities*; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*