Pulmonary atresia, VSD and Mapcas: repair without unifocalization.

The last three decades have seen considerable development in the management of infants with pulmonary atresia, ventricular septal defect, and major aorto-pulmonary collaterals. The technical difficulty of surgical treatment lies in the fashioning of a pulmonary vascular bed capable of providing suitably low right ventricular pressure for repair of the intracardiac defect. With the current trend toward early and complete unifocalization of major aortopulmonary collateral arteries (mapcas), we describe an alternative approach - "repair without unifocalization" - and explain our reasoning for pursuing this technique.

[1]  C. Brizard,et al.  Major aorto-pulmonary collateral arteries of patients with pulmonary atresia and ventricular septal defect are dilated bronchial arteries. , 2006, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[2]  C. Claussen,et al.  Imaging of aortopulmonary collateral arteries with high-resolution multidetector CT , 2006, Pediatric Radiology.

[3]  C. Brizard,et al.  Pulmonary atresia with ventricular septal defects and major aortopulmonary collateral arteries: unifocalization brings no long-term benefits. , 2005, The Journal of thoracic and cardiovascular surgery.

[4]  Y. Boudjemline,et al.  [Pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries]. , 2005, Archives des maladies du coeur et des vaisseaux.

[5]  L. Latson,et al.  Staged repair of tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries. , 2003, The Journal of thoracic and cardiovascular surgery.

[6]  F. Hanley,et al.  Surgical creation of aortopulmonary window in selected patients with pulmonary atresia with poorly developed aortopulmonary collaterals and hypoplastic pulmonary arteries. , 2002, The Journal of thoracic and cardiovascular surgery.

[7]  H. Laks,et al.  Side-to-side aorto-Gore-Tex central shunt. , 1998, The Annals of thoracic surgery.

[8]  F. Hanley,et al.  Midline one-stage complete unifocalization and repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals. , 1995, The Journal of thoracic and cardiovascular surgery.

[9]  K. Watterson,et al.  Very small pulmonary arteries: central end-to-side shunt. , 1991, The Annals of thoracic surgery.

[10]  F. Macartney,et al.  Pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries. Effect of systemic pulmonary anastomosis. , 1981, British heart journal.

[11]  R. Mee,et al.  Staged repair of pulmonary atresia with ventricular septal defect and major systemic to pulmonary artery collaterals. , 1991, The Annals of thoracic surgery.