Pulmonary Artery Plasty with Internal Thoracic Arterial Patch in Fontan Candidate

Abstract

Background: Efficient and durable intervention for residual pulmonary artery （PA）stenosis is important for the establishment of excellent Fontan circulation. However, optimal patch material for surgical PA plasty has not been clearly defined. We hypothesized that the internal thoracic artery （ITA） was the optimal viable material for surgical PA plasty.
Methods: Since 2007, four infants with single ventricle physiology developed residual PA stenosis and surgically intervened with ITA patch. The diagnosis was HLHS in 2 cases and pulmonary atresia and single ventricle in 2. They underwent surgical PA plasty with fresh autologous ITA patch for residual PA stenosis at 5-15 months of age after previous palliative surgery. Concomitant procedures were bidirectional Glenn shunt as a second palliation in 3 cases and intrapulmonary artery septation as a third palliation in 1. Intraoperatively, the dilated ITA was harvested with skeletonized fashion, and longitudinally opened. Under cardiopulmonary bypass, stenotic lesion of the PA was augmented with the ITA patch using 8-0 polypropylene continuous sutures.
Results: All patients were subsequently completed extracardiac TCPC at 20-25 months of age without further intervention. Operative findings at TCPC shows smooth PA endothelium with elasticity at the site of ITA patch plasty, revealing less degeneration and less inflammation. Neither mortality nor re-intervention was noted at 22-45 months of the follow-up period. Post-TCPC cineangiography revealed balanced and developed PA configuration without residual stenosis.
Conclusions: The ITA patch seems to be one of the materials for surgical PA patch plasty in Fontan candidates in the infantile period.