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(Circulation. 2004;109:2314-2318.)
© 2004 American Heart Association, Inc.

Clinical Investigation and Reports

Surgical Reconstruction of Occluded Pulmonary Arteries in Patients With Congenital Heart Disease

Effects on Pulmonary Artery Growth

Gabriella Agnoletti, MD, PhD; Younes Boudjemline, MD; Damien Bonnet, MD, PhD; Daniel Sidi, MD, PhD; P. Vouhé, MD, PhD

From Service de Cardiologie et Chirurgie Cardiaque (P.V.) Pédiatrique, Necker Enfants Malades, Paris.

Correspondence to Gabriella Agnoletti, Service de Cardiologie Pédiatrique, Groupe Hospitalier Necker Enfants Malades, 149, rue de Sèvres, 75743 Paris, France. E-mail gabriella.agnoletti{at}nck.ap-hop-paris.fr

Received November 5, 2003; revision received February 6, 2004; accepted February 10, 2004.

Background— This study was undertaken to determine outcomes and best strategies for treatment of occluded pulmonary arteries in patients with congenital heart disease.

Methods and Results— Between 1998 and 2002, occlusion of a previously patent pulmonary artery was established in 23 patients. Data were obtained retrospectively. Diagnoses were pulmonary atresia and ventricular septal defect in 11, tetralogy of Fallot in 6, and other forms of pulmonary stenosis or atresia in 6. Median age and weight at diagnosis were 9 years (range, 6 days to 43 years) and 24 kg (range, 2.6 to 60 kg). Fourteen patients had had a previous surgery. The occluded pulmonary artery was visualized at angiography by wedge injection or injection into the collateral circulation. The left pulmonary artery was occluded in 20 patients and the right pulmonary artery in 3. Criteria for reconstruction were estimated duration of occlusion <6 months and ratio of occluded to contralateral artery >0.2. Twelve patients fulfilled these criteria and underwent pulmonary artery reconstruction at a mean interval of 2 months (range, 6 days to 6 months) from evidence of occlusion. Six patients had pericardial patch reconstruction, 3 terminoterminal anastomosis, 2 thrombectomy, and 1 a Blalock-Taussig shunt. There was 1 late death. At a median follow-up of 4 years (2 months to 5 years), all patients underwent cardiac catheterization: in 8 patients the reconstructed artery was patent, in 3 reoccluded. Hypoplasia of the occluded artery was reversed in 6 patients.

Conclusions— Our data show that in selected patients, reconstruction of an occluded pulmonary artery can restore pulmonary vascularization and reverse hypoplasia. Strict surveillance is mandatory to prevent pulmonary artery loss.

Key Words: heart disease, congenital • arteries • surgery

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