Ascending Aorta to Right Pulmonary Artery Anastomosis

Abstract

An intrapericardial ascending aorta-to-right pulmonary artery anastomosis was performed in 123 patients with cyanotic congenital heart disease associated with pulmonary stenosis or atresia during the eight year period from 1964 through 1971. While there were 20 early postoperative deaths (16%), 90% (93 patients) of the 103 survivors were symptomatically improved. In the postoperative evaluation, 74 patients (72% of the survivors) returned for follow-up examination, which included cardiac catheterization in 57. The anastomosis was nonfunctioning in ten (13.5%) of these 74 patients and in an additional 13 (17.5%) patients, clinically silent right pulmonary artery stenosis was demonstrated angiographically at the anastomosis site. Clinical improvement had been maintained in the 64 patients with an open anastomosis (audible continuous murmur or angiographically demonstrated patency) including the 13 patients with acquired pulmonary stenosis at the operative site. Persistent right pulmonary artery stenosis was demonstrated in nine of the 14 patients who had cardiac catheterization after intracardiac repair of the congenital heart defect and closure of the anastomosis, but this was insignificant in four of these nine. The ascending aorta-to-right pulmonary artery anastomosis provides symptomatic improvement for most patients with cyanotic congenital heart disease associated with pulmonary stenosis but may produce right pulmonary artery obstruction requiring attention at the time of total intracardiac repair.