Application of a homemade stent graft to the pulmonary arteries in a patient with total cavopulmonary connection Iki Adachi, MD, Toru Kuratani, MD, Yukitoshi.

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Application of a homemade stent graft to the pulmonary arteries in a patient with total cavopulmonary connection Iki Adachi, MD, Toru Kuratani, MD, Yukitoshi Shirakawa, MD, Takayoshi Ueno, MD, Goro Matsumiya, MD, Yoshiki Sawa, MD Journal of Vascular Surgery Volume 51, Issue 5, Pages 1268-1271 (May 2010) DOI: 10.1016/j.jvs.2009.12.043 Copyright © 2010 Terms and Conditions

Fig 1 A schematic illustration depicts the cardiac anatomy of our patient. The left ventricle (LV) is rudimentary because of an atretic mitral valve. Consequently, the systemic circulation is supported by a morphologically right ventricle (RV) and a tricuspid valve, both of which are fundamentally right-heart structures. The superior (SCV) and inferior caval veins (ICV) are connected to the right pulmonary artery (RPA), either directly or with an artificial conduit, to reroute caval venous blood toward the pulmonary circulation without interposition of any pumping chamber. Ao, Aorta; LA, left atrium; LPA, left pulmonary artery; RA, right atrium. Journal of Vascular Surgery 2010 51, 1268-1271DOI: (10.1016/j.jvs.2009.12.043) Copyright © 2010 Terms and Conditions

Fig 2 Ventriculograms document before and after the graft implantation. A, A systemic right ventricle gives rise to both the anterior aorta and the posterior small pulmonary trunk (PT) with a residual flow. The subpulmonary infundibulum is marked with white arrows. B, No forward flow is seen across the PT after the graft implantation. Ao, Aorta; RV, right ventricle. Journal of Vascular Surgery 2010 51, 1268-1271DOI: (10.1016/j.jvs.2009.12.043) Copyright © 2010 Terms and Conditions

Fig 3 A, A preliminary angiogram shows the sizes of the pulmonary arteries. Insertion of the pulmonary trunk and its relationship with the stenotic portion are indicated. B, The sizing of the handmade graft was determined to follow the target vessels as closely as possible, allowing for some overdistension of the native arteries to permit stable placement. C, A postdeployment angiogram demonstrates a well-positioned stent graft, without end leakage. D, A computed tomography image 6 months after graft implantation demonstrates obliteration of a distal portion of the pulmonary trunk with thrombus (white arrows). Journal of Vascular Surgery 2010 51, 1268-1271DOI: (10.1016/j.jvs.2009.12.043) Copyright © 2010 Terms and Conditions