Fate of the “opened” arterial duct: Lessons learned from bilateral pulmonary artery banding for hypoplastic left heart syndrome under the continuous infusion.

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Fate of the “opened” arterial duct: Lessons learned from bilateral pulmonary artery banding for hypoplastic left heart syndrome under the continuous infusion of prostaglandin E1 Yoshihide Mitani, MD, PhD, Shin Takabayashi, MD, PhD, Hirofumi Sawada, MD, Hiroyuki Ohashi, MD, Hidetoshi Hayakawa, MD, PhD, Yukiko Ikeyama, MD, Kyoko Imanaka-Yoshida, MD, PhD, Kazuo Maruyama, MD, PhD, Hideto Shimpo, MD, PhD, Yoshihiro Komada, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 133, Issue 6, Pages 1653-1654.e2 (June 2007) DOI: 10.1016/j.jtcvs.2007.01.053 Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Echocardiograms and pulmonary angiograms in case 1 (a-c), case 2 (d-f), and case 3 (g-i). Echocardiograms delineating longitudinal sections of arterial ducts obtained before PAB (a, d, g) and before the simultaneous Norwood/Glenn procedure (b, e, h), before which lateral views of pulmonary angiograms were obtained (c, f, i). Continuous Doppler flow velocity in echocardiograms (left lower corner) and pressure gradient across the duct in pulmonary angiograms (left lower corner). Luminal patency of the ducts was maintained until the simultaneous Norwood/Glenn procedure in cases 1 to 3, as demonstrated by echocardiograms (b, e, h) and pulmonary angiograms (c, f, i). However, echocardiographically or angiographically obvious ridges with no pressure gradient developed at the aortic end of the ducts in cases 2 (e, f) and 3 (h, i). Arterial ducts (yellow arrows); ridges (yellow asterisk). The Journal of Thoracic and Cardiovascular Surgery 2007 133, 1653-1654.e2DOI: (10.1016/j.jtcvs.2007.01.053) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Echocardiograms, pulmonary angiograms, and macroscopic and microscopic findings of ductal tissues in cases 4 and 5. Echocardiograms delineating longitudinal sections of the arterial ducts obtained before PAB (a, e) and before the simultaneous Norwood/Glenn procedure (b, f), before which the lateral views of pulmonary angiograms (c, g) were obtained. Continuous Doppler flow velocity in echocardiograms (left lower corner) and pressure gradient across the duct in pulmonary angiograms (left lower corner). Macroscopic (d, h) and microscopic (i, j, k) photographs were obtained from the ductal tissue harvested in the operation. Luminal patency of the duct was maintained until the simultaneous Norwood/Glenn procedure (b, c, d, f, g, h). However, an echocardiographically obvious ridge with a pressure gradient of 30 mm Hg developed at the aortic end of the duct in case 4 (b, c, d). An echocardiographically obvious ridge with a continuous Doppler flow velocity of 2.1 m/s was found at the aortic end of the duct even before PAB in case 5 (e). The ridge developed to a pinhole-like lesion before the simultaneous Norwood/Glenn procedure (f, g, h). Fibrocellular intimal cushion formation (i, k) with the development of vaso vasorum (j, k) was found in the macroscopic ridges (d, h). Arterial ducts (yellow arrows); ridges (yellow asterisk). The Journal of Thoracic and Cardiovascular Surgery 2007 133, 1653-1654.e2DOI: (10.1016/j.jtcvs.2007.01.053) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions