Pulmonary Arterial Growth Pattern after Shunt Operation in Patients of Pulmonary Atresia with Ventricular Septal Defect Associated with Juxtaductal Stenosis

Lee, Kyo Joon; Park, Young Hwan; Choi, Jae Young; Cho, Bum Koo

Abstract

BACKGROUND: Pulmonary atresia (PA) with ventricular septal defect has various morphology of pulmonary arteries and pulmonary blood flow sources, so pulmonary arterial hypoplasia and arborization abnormality make this anomaly difficult to manage surgically. In cases associated with juxtaductal stenosis, we evaluated the change of the pulmonary arterial and juxtaductal stenotic site after shunt operations, and would like to find useful information in surgical planning and methodology of these patients. MATERIAL AND METHOD: Among 59 cases diagnosed as PA with ventricular septal defect associated with juxtaductal stenosis, 29 cases who had cardiac catheterization before and after shunt operation were selected from July, 1991 to July, 1996. In 10 cases of right shunt operation (Group I) and 19 cases of left shunt operation (Group II), the diameters of the descending aorta, both pulmonary arteries, and the juxtaductal stenosis site were measured before and after the shunt operation. RESULT: In both Group I and II, the pre-and postoperative ratio of diameters of the ipsilateral pulmonary artery to the descending aorta was from 0.78+/-0.31 units to 1.01+/-0.26 units and from 0.67+/-0.18 units to 0.84+/-0.27 units respectively, showing a signigicant increase. The contralateral pulmonary artery index was increased from 0.92+/-0.28 units to 1.05+/-0.15 units and from 0.94+/-0.27 units to 1.08+/-0.37 units respectively, but could not be confirmed statistically. In both groups, the change of juxtaductal stenosis showed an aggravating tendency but of no statistical significance from 0.43+/-0.27 units to 0.39+/-0.25 units and from 0.32+/-0.10 units to 0.30+/-0.16 units respectively, and we experienced 2 total obstruction in Group II. Because the increased pulmonary blood flow by shunt operation has a favorable effect to the pulmonary arterial growth, the shunt operation is a recommended treatment in patients with hypoplastic pulmonary arteries. But in PA with ventricular septal defects, the change of juxtaductal stenosis is very important. In conclusion, the growth of ipsilateral (shunt site) pulmonary artery was promoted by shunt operation, but there is a tendency for the juxtaductal stenosis to be aggravated. And we experienced 2 total obstruction in Group II.
CONCLUSION
Thus, in cases operated with shunt method, much careful postoperative follow up study including angiographic evaluation is needed, and after the shunt operation on the side of pulmonary artery associated with juxtaductal stenosis, early precise planning for total correction is recommended.