title: Early and midterm outcomes of left pulmonary artery angioplasty using an anterior wall flap of the main pulmonary artery in tetralogy of Fallot repair.
abstract: OBJECTIVE
  Postoperative left pulmonary artery (LPA) kinking is problematic in repair of tetralogy of Fallot (TOF). We used angioplasty of the proximal LPA with an anterior wall flap of the main pulmonary artery (MPA) to prevent this problem.
  
  
  METHODS
  We have used an anterior wall of the MPA as a flap for LPA angioplasty in 42 patients with TOF and pulmonary stenosis (26 males and 16 females) since February 2007. During the same period, 116 patients underwent total repair of TOF with pulmonary stenosis. The median age was 7.1 months (range, 3-88.8), and the median weight was 8.4 kg (range, 5-27). The indications for LPA angioplasty were acute-angle proximal LPA in 17 (40.5%), proximal LPA stenosis in 6 (14.3%), acute-angle and stenotic proximal LPA in 18 (43%), and short and small distal MPA in 1 patient. The patches used for MPA and LPA reconstruction were glutaraldehyde-treated autologous pericardium in 34 and bovine pericardium in 8 patients.
  
  
  RESULTS
  No operative or late death occurred. The mean follow-up duration after surgery was 26.4 ± 18.6 months (range, 0.5-67). During the follow-up period, reoperation for LPA stenosis or kinking was not required in any patient; however, balloon angioplasty was performed with good results in 4 patients (9.5%). No postoperative kinking of the proximal LPA occurred. Echocardiography or computed tomography angiography at the recent follow-up visit demonstrated good branch pulmonary arteries in all patients.
  
  
  CONCLUSIONS
  Angioplasty of the proximal LPA using an anterior wall flap of the MPA in the patients with TOF and pulmonary stenosis is an effective method in the management of acute angle and/or stenosis of LPA without postoperative kinking.
authors: Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Gyeongsangnam-do, Republic of Korea.
authors: Hyungtae
authors: H
authors: Kim
authors: Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Gyeongsangnam-do, Republic of Korea. Electronic address: scsung21@hanmail.net.
authors: Si Chan
authors: SC
authors: Sung
authors: Department of Thoracic and Cardiovascular Surgery, Catholic University St Mary's Hospital, Seoul, Republic of Korea.
authors: Yun Hee
authors: YH
authors: Chang
authors: Department of Pediatrics, Pusan National University Yangsan Hospital, Gyeongsangnam-do, Republic of Korea.
authors: Hyoung Doo
authors: HD
authors: Lee
authors: Department of Pediatrics, Pusan National University Yangsan Hospital, Gyeongsangnam-do, Republic of Korea.
authors: Ji Ae
authors: JA
authors: Park
mesh_terms: D017130:Angioplasty / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D011651:Pulmonary Artery / Q000503:physiopathology / Q000601:surgery*; D013524:Surgical Flaps; D013771:Tetralogy of Fallot / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome